EMOTIONS AND ORGANIC HEART DISEASE

Abstract

Patients on medical wards, psychosomatically studied, fall readily into several groups, presenting diverse diagnostic and therapeutic problems. The fIrst of these groups includes those patients in whom there is no organic disease found, but in whom a neurosis simulates an organic disease. In this group, the diagnosis of neurosis is usually made, although per exciusionem, i.e., according to the old formula “all tests are negative, there is nothing organically wrong, therefore, it must be neurotic.” At all events-at least in the hospital-the indication for psychotherapy is recognized and the patient referred to the psychiatrist. The second group comprises those patients in whom organic disease is present, but is overlooked because a complicating neurosis is so obvious as to attract the physician’s whole attention. Although they are relatively frequent in general practice, these cases are of course rare in the hospital, where a painstaking physical examination is undertaken in all cases, leading to a diagnosis of the organic disease in spite of any masking by psychoneurotic manifestations. In both of these groups there is little danger (at least in the hospital) that the psychic element will be overlooked. This danger, however, is serious in a third group, to which this paper calls particular attention, namely the group of patients in whom there is no doubt as to the presence and severity of the organic disease. Yet, in the course of the past three years devoted to intensive work with cardiac patients against the background of at least a superficial study of all patients with cardiovascular disease admitted to Presbyterian Hospital, the vital importance of psychotherapy in the medical handling of these patients has become increasingly apparent. The psychic factor here is overlooked largely because the organic disease is so obvious and impressive that the physician is likely