Psychoanalysis has always been used simultaneously as a therapeutic and research tool. Only after it became customary to record the psychoanalytic sessions systematically was it possible to separate therapy and research. By recording, transmissible data are obtained which can be studied independently and free from the pressure of therapeutic aims. Such data furthermore can be correlated with data obtained concomitantly by laboratory or other procedures. This kind of analytic research has afforded scientific results in the study of asthma, blood pressure, glycosuria, and disturbances of gonadal hormones.
Since the psychosomatic study of diabetes presents especially difficult methodological problems, a special project was designed to permit, 1, the observation of the correlations existing between emotional fluctuations and metabolic reactions; 2, the detection of behavioral responses which reflect the perception of metabolic dysfunction and physiologic change; 3, the investigation of the presence or absence of some 'basic biologic pattern' or 'instinctual constellation' which primarily burdens the organism in such a way that the arising conflict tension finally breaks the chain of the normal metabolic process and leads to diabetes.
The analytic study of six male and three female patients has shown that conflicts which are specific for the individual may produce an increase in glycosuria, that a diminution in the tension of the conflict may result in a decrease in glycosuria, and that the resolution of the conflict may actually lessen the metabolic derangement. Thus a glycosuria resulting from an increase in the rate of the breakdown of liver glycogen may be regarded as an unconsciously functioning emergency response of the diabetic. Furthermore, it was possible to show that the basic conflict was followed by reaction patterns related to the fact of having diabetes. Those who react with extreme compulsiveness in diet, since they have strong egos, are able to ward off anxiety by self-restriction. Those with weak egos respond by overeating with spiteful, provocative, and even delinquent attitudes toward their diet. Insulin becomes the tool for mastering anxiety, a source of gratification, a symbol of power.
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While it may be assumed that the expression of a need for replenishment on a metabolic level serves to maintain physiologic homeostasis, there is no doubt that some individuals respond to any strain on the integrative capacity of the ego by reverting to an increased desire for passive replenishment. This is regression, the depth of which is determined by the total personality as well as by the burdens which are imposed upon the ego. Analysis of the variations in ego strength, the periods of regression, and periods of reintegration may indicate the rôle of emotion in the etiology of diabetes mellitus.