Knotty Bodies: Speech, Symptom, and Circuits of Address

Across contemporary psychotherapeutic discourse, analytic speech is increasingly treated as repetitive, circular, or obstructive, while therapeutic efficacy is relocated to bodily or neural processes presumed to operate outside language. In a broader therapeutic culture shaped by neoliberal logics of self-management and affect regulation (cf. Liu, 2021), psychic life is increasingly recast as a set of interior states to be managed through neurobiological explanation, affect regulation, and somatic attunement. Within this formation, clinical and popular discourses traffic in the fantasy that bodily and neural processes provide access to psychic life unmediated by speech. What distinguishes the present moment is less the rejection of the “talking cure” per se than the proliferation of frameworks that reanimate the promise of direct access to psychic truth through the body or the brain. In trauma discourse, wellness culture, and increasingly in clinical vocabularies imported into treatment, speech is often treated as secondary, functioning as a medium of description rather than as something that organizes the experience it names.

What is new in clinical presentations lies less in the structure of the symptom than in the discursive conditions through which it is understood. Frameworks that privilege the body as a source of truth allow formations structured by language to appear as though they originate in a self-contained bodily interior. The structural effects of speech—its repetitions, deadlocks, and failures to conclude—are then recast as problems of regulation, diagnosis, or insufficient bodily knowledge.

The clinical material examined here suggests a different picture. When patients question analytic speech or seek somatic alternatives, their symptoms remain entangled in repetition and demand. This movement from S1 to S2 can be read as a passage in which master signifiers—“root,” “trauma,” “my OCD”—function as points of anchoring posed to an Other presumed to guarantee meaning. They are spoken within signifying circuits, where bodily phenomena are caught in the field of the Other. That is, symptoms and bodily experiences gain their form through how they are already directed toward and taken up in relation to others; they are not outside speech, but emerge as an excess within it. The issue, then, is not whether bodily life exceeds conscious narration—it often does—but how contemporary therapeutic discourse misrecognizes this excess by treating the body as prior to speech rather than as something already organized through it. What we call “the body” is never simply given. It is partitioned by signifiers, invested by fantasy, and encountered at points where speech falters, repeats, or exceeds what can be consciously known.

To think this problem, I draw on Lacan’s later notion of the parlêtre, which designates not a subject who uses language but a being for whom speaking and bodily life are inseparable. Voice, repetition, and even minimal utterances bear the structure of an appeal: they call to an Other and solicit response even when they communicate nothing determinate. Even the infant’s first scream enters a field of address the moment it is heard. When the Other is interpellated by it, assuming the position of addressee, the scream is retroactively transformed into an appeal (Dolar, 2006, p. 27). Drawing on three clinical vignettes, I examine how repetition, complaint, vocalization, and demands for relief organize bodily life within speech. What is often framed as the failure of talk therapy instead reveals forms of speech that do not culminate in mastery, regulation, or final interpretation, but return the subject to the imbrication of bodily and psychic enigmas.

K

Early in treatment, K expressed a familiar dissatisfaction with their sessions: “I’m bored of hearing myself talk,” they said. “It’s the same stories every week.” There was irritation in the complaint, edged with shame that hovered between self-critique and accusation. Talking, for K, had begun to feel circular, inert, oddly self-indulgent. They added that they had been reading about somatic approaches, specifically the modality Somatic Experiencing. “With somatic work,” they explained, “you get to the root of things in your nervous system. I already know what happened in my childhood. Going over it again and again doesn’t help.”

“The root?” I asked.

“Yes—the root of my anxiety and trauma. Talking just stays on the surface.”

Rather than counter this assertion, I encouraged K to pursue their curiosity. Perhaps there was in my response a hint of go then—do it: a dare that registered my own momentary sense of impasse, a faltering in my supposed position in the face of K’s questioning the efficacy of our work.

The following session, K returned and reported that the session had been helpful. They described attending closely to bodily sensations, tracking shifts in breath and muscle tone, and noticing a temporary settling by the end of the hour. The account carried, at first, a muted sense of suspension, as though something had quieted without quite taking hold. Then, after a pause, they added: “But afterward I didn’t know what to do with it. I kept wanting to explain it—to myself, I guess. I couldn’t stop thinking about why that moment felt different, or why it didn’t last.”

What followed was familiar. The momentary settling gave way to irritation; the pause dissolved into questioning. The promise of a root yielded to the return of demand. K spoke about the somatic session with the same repetitive cadence that had characterized their analytic complaints, circling the fleeting quality of the effect and the frustration provoked by its disappearance. What was sought—a point of arrival, a place where the work might finally stop—had merely shifted location.

Over the next weeks, K increasingly described treatment in terms of sorting and allocation. Somatic work was for the body; analysis was for the mind. Each, they hoped, might accomplish what the other could not. Yet the circuit repeated. The Somatic Experiencing sessions occasionally produced moments of relief that seemed to promise resolution. Yet these moments did not bring the underlying demand to rest. As their effects faded, uncertainty reemerged in a new form—why this, why now, why had it returned?—followed by renewed searching elsewhere. The complaint about “just talking” resurfaced each time as disappointment, followed by renewed seeking elsewhere.

After listening to this movement unfold once more—a temporary quieting of urgency, renewed uncertainty, and the search for another explanation—I asked what K imagined would happen if something did finally stop. K smiled and said, “I guess I’d be suspicious.” The remark was offhand, almost amused, but it named something essential. In this sense, the complaint about “just talking” did not mark a failure of speech so much as a confrontation with its unsettling persistence. What K attempted to master through splitting was not repetition itself but the discomfort surrounding desire’s movement. The new modality promised an endpoint in its suggestion of immediacy, and what it brought to K, with each disappointment, propelled their search onward.

R

A related logic appears in a different clinical presentation, though here it is organized less around therapeutic relief than around the demand for certainty. R, an obsessional patient, often arrived to sessions preoccupied with questions of inclusion and exclusion—what belonged, what could be left out, what constituted a correct form. At one point this took the form of a book proposal she had been struggling to complete. She described spending weeks agonizing over what to include, reading dozens of other proposals, and repeatedly asking, “What do other people do?” The question returned with urgency, as if an answer might finally bring the process to an end. Yet what emerges here is not simply a request for guidance, but a demand to an Other who might authorize an end to the question itself.

As she spoke, the proposal came to resemble earlier scenes of writing anxiety. Open-ended assignments provoked acute distress: once a terrain was opened, she felt obligated to include everything, only to counter this impossibility by drastically constraining the field, sometimes to a single source. She routinely produced pages when only a paragraph was requested, penalized for excess rather than insufficiency.  The effort to render the field finite and correct never quite succeeded, not because R struggled to decide, but because the demand for completion confronted a field that could not be closed. Situations left open always carried a particular threat. As a child, waiting outside the laundry room while her mother went inside was enough to provoke the certainty that she might die before her mother returned. In adolescence, this structure became focused on her body. During high school she grew preoccupied with her vulva, pathologizing its secretions and engaging in ritualized cleaning many times a day. When indeterminacy emerges, the body becomes the site toward which R directs her attempts at closure—not as a ground of certainty, but as a surface upon which the question can be reformulated.

Near the end of one session, after returning yet again to the proposal, she touched her mouth and said, almost casually, “I’m distracted by my toothache.” She added that she had read online it could be a symptom of a tumor. “So now I’m worried,” she said, then asked directly, “Do you think I’m dying?”

I replied, “How would I know?”

She laughed briefly. “Oh no—so I might be?”
After a pause, I asked, “You want me to reassure you that you aren’t dying?”
“Yes.”
“All right. You’re not dying.”
“But how would you know that?”

At the following session, she returned to the same question—this time by way of a different symptom. Her hand, she said, had gone numb, and she wondered again whether this signaled something suggestive of imminent death. What is at stake in such moments is not a failure of reassurance, nor a deficit in bodily awareness, but the persistence of a circuit that speech sustains. The question does not seek an answer so much as it requires one, only to reproduce itself at the point of its apparent resolution. Each response gives rise not to closure, but to a renewed demand, as if the act of answering were inseparable from the reconstitution of the question.

This structure becomes particularly clear in her recent concern with a symptom for which she has a medical term—“pulsatile tinnitus”—in which she hears the throbbing of her heart amplified and insistent in her ear as she lies in bed. The sound emerges at particular times in her life—often when she is preoccupied with her standing in relation to romantic partners. Her ex-girlfriend’s recent re-partnering has introduced a new uncertainty. “It’s hard for me to accept that I don’t have a hold on her in the same way,” she says. “I don’t know if she would reach out if I don’t and I’m terrified to find out.”

As this indeterminacy intensifies, so too does her bodily concern: “My hypochondria has been through the roof.” The sound of her heart thudding becomes alarming, which she quickly links to slightly elevated blood pressure, bringing on fears of cardiac arrest. Rather than a simple displacement from psyche to soma, a transfer of the question itself is at work: the opacity of the Other’s desire gives way to the enigma of the body, which offers itself as a site of legibility while never quite delivering it. The body here does not ground the subject in certainty but functions as a resonant surface, one that both receives and amplifies the question. The pulsation she hears is at once internal and alien, intimate and intrusive, as though the body were speaking in a language that calls for interpretation while resisting it. In this sense, the symptom does not interrupt the circuit of speech but extends it, providing new material through which the question can be posed again. The body becomes an ever-available site for the renewal of inquiry, its variations sustaining the very uncertainty they appear to promise to resolve.

In The Scandal of the Speaking Body, speech is framed not as transparent communication but as an act divided against itself, marked by what Felman describes as an inherent ‘dehiscence’ in which language splits at the moment it binds (Felman, 2003, p. 13). R’s repeated demands for certainty operate similarly: each answer appears to close the question only to reopen it elsewhere. The demand for knowledge functions less as a path toward resolution than as a mechanism through which uncertainty is sustained, displaced, and renewed. Speech does not fail to resolve the question; rather, it resolves it in a way that immediately reopens it. Its structure is one of reiterated opening at the very point where closure is attempted.

This dynamic becomes even more apparent in R’s preoccupation with what she refers to as “geographic tongue,” in which shifting patterns appear on the surface of her tongue based upon “what I’m eating and my anxiety level.” She tracks these changes closely, a preoccupation that intensifies when she is not in a relationship. The hypochondriac position, in turn, can be read as installing the subject as both patient and physician—compelled to read the body for signs of truth while speech narrows into a diagnostic literalism (Fédida, 1995). This is not simply a matter of heightened bodily awareness, but a characteristic obsessional maneuver that displaces the enigma of the Other’s desire onto a surface that can be monitored and, in principle, known. In the absence of a concretely situated Other—one whose desire might be sought, evaded, or managed—the question does not disappear but is instead relocated. The enigma of desire is not resolved but transferred onto the body, which offers itself as a field of observable variation through which the subject can sustain the position of one who knows, or who is at least in the process of knowing. Yet this apparent legibility is unstable, continually undermined by the very opacity it seeks to master.

Freud’s account of autoerotism in Three Essays situates this movement within a broader conceptual logic, as erogenous zones do not precede object relations as primary sites of satisfaction but become psychically invested in the wake of their disruption. “The finding of an object is in fact a refinding of it” (Freud, 1905/2016, p. 73). In this sense, R’s fixation on the tongue does not index a more immediate access to bodily truth but rather the effects of object-loss as it is registered retroactively through bodily inscription.

The encounter is not with a prediscursive body, but with a surface that calls for interpretation while resisting it. Its markings function as signs to be read, yet never conclusively, thereby perpetuating the very circuit they seem to promise to resolve. Speech does not fall away in this movement; rather, it is reorganized around the attempt to decipher what the body “says,” a decipherment that endlessly defers the subject’s implication in desire. In this sense, bodily fixation does not mark a turn away from language but a specific use of it: a way of converting the question of the Other’s desire into a problem of knowledge, and of sustaining that problem through its repeated, and necessary, failure.

Body-Mind Dualism

Contemporary somatic therapies often present themselves as a corrective to mind-body dualism while quietly reproducing its structure. Where Enlightenment accounts of the subject privileged rational consciousness over the unruly body, contemporary therapeutic discourse inverts this hierarchy by locating authenticity in bodily sensation, neurobiology, or nervous system regulation. The division remains intact; only its preferred side changes.

For Heinz Hartmann (1950), health rested in the ego’s adaptive capacity—its ability to regulate internal conflict and achieve equilibrium, rendering instinctual life compatible with external reality as it is construed by the ego. Analytic speech was valued insofar as it supported this ego function, contributing to the management of psychic conflict and its stabilization within reality-testing. Somatic and affect-regulation frameworks, by contrast, shift this regulatory ideal away from speech and interpretation and toward bodily, affective, and neurobiological processes. Allan Schore (2021), drawing on affective neuroscience, locates therapeutic action in right-hemisphere systems that process “nonverbal emotional protoconversations,” arguing that the clinician’s task is “not to intellectually understand the patient but to emotionally listen to and subjectively feel the patient . . . to listen beneath the patient’s words” (p. 14). Likewise, Ogden and Minton (2000) recast treatment as a form of “interactive psychobiological regulation,” in which the therapist functions as an “auxiliary cortex,” assisting patients in tracking and modulating sensorimotor experience. Within Somatic Experiencing, Payne, Levine, and Crane-Godreau (2015) distinguish their approach by locating intervention in “bottom-up processing,” orienting attention toward interoceptive and proprioceptive sensations.  Bessel van der Kolk (2014), for his part, contrasts narrative self-understanding with a bodily awareness that purportedly bypasses “the slipperiness of words” (p. 240). Peter Levine (1997) similarly argues that trauma may often be resolved “without long hours of therapy” and “without the painful reliving of memories” (p. 46), emphasizing renewed access to instinctual bodily processes. Taken together, these approaches converge in relocating therapeutic efficacy from speech and interpretation toward bodily, affective, or neurobiological registers. In this respect, the inversion of classical mind-body hierarchies leaves their underlying division intact, reversing the terms without abandoning the structure itself.

In the 1953 “Rome Discourse,” Lacan warns against reducing the subject to observable gestures or bodily phenomena detached from the subject’s entry into language and the divisions it introduces (Lacan, 1953/2006). The body encountered in analysis is neither a natural substrate nor a stable object of knowledge, but takes shape through image, signifier, and the points at which both fail. What presents itself clinically is therefore not a singular body but shifting configurations through which consistency is achieved or strained. At times, bodily form is secured through image and identification; at others, this relation loosens, and enjoyment circulates through the voice beyond meaning or returns in signifiers that wound and fix. The question for analytic listening is not what the body “really” means, nor how to regulate it into coherence, but how these dimensions hold together in a subject’s particular way of proceeding. As Lacan formulates it, this articulation involves “a consistence that is assigned only on the basis of the imaginary,” “a fundamental hole that emerges from the symbolic,” and “an ex-sistence which belongs to the real” (Lacan, 2016, p. 25), relations that cannot be separated or resolved. The following case makes this especially visible. L’s treatment traces shifting arrangements of the imaginary, symbolic, and real through which bodily life achieves provisional coherence—and sometimes comes undone.

L

L, a trans woman, presents in the analytic setting in a way that renders palpable not the traversal of distinct bodies, but the variable knotting of the imaginary, the symbolic, and the real through which a body comes to assume a contingent consistency. Lacan’s later notion of the parlêtre designates a being marked by the effects of language—not a subject who uses speech, but one in whom speech marks and localizes enjoyment beyond meaning. Speech does not simply express the subject; it exceeds them, running ahead of the ego and outstripping intention and mastery. Something speaks where the subject does not fully coincide with what is said and that goes for the body as well. The body within the parlêtre appears consistent, yet stumbles at the points where language fails to close. As Lacan puts it, “What is a fact? It’s precisely his doing. There is only any fact due to the fact that the parlêtre says it…There is no fact but by dint of artifice” (Lacan, 2016, p. 52). The speaking body that appears in analysis emerges through this doing—this artifice by which things are made to hold together. Lacan names this practice the sinthome: the way a subject binds the imaginary, symbolic, and real sufficiently to continue. Less a form than an activity, the body is continuously brought into consistency through the very operations that also expose its points of undoing.

L often speaks in vivid detail of her evenings at the opera, which she attends alone. She describes selecting gowns with care, delighting in her appearance, and imagining herself as the focal point as she walks down “the aisle” to her seat. In these scenes, she situates herself within a field of vision organized by the Other’s gaze. A fantasy of self-authorship emerges, but it is authored in and for that field. At one point, she links this to an early memory of her mother looking at her with what she calls “glazed donut eyes,” adding, “I want to be looked at by everyone like that.” Here, the imaginary is brought into a tight relation with the symbolic: the specular image is stabilized through the gaze, while signifiers drawn from ritual and memory (“aisle,” the maternal look) anchor and sustain it. Jouissance is thereby localized and contained within the scene of being-seen. A body whose consistency is secured through belief—through an imaginary capture that presents itself as something one has. Lacan states this simply as “the parlêtre adores his body because he believes that he has it” (Lacan, 2016, p. 52). With L, the imaginary/symbolic binding often comes to the fore, producing a specular coherence of the body sustained by the gaze of the Other. What L offers is not simply an account, but a carefully modulated unfolding that draws me into the position of the gaze she invokes. The elaboration of detail takes on a seductive quality, inviting me to occupy the place of those “glazed donut eyes.” Her presentation functions as a sort of elliptical offering, one in which her image holds together insofar as it is taken up within the field she constructs. The analytic situation thus becomes an extension of this knotting: I am implicated not simply as listener, but as a support for the gaze that sustains the image, a position that both stabilizes and fixes her within it.

At other moments in the treatment, this specular consistency loosens. L speaks of sex parties, penetration, role reversals, and what she calls “wholesome moments” of communal dressing afterward. These accounts are delivered with a striking lack of idealization. The scenes repeat, extend, and lose intensity. She recounts finding herself unexpectedly spanking a partner. “Oh no, are you a top?” the partner asks. “No, I’m just bored.” Here, the prior knotting begins to give way. The imaginary no longer organizes the field with the same force, and the symbolic appears in a reduced, almost skeletal form. In the session, such moments are offered with markedly less elaboration, as if the signifying support that once sustained the scene has thinned. What comes forward instead is a dimension less mediated and less contained—an encounter with enjoyment no longer anchored in the gaze or organized by a narrative of desire.

At the same time, another dimension comes into view in her descriptions of these encounters. She notes that at sex parties she “gives out moans like they are free—they add to the soundscape.” These vocalizations are not presented as expression or communication, nor as their absence. Rather, they function as emissions that sustain a field, like bioluminescent drift in a shoal, without stabilizing into message. L describes a discomfort with silence and a tendency to maintain a continuous flow of sound, even when it is not directed toward anyone in particular. Yet this apparent indeterminacy does not place the voice outside language, but foregrounds its minimal function: not the transmission of meaning, but the circulation toward an Other without destination. Psychoanalysis has long registered that bodily sounds enter the analytic situation as calls to an Other rather than inert somatic residue.

In Dream Analysis, Ella Freeman Sharpe amusingly attends to the seemingly minor sounds patients make before entering the consulting room—their footsteps on the stairs, the handling of umbrellas and suitcases, the force with which they lower themselves onto the couch, a man who “two out of three times blows his nose like a trumpet.”  She notes one patient whose entry was ordinarily marked by remarkable consistency and quiet. Except when she began to hear “the smallest and discreetest coughs” which repeated for many days at the moment before his entry into the session room. The patient becomes aware of this “little cough” and is annoyed: “It is most annoying to do a thing like that that goes on in you or by you cannot control, or do not control.” He addresses the analyst, “…but what purpose could be served by a little cough it is hard to think ?” When asked about a purpose, the patient associates the cough with approaching “a room where two lovers were together,” recalling that as an adolescent he would cough before entering a room where his brother and girlfriend were embracing so that “they could stop before I got in.” Sharpe observes that “he will by his cough have separated them” (Sharpe, 1937/1978, pp. 129–145). While Sharpe develops this interpretation further, my interest lies elsewhere: in how even the most minimal bodily emission enters a relational field as an act. The cough does not merely express an internal state; it intervenes in a scene, announces presence, and reorganizes proximity to the Other.

In this sense, these vocalizations can be understood as enunciations without statement—utterances that do not say anything determinate, yet nonetheless call, provoke, and solicit a response. Mladen Dolar (2006) writes:

The voice is transformed into an appeal, a speech act, in the same moment as need is transformed into desire; it is caught in a drama of appeal, eliciting an answer, provocation, demand, love. The scream, unaffected as it is by phonological constraints, is nevertheless speech in its minimal function: an address and an enunciation.

But the drama of the voice is twofold: it is not only that the other is compelled to interpret the infant’s wishes and demands, it is also that the voice itself, the scream, is already an attempt at interpretation: it tries to reach the other, provoke it, seduce it, plead with it; it makes assumptions about the other’s desire, it tries to influence it, sway it, elicit its love. (p. 28)

The “soundscape” does not mark a departure from relation but a way of sustaining it at its most minimal level. The voice here does not withdraw from the social field but saturates it, maintaining a circuit in which the Other is continuously invoked, even if no reply is secured. The moan is neither reducible to meaning nor separable from address; it is a bodily event that both seeks the Other and attempts to situate itself in relation to that Other’s desire. The continuous production of sound does not merely fill space or ward off silence, but stages a persistent appeal—one that both presupposes and tests the presence of the Other.

L describes deliberately catching herself in unflattering light, recreating earlier scenes of scrutiny and punishment in what she names “Are you ugly? drills.” In recounting one such moment, she pauses and says, “It’s like a voice invaded me,” before repeating the phrase that occurred: “You are a faggot, faggot, faggot.” The shift in the session is palpable. Here, the emphasis shifts from a scene she stages to an utterance that overtakes her. The phrase is not presented as something she thought, but as something that imposed itself. In speaking it, she does not so much claim the words as relay them, as though they carried a force that exceeded her. The symbolic here no longer serves a mediating function; rather, the signifier returns with an invasive insistence, bearing a weight that fixes and wounds at once. Its repetition introduces a rhythmic, almost incantatory dimension in which language begins to detach from communication and approach something more invasive—where the signifier is experienced less as meaning than as force.

What varies across these moments is how the imaginary, symbolic, and real hold together. At times, the imaginary and symbolic are tightly bound, producing a compelling bodily form; at others, this relation loosens, and enjoyment circulates more diffusely through the voice, exceeding meaning. The analytic setting therefore presents not a stable entity but shifting configurations through which consistency is achieved or strained within the tension of these registers. As Lacan formulates it, this articulation involves “a consistence that is assigned only on the basis of the imaginary,” “a fundamental hole that emerges from the symbolic,” and “an ex-sistence which belongs to the real” (Lacan, 2016, p. 25), relations that cannot be fully separated or resolved.

The speaking bodies of K, R, and L appear differently than contemporary somatic frameworks allow—frameworks that locate truth in the body as an object to be regulated or restored. Symptoms speak because they are already caught within language—marked, shaped, and troubled by its effects. What the cases collectively indicate is that the speaking body is a site that continually forces psychoanalytic distinctions—between speech and body, symptom and meaning—to be reworked in practice. Each case illustrates a distinct way bodily phenomena become bound to speech: through the search for a hidden root, the endless renewal of a question, or the shifting knotting of image, voice, and invasive signifiers. Bodily immediacy, here, is not given in advance but produced within these circuits. K’s movement from one therapeutic promise to the next, R’s recurring appeals for reassurance, and L’s staging of herself within scenes of spectacle, vocalization, and exposure each organize jouissance, giving it form and trajectory. Analysis does not aim at eliminating these formations in the name of regulation, but at approaching how they function, what they hold in place, and what might shift were they to loosen—without requiring that they come undone.

This orientation to the subject’s knot, as a provisional articulation, clarifies what is at issue in contemporary moves away from speech toward bodily regulation. These developments do not mark a break from Enlightenment paradigms so much as a reconfiguration of them. The ego-psychological ideals of coherence, adaptation, and mastery persist, now rewritten in the language of neurobiology and affect regulation. Yet this shift preserves the fantasy of a self-transparent subject—one that could be stabilized through the right technique or framework. As Saketopoulou (2024) notes, projects of repair are often organized around the assumption that damage can be measured against an image of prior intactness, a neutral baseline. The task is to attend to where speech wobbles—where it loops, hesitates, contradicts itself, or arrives from elsewhere. It is there that what comes to be read as bodily emerges in the disturbance of speech itself—where desire and enjoyment are already at work in fractures, hesitations, and excess.