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Winnicott, D.W. (1966). Psycho-Somatic Illness in its Positive and Negative Aspects. Int. J. Psycho-Anal., 47:510-516.

(1966). International Journal of Psycho-Analysis, 47:510-516

Psycho-Somatic Illness in its Positive and Negative Aspects

D. W. Winnicott


1. The word psycho-somatic is needed because no simple word exists which is appropriate in description of certain clinical states.

2. The hyphen both joins and separates the two aspects of medical practice which are constantly under review in any discussion of this theme.

3. The word accurately describes something that is inherent in this work.

4. The psycho-somatist prides himself on his capacity to ride two horses, one foot on each of the two saddles, with both reins in his deft hands.

5. Some agent has to be found that tends to separate the two aspects of psycho-somatic disorder, to give the hyphen a place.

6. This agent is, in fact a dissociation in the patient.

7. The illness in psycho-somatic disorder is not the clinical state expressed in terms of somatic pathology or pathological functioning (colitis, asthma, chronic eczema). It is the persistence of a split in the patient's ego-organization, or of multiple dissociations, that constitutes the true illness.

8. This illness state in the patient is itself a defence organization with very powerful determinants, and for this reason it is very common for well-meaning and well-informed and even exceptionally well-equipped doctors to fail in their efforts to cure patients with psycho-somatic disorder.

9. If the reasons for this tendency to fail are not understood medical practitioners lose heart. Then the subject of psycho-somatics becomes a subject for non-clinical or theoretical survey, and this is relatively easy because the theoretician is detached, and is not cluttered up by responsibility for actual patients.

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