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Spiegel, L.A. (1949). Meetings of the New York Psychoanalytic Society. Psychoanal Q., 18:275.

(1949). Psychoanalytic Quarterly, 18:275

Meetings of the New York Psychoanalytic Society

Leo Angelo Spiegel


Two divergent explanations have been given for the mental symptoms accompanying disorders like multiple sclerosis. One states that mental symptoms are dependent on the etiology of the disease and are the same or similar in all cases. (The evidence presented does not support this view.) The other contends that mental symptoms accompanying organic disease are determined by the psychological significance to the patient of the symptomatic disability resulting from the illness and the consequent disturbances in mental equilibrium or libido economy. The authors conclude that one can best understand why such a disability is traumatic through a knowledge of the unconscious conflicts of the patient. The illness is traumatic precisely because of the existence of an unconscious conflict even though it produced no symptoms at the onset of the illness. The neurological disorder mobilizes the unconscious conflict, and mental symptoms ensue. The psychological consequences of serious physical illness are summarized: increased dependence, deprivation of customary gratifications and sublimations, and the reappearance of forbidden gratifications such as soiling. These changes increase the task of the ego in maintaining psychic equilibrium. Certain 'weak points', characterized by significant defense mechanisms, play a specific rôle in the neuroses accompanying organic illness. Thus, in two cases where there was extensive reaction-formation against anal-sadistic drives, the most traumatic aspect was the loss of anal sphincter control. In each patient it was found that only that aspect of the neurological disease which disturbed the balance between defense and instinct in a pre-existing unconscious conflict could be considered traumatic.

Charles Davison stated that organic improvement occasionally precipitates neurosis; Ludwig Eidelberg, that the defense-stimulating nature of organic symptoms resides in their unconscious meaning.

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