PAIN DOES NOT LIE. THE BODY DOES NOT FORGET. CANCER AS A THIRD REALITY IN THE PATIENT’S MIND: PSYCHOSOMATIC IMPLICATIONS

A. Ascione¹, P. Cuccurullo², V. Alfano¹ | ¹Anima Iris Integrated Consultancy in Clinical Psychology, Pompei; ²Medical Director, Clinic Center, Napoli

In over twenty years of clinical and psychotherapeutic practice in oncological settings, more than 300 patient histories have been collected and analyzed. These experiences point toward a significant clinical phenomenon: pain in cancer patients—particularly in those in remission—persists not merely as physical memory but as a psychosomatic imprint, with highly symbolic and identity-relevant dimensions.

Among female patients who underwent surgical treatment for uterine cancer, for example, pain resurfaces through chronic itching, skin reactions, and dermatological disorders, often unexplained from a purely organic standpoint. In these cases, the skin becomes a symbolic boundary—a “place of inscription” for unresolved trauma. The pain becomes both a witness and residue of the disease, not only as memory but as a real-time manifestation of the unelaborated.

One of the most profound clinical observations concerns the psychic transformation of cancer into a “third reality”, an internalized object that remains alive in the patient's mental world. Cancer becomes more than a past illness: it becomes a presence—inhabiting thoughts, relationships, and the psychic architecture of identity. This phenomenon is especially evident in patients in remission, where the "cure" has not translated into psychic integration.

A patient affected by Chiari Syndrome said: “Chiari… him… he’s inside me. He’s a man, not a syndrome. It’s like having a jealous lover who won’t let me live.”

In a couple undergoing psychotherapy for psycho-oncological support, the wife said: “If he had cheated on me with a woman it would have been better! Even now that he’s fine, that one is his only thought! He’s always thinking about him! He’s between me and him in everything we have to do.”

A patient who survived a mandibular osteosarcoma after ten years of remission, at the onset of a new relationship, stated: “How can I tell this man that it’s a threesome! He and I (the cancer) are already two. Even though I’m cured, he’s still there.”

These direct narratives shed light on a symbolic structure in which cancer becomes a third psychic presence: a pathological transitional object that escapes symbolization and resists narrative elaboration. According to psychoanalytic models (Marty, McDougall, Roussillon), these internal objects-traumatic, unintegrated, unsymbolized-anchor the Self to a traumatic identity, crystallizing affect and impeding psychic transformation.

This “third” presence in the psyche interferes with new attachments, relational investments, and subjective time. The individual continues to “live with” the disease, not biologically but mentally. The therapeutic challenge becomes then how to transform this psychic presence from a persecutory object to a representable narrative element.

From the perspective of integrated and narrative psychotherapy, the objective is not to eliminate this internal companion but to relocate it: to convert the trauma into a story, transforming a haunting presence into a symbolic past. Only by doing so can patients regain authorship of their identity, freeing themselves from a psychic dyad perpetually occupied by illness.