Mental Imagery pp 167-177 | Cite as

Imagery and the Sinistrality of Symptoms

  • Paul Bakan


I would like to consider a phenomenon which has been observed over many years, namely, the greater likelihood of symptoms, especially psychogenic symptoms, on the left side of the body, i.e. the sinistrality of symptoms. The symptom is at the heart of all medical encounters. This encounter begins with one symptom and then goes on to diagnosis, prognosis and treatment. But at the very core of this encounter, in the very conception of the symptom, there is a semantic confusion which becomes obvious in distinctions between organic and functional, real and imaginary, organic and hysterical and so on. It was the problem of hysterical symptoms which gave rise to psychoanalysis and its many psychotherapeutic offshoots. The possibility of a relationship between imagination and symptom formation was seriously considered well before the nineteenth century. Let us consider Robert Burton’s seventeenth century work, The Anatomy of Melancholy (Burton, 1948), for some historical perspective on this matter. Burton was a Christian minister, whose book was referred to by the famous physician William Osier as “a medical treatise, the greatest indeed written by a layman...” (Jackson, 1989). Burton saw the root cause of melancholy or depression, as well as other symptoms, in a “damaged imagination”, i.e. an imagination which somehow had escaped from the control of reason to become a faculty that “is most powerful and strong, and often hurts…”. The faculty of imagination when corrupted, hurt, misaffected, depraved, or damaged, he saw as the cause of melancholy. The damaged imagination, he said, misrepresents matters to the understanding, and makes patients see and hear “that which indeed is neither heard nor seen”. Burton seems to be distinguishing here between imagery and perception. In reviewing the work of other physicians Burton singles out the work of Thomas Fienus (1567–1631) for whom he had the highest regard, referring to him as “worth all of them together” (Rather, 1967). Fienus presented a model in which the imagination was seen to stir up the emotions—leading to bodily changes in the humours and spirits, which in turn lead to bodily symptoms. This is essentially a psychosomatic model, wherein a disturbed imagination produces physiological changes leading to psychogenic symptoms. This sixteenth century model prefigures contemporary understanding of the relationship between imagination and symptoms.


Left Hemisphere Pain Threshold Hemispheric Asymmetry Phantom Experience Hemispheric Specialization 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Axelrod, S., Noonan, B. S., & Atanacio, B. (1980). On the laterality of psychogenic somatic symptoms. Journal of Nervous and Mental Disease, 168, 517–525.PubMedCrossRefGoogle Scholar
  2. Backon, J. (1989). An animal analogue of forced unilateral nostril breathing: relevance for physiology and pharmacology. Medical Hypotheses, 28, 173–175.PubMedCrossRefGoogle Scholar
  3. Bakan, P. (1969). Hypnotizability, laterality of eye movements, and functional brain asymmetry. Perceptual and Motor Skills, 28, 927–932.PubMedCrossRefGoogle Scholar
  4. Bakan, P. (1977). Dreaming, REM sleep and the right hemisphere: a theoretical integration. Journal of Altered States of Consciousness, 3, 285–307.Google Scholar
  5. Bakan, P. (1990). Non-right-handedness (NRH) and the continuum of reproductive casualty. In S. Coren (Ed.), Left-Handedness: Behavioral Implications and Anomalies (pp. 33–74 ). Amsterdam: Elsevier.Google Scholar
  6. Blau, J. N., Wiles, C. M., & Solomon, F. S. (1983). Unilateral somatic symptoms due to hyperventilation. British Medical Journal, 286, 1108.PubMedCrossRefGoogle Scholar
  7. Borod, J. C., Koff, E., & Caron, H. S. (1983). Right hemispheric specialization for the expression and appreciation of emotion: a focus on the face. In E. Perecman (Ed.), Cognitive Processing in the Right Hemisphere. New York: Academic Press.Google Scholar
  8. Briquet, P. (1859). Traite Clinique et Therapeutique de l’Hysterie. Paris: Bailliere et Fils. Burton, R. (1948). The Anatomy of Melancholy. New York: Tudor.Google Scholar
  9. Clarke, J. M. (1892). On hysteria. Brain, 15, 522–612.CrossRefGoogle Scholar
  10. Crawford, H. J. (1981). Hypnotic susceptibility and Gestalt closure. Journal of Personality and Social Psychology, 40, 376–383.PubMedCrossRefGoogle Scholar
  11. Cubelli, R., Caselli, M., & Neri, M. (1984). Pain endurance in unilateral cerebral lesions. Cortex, 20, 369–375.PubMedCrossRefGoogle Scholar
  12. Davidson, R. J., & Fox, N. A. (1982). Asymmetrical brain activity discriminates between positive and negative affective stimuli in infants. Science, 218, 1235–7PubMedCrossRefGoogle Scholar
  13. DeBenedittis, G., & DeGonda, F. (1985). Hemispheric specialization and the perception of pain: a task-related EEG power spectrum analysis in chronic pain patients. Pain, 22, 375–384.CrossRefGoogle Scholar
  14. Dimond, S. J., Farrington, L., & Johnson, P. (1976). Differing emotional response from right and left hemispheres. Nature, 261, 690–692.PubMedCrossRefGoogle Scholar
  15. Drake, R. A. (1986). Left cerebral hemisphere contributions to tachycardia: evidence and recommendations. Medical Hypotheses, 19, 261–266.PubMedCrossRefGoogle Scholar
  16. Drake, R. A. (1987). Effects of gaze manipulation on aesthetic judgments: hemisphere priming of affect. Acta Psychologica, 65, 91–99.PubMedCrossRefGoogle Scholar
  17. Durden-Smith, J., & deSimone, D. (1983). Sex and the Brain. New York: Arbor House.Google Scholar
  18. Edmonds, E. P. (1947). Psychosomatic non-articular rheumatism. Annals of Rheumatic Disease, 6, 36–49.CrossRefGoogle Scholar
  19. Ferenczi, S. (1926). An attempted explanation of some hysterical stigmata. In S. Ferenczi (Ed.), Further Contributions to the Theory and Technique of Psychoanalysis (pp. 110–117 ). London: Hogarth Press.Google Scholar
  20. Fleminger, J. J., McClure, G. M., & Dalton, R. (1980). Lateral response to suggestion in relation to handedness and the side of psychogenic symptoms. British Journal of Psychiatry, 136, 562–566.PubMedCrossRefGoogle Scholar
  21. Flor-Henry, P. (1979). On certain aspects of the localization of the cerebral systems regulating and determining emotion. Biological Psychiatry, 14, 677–698.PubMedGoogle Scholar
  22. Frumkin, L. R., Ripley, H. S., & Cox, G. B. (1978). Changes in cerebral hemispheric lateralization with hypnosis. Australian Journal of Hypnosis, 13, 741–750.Google Scholar
  23. Galin, D. (1974). Implications for psychiatry of left and right cerebral specialization. Archives of General Psychiatry, 31, 572–583.PubMedCrossRefGoogle Scholar
  24. Galin, D. (1976). Hemispheric specialization: implications for psychiatry. In R. G. Grenell, & S. Gabay (Ed.), Biological Foundations of Psychiatry (pp. 145–176 ). New York: Raven Press.Google Scholar
  25. Galin, D., Diamond, R., & Braff, D. A. (1977). Lateralization of conversion symptoms: more frequent on the left. American Journal of Psychiatry, 134, 578–581.PubMedGoogle Scholar
  26. Glick, S. D., & Shapiro, R. (1985). Functional and neurochemical mechanisms of cerebral lateralization in rats. In S. D. Glick (Ed.), Cerebral Lateralization in Nonhuman Species (pp. 157–183 ). New York: Academic Press.Google Scholar
  27. Gruzelier, J., Brow, T., Perry, A., Rhonder, J., & Thomas, M. (1984). Hypnotic susceptibility: a lateral predisposition and altered cerebral asymmetry under hypnosis. International Journal of Psychophysiology, 2, 131–139.Google Scholar
  28. Harrington, A. (1987). Medicine, Mind and the Double Brain: A Study in Nineteenth Century Thought. Princeton, N.J.: Princeton Univ. Press.Google Scholar
  29. Heilman, K. M., Bowers, D., Valenstein, E., & Watson, R.T. (1985). The right hemisphere: neuropsychological functions. Journal of Neurosurgery, 64, 693–704.CrossRefGoogle Scholar
  30. Irwin, P. (1985). Greater brain response of left-handers to drugs. Neuropsychologia, 23, 61–67.PubMedCrossRefGoogle Scholar
  31. Jackson, S. W. (1989). Robert Burton and psychological healing. Journal of the History of Medicine and Allied Sciences, 44, 160–178.PubMedCrossRefGoogle Scholar
  32. Johan, H. (1989). Breath, Mind, and Consciousness. Rochester, Vermont: Destiny.Google Scholar
  33. Keane, J. R. (1989). Hysterical gait disorders: 60 cases. Neurology, 39, 586–589.PubMedCrossRefGoogle Scholar
  34. Kenyon, F. E. (1964). Hypochondriasis: a clinical study. British Journal of Psychiatry, 110, 478–488.PubMedCrossRefGoogle Scholar
  35. Kramer, M. A., Albrecht, S., & Miller, R. A. (1985). Handedness and the laterality of breast cancer in women. Nursing Research, 34, 333–337.PubMedCrossRefGoogle Scholar
  36. Ley, R. G. (1980). An archival exploration of an asymmetry of hysterical conversion symptoms. Journal of Clinical Neuropsychology, 2, 1–9.CrossRefGoogle Scholar
  37. Magee, K. (1962). Hysterical hemiplegia and hemianaesthesia. Postgraduate Medicine, 31, 339–345.PubMedGoogle Scholar
  38. McGlone, J. (1980). Sex differences in human brain asymmetry: a critical review. Behavioral and Brain Sciences, 3, 215–263.CrossRefGoogle Scholar
  39. Merskey, H. (1965). The characteristics of persistent pain in psychological illness. Journal of Psychosomatic Research, 9, 291–298.PubMedCrossRefGoogle Scholar
  40. Merskey, H., & Spear, F. G. (1967). Pain, Psychological and Psychiatric Aspects. London: Bailliere, Tindall and Cassell.Google Scholar
  41. Merskey, H., & Watson, G. D. (1979). The lateralization of pain. Pain, 7, 271–280.PubMedCrossRefGoogle Scholar
  42. Morgenstern, F. S. (1970). Chronic pain: a study of some general features which play a role in maintaining a state of chronic pain after amputation. In O. W. Hill (Ed.), Modern Trends in Psychosomatic Medicine (pp. 225–245 ). New York: Appleton-Century Crofts.Google Scholar
  43. Murray, F. S., & Safferstone, J. F. (1970). Pain threshold and tolerance of right and left hands. Journal of Comparative and Physiological Psychology, 71, 83–86.PubMedCrossRefGoogle Scholar
  44. Myslobodsky, M. S., & Weiner, M. (1988). Directed drug distribution: adding controlled brain activity to a drug. International Journal of Neuroscience, 42, 7–19.PubMedCrossRefGoogle Scholar
  45. Otto, M. W., Dougher, M. J., & Yeo, R. A. (1989). Depression, pain and hemispheric activation. Journal of Nervous and Mental Disease, 177, 210–218.PubMedCrossRefGoogle Scholar
  46. Ottoson, D. (Ed.) (1987). Duality and Unity of the Brain: Unified Functioning and Specialisation of the Hemispheres. New York: Plenum PressGoogle Scholar
  47. Purves-Stewart, J. (1924). The Diagnosis of Nervous Diseases. London: Arnold.Google Scholar
  48. Rather, L. J. (1967). Thomas Fienus’ (1567–1631) “Dialectical Investigations of the Imagination as a Cause and Cure of Bodily Disease”. Bulletin of the History of Medicine, 41, 349–367.PubMedGoogle Scholar
  49. Regan, J., & LaBarbera, J. D. (1984). Lateralization of conversion symptoms in children and adolescents. American Journal of Psychiatry, 141, 1279.PubMedGoogle Scholar
  50. Renoux, G., Biziere, K., Renoux, M., & Gulliaumin, J. M. (1983). The production of T-cell inducing factors in mice is controlled by the brain neocortex. Scandinavian Journal of Immunology, 17, 45–50.PubMedCrossRefGoogle Scholar
  51. Romano, J. M., & Turner, J. A. (1985). Chronic pain and depression: does the evidence support a relationship. Psychological Bulletin, 97, 18–34.PubMedCrossRefGoogle Scholar
  52. Sackeim, H. A. (1982). Lateral asymmetry in bodily response to hypnotic suggestions. Biological Psychiatry, 17, 437–447.PubMedGoogle Scholar
  53. Sackeim, H. A., Gur, R. C., Weiman, A. L., Gur, R. C., Hungerbuhler, J. P., & Geschwind, N. (1982a). Hemispheric asymmetry in the expression of positive and negative emotions: neurological evidence. Archives of Neurology, 39, 210–218.PubMedCrossRefGoogle Scholar
  54. Sackeim, H. A., & Weber, S. L. (1982b). Functional brain asymmetry in the regulation of emotion: implications for bodily manifestations of stress. In L. Goldberger, & S. Breznitz (Ed.), Handbook of Stress: Theoretical and Clinical Aspects (pp. 183–199 ). New York: Free Press.Google Scholar
  55. Schilder, P. (1950). The Image and Appearance of the Human Body. New York: John Wiley.Google Scholar
  56. Shavit, Y., Lewis, J. W., Terman, G. W., Gale, R. P., & Liebeskind, J. D. (1984). Opioid peptides mediate the suppressive effects of stress on natural killer cell cytotoxicity. Science, 223, 188–190.PubMedCrossRefGoogle Scholar
  57. Sivak, B., Sivak, J. G., & MacKenzie, C. L. (1985). Contact lens for lateralizing visual input. Neuropsychologia, 23, 801–803.PubMedCrossRefGoogle Scholar
  58. Stern, D. B. (1977). Handedness and the lateral distribution of conversion symptoms. Journal of Nervous and Mental Disease, 164, 122–128.PubMedCrossRefGoogle Scholar
  59. Stern, D. B. (1983). Psychogenic somatic symptoms on the left side: review and interpretation. In M. S. Myslobodsky (Ed.), Hemisyndromes (pp. 415–445 ). New York: Academic Press.Google Scholar
  60. Stillman, R. C., Wolkowitz, O., Weingarten, H., Waldman, I., DeRenzo, E. V. & Wyatt, R. J. (1977). Marijuana-differential effects on right and left hemisphere functions in man. Life Sciences, 21, 1793–1799.CrossRefGoogle Scholar
  61. Tavel, M. E. (1964). Hyperventilation syndrome with unilateral somatic symptoms. Journal of the American Medical Association, 187, 301–303.PubMedCrossRefGoogle Scholar
  62. Tucker, D. M., & Williamson, P. A. (1984). Asymmetric neural control systems in human self-regulation. Psychological Review, 91, 185–215.PubMedCrossRefGoogle Scholar
  63. Ward, N. G., Bloom, V. L., & Friedel, R. O. (1979). The effectiveness of tricyclic antidepressants in the treatment of coexisting pain and depression. Pain, 7, 331–341.PubMedCrossRefGoogle Scholar
  64. Weinstein, S. (1969). Neuropsychological studies of the phantom. In A. L. Benton (Ed.), Contributions to Clinical Neuropsychology (pp. 73–106 ). Chicago: Aldine Publishing Co.Google Scholar
  65. Weinstein, S., & Sersen, E. A. (1961). Tactual sensitivity as a function of handedness and laterality. Journal of Comparative and Physiological Psychology, 54, 665–669.PubMedCrossRefGoogle Scholar
  66. Wolff, B. B., & Jarvick, M. E. (1964). Relationship between superficial and deep somatic thresholds of pain with a note on handedness. American Journal of Psychology, 77, 589–599.PubMedCrossRefGoogle Scholar
  67. Wolff, W. (1952). The Threshold of the Abnormal: a basic survey of psychopathology. London: Medical Publications.Google Scholar

Copyright information

© Springer Science+Business Media New York 1990

Authors and Affiliations

  • Paul Bakan
    • 1
  1. 1.Psychology DepartmentSimon Fraser UniversityBurnabyCanada

Personalised recommendations