Customer Service | Help | FAQ | PEP-Easy | Report a Data Error | About
Tip: To suggest new content…

PEP-Web Tip of the Day

Help us improve PEP Web. If you would like to suggest new content, click here and fill in the form with your ideas!

For the complete list of tips, see PEP-Web Tips on the PEP-Web support page.

Shaw, L.N. (1977). Meeting of the Psychoanalytic Association of New York. Psychoanal Q., 46:183-184.

(1977). Psychoanalytic Quarterly, 46:183-184

Meeting of the Psychoanalytic Association of New York

L. Noah Shaw

February 24, 1975. THE BOOK OF THE "IT" REOPENED: PSYCHOANALYSIS AND PSYCHOSOMATIC MEDICINE (First Annual Melitta Sperling Memorial Lecture). Peter H. Knapp, M.D.

After reviewing the development and growth of psychosomatic medicine, Dr. Knapp suggested that we attempt to integrate the concepts of learning theory with psychoanalytic concepts in order to understand the conundrum of psychosomatic symptoms. The contributions and ideas of Groddeck were considered, particularly Groddeck's emphasis on the body's symbolically expressing psychological conflict and on illness as having a purpose—"to resolve conflict, repress it or punish sins." Knapp then pointed out that in the "dual Freudian heritage" ("meaning" and "force"), meaning deals with the symbolic aspects of behavior while force focuses on the energies assumed to be inherent in the organism and problems of release and management, especially in conflictual states. The concept of "meaning," Knapp feels, was developed by Freud to explain conversion symptoms, while "force" led to the Aktualneurose. The symbolic manifestations of the purpose and conflict in psychosomatic illness are illustrated in several clinical vignettes which pinpoint psychological factors as causative in physical illness.

Knapp then postulated that the appearance of psychophysiologic manifestations of selective learned dysfunction "represents a symbolic learned reflection of an individual's past experience or the expression of learned and planned future intentions." The two major paradigms in learning theory are the Respondent (also known as Pavlovian, classical, or Type 1) and the Instrumental (also known as operant, Skinnerian, or Type 2). In respondent conditioning, "the stimulus precedes the response; it is initiated by the environment and follows as an automatic, quasi-passive response by the organism." In instrumental conditioning, "the response precedes the stimulating or reinforcing event; it is initiated quasi-actively by the organism."

Clinical examples, previously viewed according to the respondent paradigm, suggest that the instrumental paradigm fits the clinical data more convincingly. The timing and localization of the symptoms "suggest their use as instruments to avoid continued pain of some sort, invoking a response which was in some way rewarding."

[This is a summary or excerpt from the full text of the book or article. The full text of the document is available to subscribers.]

Copyright © 2019, Psychoanalytic Electronic Publishing, ISSN 2472-6982 Customer Service | Help | FAQ | Download PEP Bibliography | Report a Data Error | About

WARNING! This text is printed for personal use. It is copyright to the journal in which it originally appeared. It is illegal to redistribute it in any form.