Psychosomatic Phenomena Research Articles

Acting, feeling and thinking: psychoanalytic psychotherapy with Tracey

This paper consists of a case study and commentary which formed a part of the inaugural lecture in a series entitled ‘Working with Psychosomatic Issues’*. The audience consisted of psychoanalytic, body psychotherapy and integrative practitioners. The presentation was divided into three parts, (1) an outline of philosophical themes that inform perspectives on health, illness and psychosomatic phenomena, (2) the case study reproduced below and (3) a summary of Winnicott's work (1960, 1966, 1988) on ‘the indwelling of the psyche in the soma’.The case study describes work with a young woman who harms herself through self-hitting and, in addition, expresses other physical manifestations of psychological distress. The core approach of the practitioner is psychoanalytic. The work is informed also by postmodern sensibilities and phenomenological themes.

Assessment of Patients by DSM-III-R and DSM-IV in a Japanese Psychosomatic Clinic

Background: The aim of this study was to investigate the clinical features of psychosomatic disorders in Japan. Methods: A total of 1,432 outpatients (515 males and 917 females; 9–95 years of age, mean age 36) attending a psychosomatic clinic for the first time were assessed by the DSM-III-R or DSM-IV semistructured interview. Results: Major ICD-10 diagnoses found were eating disorder, other anxiety disorders, autonomic nervous dysfunction, somatoform disorders, and irritable bowel syndrome. The most frequent diagnosis on the DSM-III-R and DSM-IV axis I was ‘somatoform disorders not otherwise specified’, followed by bulimia nervosa, ‘depressive disorder not otherwise specified’, anorexia nervosa, conversion disorder, major depression or depressive disorder, ‘panic disorder with agoraphobia‘, and ‘psychological factors affecting physical or medical condition’. On axis II, 11–17% of the patients met the criteria for personality disorder. On axis IV, 78–80% had mild or moderate psychosocial stress; major psychosocial and environmental problems classified by the DSM-IV were the problems with primary supports and occupation. Conclusions: The results seem to reinforce the belief that the diagnoses on the DSM-III-R and DSM-IV axis I are inadequate for describing psychosomatic phenomena. A new diagnostic system in combination with the multidimensional assessments by the DSM-III-R and DSM-IV is needed to form the common guidelines of diagnoses and therapies in psychosomatic medicine.

The Powerful Placebo Effect: Fact or Fiction?

In 1955, Henry K. Beecher published the classic work entitled “The Powerful Placebo.” Since that time, 40 years ago, the placebo effect has been considered a scientific fact. Beecher was the first scientist to quantify the placebo effect. He claimed that in 15 trials with different diseases, 35% of 1082 patients were satisfactorily relieved by a placebo alone. This publication is still the most frequently cited placebo reference. Recently Beecher's article was reanalyzed with surprising results: In contrast to his claim, no evidence was found of any placebo effect in any of the studies cited by him. There were many other factors that could account for the reported improvements in patients in these trials, but most likely there was no placebo effect whatsoever. False impressions of placebo effects can be produced in various ways. Spontaneous improvement, fluctuation of symptoms, regression to the mean, additional treatment, conditional switching of placebo treatment, scaling bias, irrelevant response variables, answers of politeness, experimental subordination, conditioned answers, neurotic or psychotic misjudgment, psychosomatic phenomena, misquotation, etc. These factors are still prevalent in modern placebo literature. The placebo topic seems to invite sloppy methodological thinking. Therefore awareness of Beecher's mistakes and misinterpretations is essential for an appropriate interpretation of current placebo literature.

The role of the testicles in male psychological development.

In this paper the role of the testicles in male psychological development is thoroughly investigated. All previous psychoanalytic studies are reviewed; new clinical material is presented; critical research data from pediatric urology and physiological sex research are utilized. A number of significant conclusions emerge. (1) Certain cases of pathological castration anxiety are explained by a psychosomatic phenomenon (the "testicular vicious cycle") caused by actual and perceived threats to the genitals. (2) Testicular factors may be decisive in various neurotic symptom formations beginning with the early toilet training period. The testicular contribution then takes place along certain preferred pathways of symbolic displacement. (3) Testicular symptoms are observed in many cases of physical and sexual abuse. This finding has application to the treatment of male abuse survivors and to their related sexual dysfunctions. (4) Masturbation involving the testicles is not infrequent in young boys; the most common practice consists of inserting the testes inside the body. (5) The condition of cryptorchism may contribute to psychopathology, especially in the area of masculine self-image; however, cryptorchid boys do not tend to be gender-disordered, effeminate, or prehomosexual. (6) Male body image formation after the phallic stage is a complex emotional and intellectual task involving temporary denial of the inner body and the testicles. Finally it is suggested that a revised account of male sexuality, including both penis and testicles, is a prerequisite for any psychoanalytic theory of gender.

Differing mechanisms for proactive effects of intermittent and single shock on gastric ulceration

Rats exposed to either 80 5-s shocks on a VT 60-s or to a single 400-s shock plus 80-min rest in the shock apparatus show dramatically increased degree of ulceration induced 72 h later by exposure to 75-min restraint-in-water stress (at 19°C). However, the proactive effect of the 80 shocks on later gastric ulceration was blocked by SC injection of 7 mg/kg naltrexone 20 min prior to the shock session; naltrexone treatment prior to the single shock session had no ameliorating effect. A second experiment confirmed opioid involvement in the proactive augmentation of vulnerability by showing that when a 20 mg/kg injection of morphine replaced the shocks, rats showed a comparable increase in vulnerability. A third experiment replicated the basic findings from the first experiments that 80 intermittent shocks increase vulnerability to the ulcerogenicity of restraint-in-water and that this effect can be mimicked by replacing the shock stress with a 20 mg/kg injection of morphine; however, other groups showed that injection of 40 mg/kg produced a similar effect whereas 10 mg/kg was ineffective as a mimic. This suggests that there are at least two types of proactive effects from shock experiences that can increase later vulnerability to shock-induced gastric ulceration; one is opioid mediated and the other is not. This finding parallels reports made about mediation of prior shock-induced hypoalgesias and expands the spectrum to psychosomatic phenomenon.

Teresa of Avila: The will and the weaving

For more than forty-five years as a Carmelite nun in the sixteenth century, Teresa of Avila suffered from great physical pain. We see in her life how disciplined prayer can become a healing experience that moves from minimal psychic representation to full symbolic representation. After a brief examination of Teresa's life, two theoretical perspectives on somatic manifestation will be reviewed: the theory of conversion hysteria of the classical Freudian school, and the differentiation Joyce McDougall draws between hysterical and psychosomatic phenomena. For the psychosomatic, as the mystic, the void of wordless space has significance. Following after McDougall on the suffering body, a third perspective will be offered: the concept of conscious body suffering as a means to inner change.

Zur Begrifflichkeit in der Pathologie

There are good historical reasons for the classification of pathology into general, experimental and special pathology . The development of methods of investigation has led beyond that to the formation of specific lines of investigation such as histopathology, molecular pathology and immunopathology, etc. These empirically investigated areas are complemented by the wider field of theoretical pathology. This theoretical pathology is part of a theory of medicine. It is not empirical, not experimental and not descriptive, but considers the general phenomenon of “illness”. It is a purely intellectual, theoretical discipline in the framework of pathology; it reflects on the pathological, and concerns itself with the clarification of theoretical preliminary and basic questions of pathology which can be seen not only as the prolegomena but also as the postlegomena of this science. Considered as belonging to theoretical pathology are (1) the conceptualization of the field, (2) endeavor to interpret the pathological in its different manifestations, and (3) the question of the function of illness. From among the concepts of theoretical pathology are discussed here the notion of disease, the idea of disease and the concept of disease. Further suggestions will be made indicating a more precise and more uniform use of the terms “pathos”,“nosos”,“nosology”, “nosogram”, “pathogenesis”, “pathogenesis”, etc. Another subject of a theoretical pathology, which will not be further treated here, might be termed a search for an interpretation of illness against the background of broad general theories, e.g., illness as a biological phenomenon based on a theory of the organism, and similarly illness as a psychosomatic phenomenon and as a sociological and anthropological phenomenon. Finally there is the question of whether illness has a function, and if so, in which context. Theoretical pathology is necessarily concerned with many problems which touch on the philosophy of science, history of science, philosophy and theology.

Causes and Mechanisms in Psychosomatic Phenomena

Abstract The bases for a presumed crisis in psychosomatic research are examined with special reference to the nature of evidence required to establish etiologic significance in the field of digestive diseases. Future research should exploit the rapid advances that have been developing in neurophysiology in order to identify the central and peripheral circuitry involved in psychosomatic mechanisms. In the experimental study of human subjects emphasis is needed on the interaction of a variety of potentially causative as well as protective factors. The modern sophisticated recording instruments may be of great value in documenting the perceptions of the investigator. The current trend away from descriptive research and human experimentation should be reversed. Medical research is basically a process of inquiry. The rigorous testing of hypotheses has its place, an important place, but enthusiasm for such should not be allowed to block the powerful inferences that may derive when a trained and talented observer records what he sees or experiences. Moreover, inability to replicate an event does not negate its authenticity. Descriptive evidence is usually called anecdotal and is thereby scorned. Darwin could provide a felicitous example here that many of the most revolutionary discoveries have resulted from astute observations and perceptive descriptions of relationships in nature. The work of Konrad Lorenz provides a more recent example.

Alexithymia: anxiety and hostility in psychosomatic and psychoneurotic patients.

Verbal samples obtained from 40 psychoneurotic and 40 psychosomatic patients, matched with respect to age, sex, intelligence and some social indicators, were examined using different methods of content analysis. According to the concept of 'alexithymia' it was postulated that the restricted fantasy life and difficulty in expressing feelings attributed to psychosomatic patients would be reflected at the speech level (psycho-analytic interviews). The measurement of anxiety and hostility using the Gottschalk-Gleser scales gave the following results: with total anxiety in particular, and its subscales guilt, shame, separation and diffuse anxiety, and with hostility, the psychosomatic patients showed lower values than the neurotic patients, which were in part highly significant. The results confirm the existence of the 'psychosomatic phenomenon' but they do not permit statements concerning its etiology.

Updating the Model for Psychotherapy of Psychosomatic Problems

There is a pressing need to broaden the base of the therapeutic efforts used to treat psychosomatic and stress induced disorders. Before this can be accomplished, it is necessary to accept the heterogeneity of the disorders which carry the same label. Psychosomatic phenomena must be clearly defined so that specific treatment goals can be formulated for the various treatment modalities which are available, e.g., modifying patterns of communication and of human relationships; altering expressive and instrumental behavior patterns; broadening of an individual’s perception of the external world and internal experiences; changing the internal state through feedback, drugs, relaxation; modifying mal-adaptive behavioral or psychopshysiological response patterns with conditioning techniques. The range of symptoms which can be defined as psychosomatic include: (1) Symptoms referable to the body which are the expression of ideas, thoughts, or feelings and are not related to altered physiology (conversion, depressive, hypochondriac or body delusional symptoms). (2) Specific physiological changes which accompany psychological states (anxiety, anger, vigilance). (3) Symptoms of organic disease which lead to secondary psychological reactions (somato psychic). (4) Symptoms of diseases whose onset is related to the loss of significant objects and the feeling of hopelessness and helplessness. In order to integrate relevant developmental, psychodynamic, social stress and biological data in relation to illness, a new biopsychosocial model is needed. <i>Engel</i> (11), <i>Weiner</i> (40), <i>Nemiah</i> and <i>Sifenos</i> (29), <i>Sandler</i> (34), <i>Mason</i> (25), <i>Bahnson</i> (6), <i>Luria</i> (22) and <i>Miller</i> (26) have all suggested comprehensive psychobiological etiologic models. These models should be useful in establishing the methods and goals of a more scientific psychobiologically based therapy for psychosomatic disorders.

Hypnosis, suggestions, and psychosomatic phenomena: a new look from the standpoint of recent experimental studies.

Abstract A series of investigations are reviewed which indicate that suggestion (a) can block the skin reaction (dermatitis) that is produced by poison ivy-like plants, (b) can give rise to a localized skin inflammation that has the specific pattern of a previously experienced burn, (c) can be effective in the cure of warts, (d) can ameliorate congenital ichthyosiform erythrodermia (“fish skin disease”), and (e) can stimulate the enlargement of the mammary glands in adult women. Experiments are also summarized supporting the hypothesis that the aforementioned suggested phenomena may be due, in part, to localized alterations in blood flow to the skin and other organs that can occur when certain types of suggestions are accepted.

Pathological primary identifications and their effects on the psychosomatic economy of the individual.

The paper deals with the problem of the unstable psychosomatic economy and the patient's consequent susceptibility to psychosomatic disturbances. This goes back to a primary psychobiological defect in the sphere of his earliest identifications, which comes to the surface in emotional crisis situations. The term "Psychosomatic Phenomenon' is used to describe this basic disturbance in the patient's relationships, which can be observed in his interactions with the psychotherapist or interviewer, where it takes the form of a noticeable lack of fantasy, poor relationships and a reduced capacity for psychic experience and elaboration. The author's object-psychological approach has grown out of years of experience in the analytical treatment of hospitalized psychosomatic patients. A 'toxic environment' can be seen to have been a disturbing influence on the early development of the infant. A child whose mother herself knows no autonomy cannot develop its own fantasies through autoerotic activity and thus cannot build up a libidinal object in its inner world. The result is that such an individual is incapable of meeting the inevitable somatic disorganizations with differentiated reorganization processes and so has no defense against physical illness.

Psychosomatic phenomena: An extension of Wright.

Psychosomatic phenomena: An extension of Wright.

A concept of analytical treatment for patients with psychosomatic disorders. Report on the psychosomatic phenomenon and its consequence for therapy.

With the Paris school the author holds the view that the 'pensée opératoire' is pathognomic for the psychosomatic patient. This archaic, 'automatistisch-mechanistisch' thinking is a consequence of defects in the sphere of the physiological pre-ego. Certain typical findings, such as reduplication and mechanized object relations are seen as correlates of disturbances in the patient's early identification processes. Analytical therapy must thus aim at shifting the all but inaccessible psychosomatic phenomenon into a historical perspective. The psychological event can set in only when the patient has discovered the connexion between his somatic reaction patterns and the emotions he is beginning to feel for the security-giving therapist. An account of the development of the treatment of one patient (Birgit) illustrates the author's concept of analytical therapy in psychosomatics. The 'facilitating environment' helped the patient Birgit to differentiate herself from her dual object and thus to be able to cathect the level of the triangular relationship. The concept of the model ward led on to the development of an ambulatory method of therapy, 'relaxation analytique', which is based on investigations into the concept of the holding function. 'Taking care' of the patient is function of the therapist's own inner attitude, of his being prepared to do everything to encourage the therapeutic regression. The correlate of this attitude, on the side of the patient, is the sense of security which is an essential condition for the 'new beginning' to set in.

Einige Überlegungen zur Psychodynamik der Ulkuskranken anhand des Giessen-Tests

Using the Giessen-Test in a series of investigations among ulcer patients our findings are compared with the psychodynamic personality characteristics of ulcer patients as reported in the literature. We were able to confirm identity of the contents. Special attention, however, is directed toward a few surprising results which appear incompatible with the prevailing concept that ulcer is of ‘neurosis-psychological’ orientation. On the basis of other observations in the literature, we interpret these findings as related to limited achievement capacity of the psychic defense organization of ulcer patients. Whether this Ego-psychological aspect is of general importance for patients with psychosomatic disturbances and whether it represents, perhaps, one of the ways of access to the specifically ‘psychosomatic phenomenon’ of these diseases, are the final points under discussion.

Substance, Structure, Form and Function in the Psychosomatic Phenomenon

To explain the psychosomatic phenomenon it has been proposed on thermodynamic evidence that all biological information is eventually transmitted in terms of molecular form and that the primeval basis of mind is the informational system which results [Black, 1969, 1970]. Logical analysis now shows that the substance of inanimate matter always constrains its structure, which in turn constrains its form, to give the causal chain: substance→structure→form. Introducing the concept of function, the only rational causal chain which then explains the living chemistry is found to be: form→function→substance→structure. This conclusion supports the thermodynamic model quoted.

La menstruation apparente au cours de la grossesse

The menstruation-like bleeding (M-LB) during pregnancy is, according to my clinical observations (1952, 1953), a psychosomatic phenomenon, because it occurs in emotional women, especially when they ar

The duration of normal menses as a psychosomatic phenomenon.

The duration of normal menses as a psychosomatic phenomenon.

The varieties of resistance in group psychotherapy considered from the viewpoint of adaptation.

Resistance in group therapy in particular was considered from the point of view that the unchanging behavior reveals the patient's generalized mode of adaptation utilized to maintain stability and avoid anxiety while achieving his goals. “Constitutional” resistance (I.) refers to the imprecise response of the nervous and vegetative systems to changing circumstances, divisible into (A) genetic lag and (B) cognitive styles, with clinical manifestations of chronic posicatastrophic stress reaction, certain psychosomatic phenomena, and perceptual distortions such as defective reception, attribution, and projection. “Dynamic Maintenance of Stability” (II.) is subdivided into (A) The self-signaling system: feeling of weakness; blaming others; and (B) overt-social-manipulative efforts: (1) Learned role as a patient: passivity; and (2) Unwillingness to yield infantile gratification: weak motivation; pseudoparticipation; defective transmission; nonverbal behavior; character armoring; disturbing activities; and, transference. The topic is approached as an extension of the biological theory of adaptation.

Psychophysiological Bases of Psychosomatic Phenomena

• Psychosomatic will be used here in the broadest sense to refer to symptoms or signs in \',hich infectious or traumatic or degenera­ tive antecedents are not discernible, but in which emotional antecedents or concomitants are present. Such psychosomatic phenomena do not easily fit the traditional disease model the physician uses to program responses to patients, precisely because causal factors are not readily identifiable. It is, particularly, hard to understand how apparently mental events result in somatic disturbances. Tradi­ tional psychiatric explanations, involving models of the transmutation of psychic energy (somatization), are difficult to trans­ late into physiological terms and difficult for the physician to apply to the patient at hand. However, recent psychophysiological re­ search has generated some principles· which help to conceptualize psychosomatic events, and which may provide a framework for the effective management of particular patients. In this paper we will address ourselves to three questions, whose understanding must precede such effective management: (1) \Vhy is it this person, rather than another, who is the patient? (2) Why does he have this symptom or sign, rather than some other? (3) Why does it happen now, rather than some other time? In our description of the principles below, we must extrapolate from purely experimental findings to answer such clinical questions; yet the generalizations we will he making are conservative ones. ACTIVATIOt AKD PATfERNItG