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Allen, D.W. (1960). Psychosomatic Medicine. XXI, 1959: The Ego and the Psychosomatic State: Report of Two Cases. Peter L. Giovacchini. Pp. 218-227.. Psychoanal Q., 29:291.
Psychoanalytic Electronic Publishing: Psychosomatic Medicine. XXI, 1959: The Ego and the Psychosomatic State: Report of Two Cases. Peter L. Giovacchini. Pp. 218-227.
This article seeks to illustrate a temporal relationship of shifts in psychic integration and somatic dysfunction. A woman in psychoanalytic treatment for migraine headaches used obsessive-compulsive defenses against repressed anger. Because of repression, the anger only minimally affected the higher, reality-oriented ego systems. As some of the defenses were breached in the analysis, the ego was flooded with conscious anger and the migraine disappeared; hypertension appeared, however, as the patient tried consciously to suppress her anger. The patient succeeded in suppressing anger, and gained confidence and defensive stability; anxiety vanished. But hypertension progressed and retinal changes developed. Further breakdown of defenses brought regression to a panicky, infantile, orally incorporative state with anger finally expressed openly; and then the hypertension disappeared.
A second patient, a male scientist, also suffering from migraine, began analysis in a relatively stable ego state, his defenses repressing anger. When ego decompensation occurred, rage emerged in the transference, migraine disappeared, and asthma appeared. Unlike the first case this patient was fearful of deriving any dependent gratification in analysis in the period of disintegration. Later still, in a placid, ego-reintegrated state in which he allowed himself partial dependent gratification, the patient lost his asthma but acquired a peptic ulcer.
The author suggests that somatic dysfunctions may be either integrative or disintegrative in affecting the equilibrium of the ego, and that these reactions are not mutually exclusive if various levels of ego function are considered. In the hierarchy of levels of drivedischarge, massive primitive methods of affective discharge recede with maturation. Where higher integrative centers (secondary process operations) fail to provide drivedischarge, drive energy is dealt with relatively diffusely by more archaic ego systems, including somatic and visceral ego systems. Interrelationships among multicausal variables determine whether a particular syndrome emerges.