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Engel, G.L. Schmale, A.H., Jr. (1967). Psychoanalytic Theory of Somatic Disorder—Conversion, Specificity, and the Disease Onset Situation. J. Amer. Psychoanal. Assn., 15:344-365.

(1967). Journal of the American Psychoanalytic Association, 15:344-365

Psychoanalytic Theory of Somatic Disorder—Conversion, Specificity, and the Disease Onset Situation

George L. Engel, M.D. and Arthur H. Schmale, Jr., M.D.


The extension of psychoanalytic study to a more heterogeneous population of patients with somatic disease has brought forth new data and new perspectives relevant to psychoanalytic theory.

The concept of conversion has been examined and proposals have been put forth as to how conversion may at times lead to somatic disease. The latter, however, must be regarded as a complication of conversion, having no primary symbolic or defensive function.

The role of specificity in somatic disease genesis has been re-examined and the term somatopsychic-psychosomatic proposed to encompass a group of disorders in which primary biological factors influence both psychic development and somatic vulnerability. Patients sharing the same biological factor resemble each other both psychologically and in their predisposition to specific disease.

The setting of illness, the onset situation, has been proposed as the crucial period in which to study the nature of the psychological factors involved in the development of illness.

As one important nonspecific onset situation we have described in phenomenological terms the "giving up-given up" complex and considered its metapsychology, with particular reference to helplessness and hopelessness as the characteristic affects of this

state. We propose that the "giving up-given up" complex acts as a frequent factor contributing to the the emergence of disease, but is neither necessary nor sufficient for the development of disease.

"Flight-fight" and "conservation-withdrawal" are identified as two primary biological defense systems. Their relationship to the "giving up-given up" complex is discussed.

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