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G., R. (1946). Psychosomatic Medicine on General Medical Wards: William C. Menninger. Bulletin of the U. S. Army Medical Dept., IV, No. 5, 1945, pp. 545–550.. Psychoanal Q., 15:408-408.
Psychoanalytic Electronic Publishing: Psychosomatic Medicine on General Medical Wards: William C. Menninger. Bulletin of the U. S. Army Medical Dept., IV, No. 5, 1945, pp. 545–550.
A recent survey from eleven general hospitals in the zone of the interior indicated that 24.2 per cent of the patients on the 'cardiovascular wards' were 'functional' and that 20.7 per cent of the cases on the 'gastrointestinal wards' were 'functional'. In a station hospital these figures rose to 41 per cent (cardiovascular) and 30 per cent (gastrointestinal). These data were supplied by internists. Surveys by or with psychiatrists would have given higher figures.
Too few physicians have sufficient scientific understanding of these illnesses adequately to diagnose or to treat them. Medical education which stresses anatomy, organic physiology and pathology leaves the physician embarrasingly ignorant of the functioning of the individual as a biological unit.
Several types of problems are outlined. There is a quotation from Crook-shank (no reference): 'It has seemed to me odd in the extreme that doctors, who, when students, suffered with frequency of micturition before an examination, or, when in France, had actual experiences of looseness of the bowel before action, should persistently refuse to seek a psychological correlative—not to say an etiological factor—when confronted with … enuresis or mucous colitis. I … wonder that some hard-boiled and orthodox clinician does not describe emotional weeping as a new disease, calling it paroxysmal lacrimation and suggesting treatment by belladonna, astringent local applications, avoidance of sexual excess, tea, tobacco, alcohol, and a salt free diet with restriction of fluid intake proceeding, in the event of failure, to early removal of the tear glands…'
Physicians must become aware of prevailing mistaken attitudes and practices which make diagnoses by exclusion, examine the patient physically and chemically but have no knowledge or training to proceed beyond the stethoscope, test tube and the x-ray.
Basic in this education is the rôle of anxiety … a central dynamic force which must be distinguished from fear. Its manifestations and transformations include direct anxiety, depression, hysterical conversions, hypochondriasis, paranoid trends, etc., etc. The physician must have some rationale for understanding the manifestations he sees, some basis for comprehending the irrationality of treatment by platitudes and placebos, and, most important, that those illnesses which the physician is prevented by his limitations from demonstrating organically are just as real and disabling as valvular heart disease or infectious diseases.
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G., R. (1946). Psychosomatic Medicine on General Medical Wards. Psychoanal. Q., 15:408-408