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(1951). Psychosomatic Medicine. Psychoanal. Rev., 38(3):276-296.
Psychoanalytic Electronic Publishing: Psychosomatic Medicine

(1951). Psychoanalytic Review, 38(3):276-296


Psychosomatic Medicine

(Vol. 11, No. 1)

1.   Lidz, Theodore. Emotional Factors in Hyperthyroidism.

2.   Malmo, Robert B. and Shagass, Charles. Reaction to Stress in Anxiety and Early Schizophrenia.

3.   Malmo, Robert B. and Shagass, Charles. Symptom Mechanisms in Psychiatric Patients Under Stress.

4.   Mahl, George F. Chronic Fear and Gastric Secretion of HCL in Dogs.

5.   Grinker, Roy R. and Gottschalk, Louis. Headaches and Muscular Pains.

6.   Brenner, Charles; Friedman, Arnold F. and Carter, Sidney. Psychologic Factors in Chronic Headache.

1.   Lidz, Theodore. Emotional Factors in Hyperthyroidism. The purpose of the presentation is to summarize a preliminary survey, carried out to determine whether or not emotional factors are of sufficient relevance to the development of hyperthyroidism to warrant further study. The constancy with which emotional disturbance precedes the onset of illness, the similarity between the emotional traumata, and the striking similarities in the configurations of the personality structures of patients subject to thyrotoxicosis, leads to the assumption that emotional factors are of major importance. This study of 15 patients gains significance by comparison with the studies of Mittelman and Conrad. The conclusions reached from three separate studies approach a unanimity of opinion rarely found in psychosomatic investigations. Although it is believed that this paper further clarifies the picture of the personality configuration of hyper-thyroid patients, the simple confirmation of the prior studies is considered of greater significance.

2.   Malmo, Robert B. and Shagass, Charles Reaction to Stress in Anxiety and Early Schizophrenia.

1.   An unselected population of 75 patients was divided into three groups: A) 36 patients in whom anxiety was the predominant symptom; B) all other patients, except early schizophrenics (N = 28), and C) 11 early schizophrenics. Eleven normal control subjects were employed in order to provide a base line.

2.   A standardized series of pain stimulations were presented by a Hardy-Wolff stimulator. Physiologic recordings were taken continuously throughout the test. Quantitative data obtained from analysis of records were compared with the clinical status of the case.

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3.   The results and major conclusions may be summarized as follows: A) In general, severity of anxiety appeared to be related to degree of physiologic disturbance. B) The clearest correspondence between degree of anxiety and degree of physiologic disturbance under stress was found with measurements reflecting striate muscle activity such as finger movement and neck muscle potentials. C) In general, the more severe the anxiety, the greater was the overreaction to pain stimulation. D) In terms of general level of responsiveness, the early schizophrenic group resembled the most anxious group more than any other. But in two quite different types of reaction, the schizophrenic group showed a relative lack of discrimination among the various intensities. This poor discrimination appeared to reflect (at a simple level) the inappropriateness of response, which is generally typical of schizophrenia.

4.   Current theories of action and of anxiety are discussed in the light of present findings.

3.   Malmo, Robert B. and Shagass, Charles. Symptom Mechanisms in Psychiatric Patients Under Stress.

1.   Physiologic recordings were taken from 74 mental patients in an experimental stress situation, consisting of a standard series of painful stimulations, presented by a Hardy-Wolff thermal stimulator. Patients were classified with respect to the presence or absence in the clinical history of 1) cardiovascular complaints, and 2) head and neck pains. The physiologic battery included recordings of: heart rate, respiration, and neck muscle potentials which are known to be related to the symptoms considered. The physiologic reactions of the patients, with and without each type of symptom, were then compared.

2.   Results were as follows: a) Mean heart rate, mean heart rate variability, and median respiratory variability were all reliably greater for the group of patients with cardiovascular complaints. b) Muscle potential scores were reliably higher for the group of patients whose symptoms included complaints of head and neck pains. c) There was no reliable difference in muscle score between patients with cardiovascular complaints and those without such complaints. d) Nor were there any reliable differences in heart rate or respiration scores between patients with head and neck complaints and those without such complaints. e) At the time of testing, only 7 patients presented any of the complaints studied.

3.   It was concluded that psychiatric patients with somatic complaints tend to manifest increased physiologic responsiveness in the related physiologic system or mechanism, upon exposure to stress. The disturbance appears specific to the physiologic system associated with the complaint, and can be demonstrated objectively even though the subjective symptom is not experienced at the time of stress.

4.   Mahl, George F. Chronic Fear and Gastric Secretion of HCL in Dogs

1.   A review of the literature concerned with specific psychologic

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processes involved in the etiology of peptic ulcer revealed a confusing array of contrasting proposals resulting from personality studies of ulcer patients. Of these proposals, that which emphasized the primary role of chronic fear or anxiety appeared to be the best substantiated one.

2.   Experimental evidence shows that vagal discharge and associated increased gastric acidity plays a primary role in the physiologic mechanism of ulcer formation.

3.   From the foregoing, one would predict a positive relation between chronic fear behavior and gastric acidity. This prediction was not adequately supported experimentally and it is contradictory to Cannon's thypothesis that increased sympathetic discharge is associated with inhibited parasympathetic discharge in the emotional response of fear.

4.   This study was performed to obtain direct experimental evidence relevant to these two hypotheses: a) during a state of chronic fear behavior, the acidity of the gastric contents is higher than during normal behavior; b) if persistent fear behavior occurs over an extended period of time, peptic ulcers will develop. It was also desirable to measure gastric emptying rate, heart rate, and behavioral changes under these two conditions of behavior.

5.   A modified conditioning procedure was used to develop a state of chronic fear in 7 dogs. Behavioral observations revealed that 6 of these dogs developed chronic fear behavior and at the same time showed increased gastric acidity, gastric emptying rate, nonresting heart rate, and increased variability of both nonresting and resting heart rates. The dog who failed to develop chronic fear behavior was the only exception to this pattern of autonomic changes. Removal of the animals from the experimental environment or omission of the reinforcing pain stimulus resulted in recovery of these behavioral, gastric, and cardiac changes. Evidence showed that increased acidity occurs during conditioned fear in the absence of the primary experience of pain. No sexual difference was found in the acid response to the induction of chronic fear.

6.   Gross and histologic examination of the stomach and duodenum of each dog showed no signs of tissue pathology in any case.

7.   The implication of these results for the problem of ulceration in humans was discussed. In addition, they indicated that the direct extension of Cannon's hypothesis to chronic emotional states, which are of basic importance in psychosomatic disorders, is not justified.

5.   Grinker, Roy R. and Gottschalk, Louis. Headaches and Muscular Pains. A Psychosomatic Conference of the Michael Reese Hospital.

6.   Brenner, Charles; Friedman, Arnold F. and Carter, Sidney. Psychologic Factors in Chronic Headache. In the present paper it is endeavored to discuss and illustrate a number of factors with which the authors have been impressed by experience with several hundred patients

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with chronic headache. Headache has very often been found to be present in patients who had suppressed (or were unconscious of) strong feelings of resentment or anger. A variety of other mechanisms have of course been observed: hysterical identification or conversion through symbolic displacement, satisfaction of a need for punishment, hypochondriasis of psychotic type, high degree of secondary gain, etc.

The great importance in psychotherapy of the physician-patient relationship has been emphasized. Even in those patients to whom formal psychotherapy is not given, the therapeutic results often depend in large measure on the psychologic effect of the treatment situation on the patient and especially on the emotional relationship between patient and physician. Wherever possible ventilation of wholly or partly unconscious emotional conflicts is of course therapeutically valuable, as is suitable environmental manipulation.

(Vol. 11, No. 2)

1.   Brody, Eugene B. Psychologic Tension and Serum Levels in Psychiatric Patients Without Evidence of Thyroid Disease.

2.   Pincus, Gregory, Et Al. Pituitary-Adrenocortical Function in Normal and Psychotic Men.

3.   Hoskins, R. G. and Pincus, Gregory. Sex-Hormone Relationships in Schizophrenic Men.

4.   French, Thomas M. and Shapiro, Louis B. Dream Analysis in Psychosomatic Research.

5.   Lhamon, William T. Relation Between Finger Volume Changes, Brain Activity, and Psychopathologic Reactions.

6.   Diethelm, Oskar, Et Al. Mental Hygiene in a General Hospital.

7.   Shilkret, Harry H. Psychogenic Sneezing and Yawning.

1.   Brody, Eugene B. Psychologic Tension and Serum Levels in Psychiatric Patients Without Evidence of Thyroid Disease. When a heterogeneous population of psychiatric patients without clinical thyroid disease was divided on the criterion of serum precipitable iodine concentration, a simultaneous qualitative segregation of the population in respect to higher and lower levels of psychologic tension was discovered. There were statistically significant, though very small, mean differences in serum precipitable iodine concentration between patients with higher and those with lower levels of tension. These findings may reflect gradual increases in thyroid activity (within the “normal” range) associated with repeated psychologically stressful experiences; and, in turn, the increased neural sensitivity associated with higher thyroid hormone output may help to perpetuate high levels of tension. Increased thyroid secretion may result from the stimulation of anterior pituitary thyrotropic hormone output by adrenergic substances discharged during stressful experiences.

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2.   Pincus, Gregory, Et Al. Pituitary-Adrenocortical Function in Normal and Psychotic Men. Report is made of measurement of certain blood and urine constituents determined before and after four tests designed to evoke endogenous adrenocortical activity (glucose administration, pursuit-meter operation, target-ball frustration test, adrenocortico-trophin [ACTH] administration) and one test involving the administration of active corticosteroids (ACE). Thirty-six normal men and 34 psychotic men underwent one or more of these tests. Of these procedures the target-ball frustration test proved to be least effective in eliciting blood and urine changes indicative of adrenocortical activity. Data significantly indicative of adrenal cortex activation were obtained for the normal men in the glucose tolerance, pursuit-meter and ACTH tests whereas significant evidence of responsivity in the patients' data occurred only in the lymphocyte response to glucose administration. The behavior of the indices of adrenocortical function following ACE was similar in the two groups and they could not be significantly differentiated. It is deduced that the responsivity to ACE is similar in the two groups, but that activation of endogenous adrenocortical secretion generally fails in the psychotic subjects. Evidence is thus provided of a species of hypoadrenalism in the psychotic subjects. The significance of this hypoadrenalism is discussed.

3.   Hoskins, R. G. and Pincus, Gregory. Sex-Hormone Relationships in Schizophrenic Men. Groups of 23 normal men, 11 normal women, and 29 schizophrenic men were compared as to the urinary output of androgen, of estrogen, and of 17-ketosteroids. The ratios of these substances to each other were calculated for each of the three groups. There was considerable overlapping in the various categories but the women were found to have excreted more estrogen and less androgen and 17-ketosteroids than did the men, the differences in the means being statistically valid.

The androgen: estrogen ratio in the men surpassed that in the women in proportion of 16:3 to 2:3. The proportion of active androgen in the total ketosteroid output was also higher in the normal men than in the women.

In case of the patients (men) the total estrogen output was lower than that of the women in proportion of 15.8 to 26.8 whereas it was slightly but significantly higher (15.8 to 12.6) than that of the normal men.

The androgen output of the patients surpassed that of the women in proportion of about 12 to 7 but fell significantly below that of the normal men by a ratio of 12 to 18.

The mean androgen: estrogen ratios in the women were 2.3, in the men 16.3, and in the patients the intermediate ratio of 9.7.

In all these various hormonal categories, therefore, the schizophrenic men showed a definite approach toward the feminine patterns but remained more “masculine” than the normal women.

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As regards psychologic characteristics the 5 patients with the lowest androgen-to-estrogen ratios were less aggressive than the 4 with the highest ratios. Such homosexuality as was evident was also a matter of more active concern in the latter group.

4.   French, Thomas M. and Shapiro, Louis B. Dream Analysis in Psychomatic Research. Dreams of patients suffering with psychosomatic disorders often show a very close relationship between the experiences represented in the dream and the somatic symptoms that accompany or follow it. A case is reported. One explanation is the patient reflexly stiffens up her arms to protect herself from the pain. Another is that the inhibitory effect of being tied to the mother's apron strings has had something to do with precipitating the recurrence of the arthritic symptoms. Clumsiness is connected with the mother's restrictive attitudes about sex. Inner restlessness precedes the arthritic attack. A dream of falling and jumping up precedes the disappearance of the attack. Inhibitions precede the attack and diminish with relaxation and the end of the attack. Hints are given as to how the conflict was transfered over to the musculature.

5.   Lhamon, William T. Relation Between Finger Volume Changes, Brain Activity, and Psychopathologic Reactions. A study of 11 patients with a characteristic type of disorderly finger plethysmogram disclosed that all of the patients demonstrated emotional outbursts accompanied by disturbances of thinking or impulsive behavior. Furthermore, 10 of the patients had abnormal electroencephalographic responses to hyper-ventilation, and 8 patients had excess slow wave activity without over-breathing. Disorderly finger plethysmograms were defined by gross, abrupt changes in pulse wave amplitude with runs of small or large amplitude lasting thirty seconds or less which gave a paroxysmal and disorderly appearance. In these cases pulse wave fluctuations were superimposed on a background of large alpha wave activity. No significant correlation between the physiologic findings and diagnostic groups was found. There was a low incidence of disorderly finger plethysmograms and abnormal electroencephalograms in the patients not demonstrating emotional outbursts with disturbances of thinking and impulsive behavior. A common descriptive feature in the physiologic and psychologic behavior of these patients was a sudden unpredictable marked change of state with respect to time.

6.   Diethelm, Oskar, Et Al. Mental Hygiene in a General Hospital. This subject is discussed under the headings of Gynecology and Obstetrics, Pediatrics, Personnel, and The Community.

7.   Shilkret, Harry H. Psychogenic Sneezing and Yawning.

1.   A case is presented of a woman suffering with violent and almost continuous

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sneezing spells which occasionally was interrupted by short spells of yawning. These symptoms were alleged to have occurred by contact with a “gunpowder smoke.”

2.   The standard methods of testing allergic patients were used and gave no evidence that we were dealing with an allergic individual. These included complete intradermal testing with the common extracts of inhalants and foods as well as “snuff,” inhalation tests with the various mixtures of “gunpowder smoke,” and materials with which the patient came in contact at her work.

3.   Psychotherapeutic measures (suggestion) were used and caused disappearance and recurrence of the patient's symptoms at will.

4.   It is assumed that the patient's symptoms in this case were purely psychogenic in origin.

(Vol. 11, No. 3)

1.   Perloff, William H. Role of Hormones in Human Sexuality.

2.   Tauber, Edward S. and Daniels, George E. Androgenic Hormones and Psychic Conflict.

3.   Pincus, Gregory, Et Al. Responsivity of Schizophrenic Men to Pituitary Adrenocorticotrophin.

4.   Kennard, Margaret A. Inheritance of Electroencephalogram Patterns in Children with Behavior Disorders.

5.   Funkenstein, Daniel H. Tertian Malaria and Anxiety.

6.   Forbes, Alexander. Dream Scintillations.

7.   Obermayer, Maximilian E. and Greenson, Ralph R. Treatment by Suggestion of Verrucae Planae of the Face.

8.   Rado, Sandor. Mind. Unconscious Mind, and Brain.

1.   Perloff, William H. Role of Hormones in Human Sexuality. Three elements are concerned with the determination of human sexuality. The genetic factor sets the sexual pattern and defines the general limits within which the other factors may operate. The hormonal component develops the organs needed for the sex act and increases their sensitivity to stimulation. The psychologic aspect is concerned essentially with the choice of the sex object and with the intensity of the sexual emotions.

Castrate humans may show sexual behavior similar to intact persons, proving that the gonadal hormones are not indispensable to at least partial sexual activity. Studies of the endocrine systems of homosexual subjects demonstrate no constant nor significant variation from the average for the respective somatic sex. The administration of large amounts of estrogen to normal men decreases, in some cases, their libido, but does not increase their attraction for other men, acting by depressing the endogenous production of androgen and by antagonizing androgens directly. The exhibition of large doses of androgen in normal women may intensify their

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libido—possibly by increasing the sensitivity of the clitoris—but will not cause them to assume the male sexual role. The treatment of the homosexual patient with the hormone of his somatic sex will in no way influence his sexual behavior unless this substance be an androgen, in which event his sexual activity may increase, but always in the direction determined psychologically.

It must be concluded that homosexuality is a purely psychologic phenomenon, neither dependent on an hormonal pattern for its production nor amenable by endocrine substances to change.

So-called “sexual mannerisms” and aggressive behavior, as well as impotence and frigidity, cannot ordinarily be related to hormonal patterns. It is usually not possible to prognosticate the type and amount of hormones produced in a patient by observing his behavior, and “sexual mannerisms” cannot be influenced by the administration of exogenous hormones.

Investigation into the problems of abnormal sexual behavior must include evaluation of the total individual and certain disturbances may be ascribed to endocrine factors only when other manifestations of endocrine disease are present. Even in the presence of endocrine disease, libido may be normal; but, where it is not, endocrine therapy may reestablish a previously existing normal sexual state.

2.   Tauber, Edward S. and Daniels, George E. Androgenic Hormones and Psychic Conflict. Three cases of androgen insufficiency have been discussed in order to illustrate and emphasize the existence of psychological factors in the handling of such cases. The patient enters the treatment situation presumably with the intention of gaining some help with his sexual problems which are regarded by him primarily as a deficiency condition. In these cases one can see that the urge to treatment is partly an effort to resolve nonsexual insecurities which appear to the patient to be exclusively sexual in nature. Androgen therapy actually hastens a clarification of the patient's problems if not for both the patient and the doctor, at least for the doctor.

3.   Pincus, Gregory, Et Al. Responsivity of Schizophrenic Men to Pituitary Adrenocorticotrophin. Two schizophrenic men who exhibited a normal adrenocortical responsivity to administered adrenocorticotrophin and 7 men with no significant responsivity were given over a period of twelve to fourteen days a dietary supplement high in proteins and vitamins. All of the subjects exhibited at the end of the dietary supplement significant increases in plasma ascorbic acid and globulin and decreases in total plasma protein and albumin. All save one had lower blood hemoglobin concentrations. There was no significant change in blood lymphocyte number and irregular but average drops in total leukocytes and red blood cells. All of the subjects save 2 showed a net gain in weight. Despite these obvious evidences of nutritional repair the ACTH responsivity of

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the originally responsive men did not change and only 1 of the 7 ACTH nonresponders exhibited a normal ACTH responsivity at the end of the dietary supplement period. It is suggested that the responsivity of schizophrenic men to ACTH is not a function of their nutritional status nor of their C-avitaminosis.

4.   Kennard, Margaret A. Inheritance of Electroencephalogram Patterns in Children with Behavior Disorders.

1.   In the families of children with behavior disorders, there is a marked similarity in EEG pattern in the various members of a single family. This is very obvious in members of a family who are of similar age. It is present even in the EEG patterns of parents and their children. A similar familial patterning has been shown in the families of epileptics.

2.   There is a higher incidence of dysrhythmic and hence abnormal records in the patients, 60 per cent, than in their “normal” relatives, 40 per cent.

3.   The incidence of EEG's in the “normal” relatives having 40 per cent abnormality is different from that of the total normal population, which has only 10-15 per cent of abnormal records.

4.   It is suggested that anxiety or tension may be related to dysrhythmic and unstable EEG patterns, and that, in consequence, a very high incidence of abnormal EEG's appears in the neurotic or psychotic members of families with relatively unstable psychologic background. This is reflected more in the EEG's of children than of adults because the cortical potentials of the former are, under any circumstance, more labile than are those of the latter.

5.   Funkenstein, Daniel H. Tertian Malaria and Anxiety. A note is made that at Guadalcanal in 1943, those who had had malaria were under suppressive atabrine treatment. When there were nightly air raids there was a marked increase in the incidence of clinical malarial break-throughs, from 10-20 to 60-70 cases weekly. Greater exposure to mosquitoes in foxholes and anxiety are given as two reasons.

6.   Forbes, Alexander. Dream Scintillations. The author gives experiences with this phenomenon in himself. Three types are recognized, narrative dreams, dreams at onset of sleep or dozing, and effort dreams. Four examples of the second type are given. These are described and studied.

7.   Obermayer, Maximilian E. and Greenson, Ralph. Treatment by Suggestion of Verrucae Planae of the Face.. A case is reported in which the treatment had good results.

8.   Rado, Sandor. Mind, Unconscious Mind, and Brain. The subject is discussed under the headings; Awareness and Reporting, The Postulate

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of Spinoza, Evolutionary View of Awareness and Reporting, Non-Reporting Nervous Activity, Psychoanalytic Explanation of Non-Reporting Phases of the Goal Mechanism of Behavior, and To-From-At Non-Reporting Levels.

(Vol. 11, No. 4)

1.   Szasz, Thomas S. Psychiatric Aspects of Vagotomy.

2.   Bruch, Hilde. Physiologic and Psychologic Interrelationships in Diabetes in Children.

3.   Rosen, Harold. and Lidz, Theodore. Emotional Factors in the Precipitation of Recurrent Diabetic Acidosis.

4.   Henry, Jules. Anthropology and Psychosomatics.

5.   Stevenson, Ian P. and Wolff, Harold G. Life Situations, Emotions, and Bronchial Mucus.

6.   Ascher, Eduard. Motor Attitudes and Psychotherapy.

1.   Szasz, Thomas S. Psychiatric Aspects of Vagotomy. Twenty-five vagotomized ulcer patients were studied from the psychiatric point of view. Cases were selected in such a manner that the results have no statistical significance concerning the therapeutic value of vagotomy. Sixteen patients (64 per cent) were definitely helped by the operation; 5 patients (20 per cent) were found to be “status quo ante”; and 4 patients (16 per cent) became more incapacitated following vagotomy.

The symptoms encountered in patients after vagotomy are listed and some are discussed briefly. It was concluded that when sufficient information is obtained about the patient, his postoperative symptoms can usually be understood in terms of his (preoperative) personality structure. It was common to see in these cases a re-emergence or exacerbation of symptoms (defenses) which had been employed by the patient some time in his past.

In studying the psychologic factors which determine the outcome of vagotomy, the importance of understanding the psychic economy of the patient is emphasized. This is contrasted with the attention focused on psychodynamics in elucidating the etiology of peptic ulcer. The psychologic characteristics of two types of cases—those representing good candidates for vagotomy on the one hand, and candidates with an unfavorable prognosis on the other—are described. It was found that the more psychic energy is bound by the organic illness (i.e., ulcer symptoms) and by the therapy (diet, etc.)—the more likely the result of vagotomy will be unfavorable; and conversely, the less psychic energy is bound in this manner (i.e., little instinctual gratification being derived from being ill and from the medical regimen, and little secondary gain)—the better is the prognosis.

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2.   Bruch, Hilde. Physiologic and Psychologic Interrelationships in Diabetes in Children. The study is based on psychiatric observation of 37 diabetic children. No uniform psychologic picture could be discovered. Although the families tended to relate the onset of diabetes to upsetting events, only in exceptional cases was there real evidence of such a relationship. The psychologic structure of the families showed great variety. It was found that these existing attitudes were of great importance for the course of treatment. This point is illustrated by 8 selected case histories. The findings were compared to observations on obese children, in whom a characteristic psychologic picture could be described, which in turn was related to a typical family frame. These observations, particularly the marked difference between the picture in diabetes and obesity, seems to be of more general importance.

There has been a tendency in psychosomatic research to focus on the association of certain basic personality traits with certain organic illnesses. In this orientation the illness may be likened to a neurotic symptom expressing unconscious conflicts and needs. Failure to establish such central relationship has been attributed to inadequate technic. The opinion has been expressed that only intensive psychoanalytic studies could reveal the fundamental interrelationships.

In the study of obese children, common psychologic characteristics could be readily recognized and were found to be intrinsically interrelated with the development of obesity. One might say that obesity is a way of life and, though resented as an embarrassing handicap, serves the function of giving the security of size. No psychologic factors of such central importance were recognized in diabetic children studied by the same technic. Diabetes enforces a certain way of life to which a child and his family will react according to preexisting yet unspecific patterns. Diabetes seems to reinforce existing problems. From the comparison of obesity and diabetes in childhood one might conclude that physical changes and psychologic reaction are integrated on different levels and in different ways in different somatic disorders.

3.   Rosen, Harold and Lidz, Theodore. Emotional Factors in the Precipitation of Recurrent Diabetic Acidosis. Twelve patients who had repeatedly been admitted to the hospital in diabetic acidosis were studied by psychiatric interviews and social-service casework. The failure of all of these patients to maintain diabetic regulation was due to abandonment of their diabetic regime. Direct influence of emotions upon metabolic processes could not be studied because of the patients' unreliability, but it could not have been more than a secondary factor. These patients were utilizing their diabetes as a means of escape either into the shelter of the hospital or through suicide. An attempt has been made to sketch some common features of the immature and poorly integrated personality structure of the patients as a group. The alterations in the therapeutic management

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induced by the study in an effort to forestall the self-destructive tendencies have been outlined. It is recognized that it is hazardous to draw generalizations from this group to apply to diabetics in general, for the problem seems to consist of the difficult task of treating patients who are both diabetic and also either psychotic or borderline psychotic.

4.   Henry, Jules. Anthropology and Psychosomatics. From the anthropologic point of view psychosomatics may be considered an aspect of the study of response systems acquired by homo sapiens during domestication. In contemporary anthropology psychosomatics would fall in the field of “personality and culture,” the newest subject of anthropologic investigation. In studying the somatic correlates of psychic disturbance anthropology has faced and continues to face the following difficulties: 1) Anthropologic expeditions have generally not included physicians. 2) Anthropologists have been strangers to the problems of psychosomatics. 3) In the presence of culture change it is difficult to tell what is “primitive” and what has been induced through contact between native and European culture. 4) It is difficult to obtain large samples and adequate controls. 5) It is impossible to compare specific etiologic factors cross-culturally because these factors are not constants and exist in cultural totalities that generally are radically different one from the other.

In spite of the difficulties cited, combined anthropologic, medical, and biochemical research among non-European cultures would give additional, much needed insight when carried out in large populations and where other conditions make good experimental design possible.

Study of Pilagá Indian culture reveals a number of psychically-related somatic disorders particularly in the areas of speech, hearing, and muscle function. Such study shows also that, in terms of some currently debated psychosomatic theories, the Pilagá Indians are free from certain expected disorders. This points to the importance of more precise definitions of etiologic factors, and the study of cultural totalities—as contrasted with single complexes—if medico-anthropological cooperation is to be fruitful in the field of psychosomatics.

5.   Stevenson, Ian P. and Wolff, Harold G. Life Situations, Emotions, and Bronchial Mucus. In a subject with bronchiectasis it was found that during stressful life situations the bronchial mucus secretion increased markedly, sometimes as much as eightfold, and again diminished when the stress was over.

6.   Ascher, Eduard. Motor Attitudes and Psychotherapy. Case abstracts are reported of a representative group of hospitalized patients who showed striking motor behavior which became modified or remained unchanged in the course of psychiatric treatment. Observations included those made by physicians as well as other hospital personnel and indicated that they were not only more complete, but a much more reliable

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factor in evaluating dynamics and therapeutic progress. A considerable variety of commonly encountered themes were expressed in motor attitudes of which the patient was usually unaware. Relative freedom from restrictive interference was helpful to study the patient in action. the opinion is expressed that careful history taking of motor acts in addition to observing them while the patient is in the hospital should prove to be of considerable aid in a more objective evaluation of therapeutic progress.

7.   Maholick, Leonard T. The Infant in the Adult. A case 47-year-old man with a psychogenic gastrointestinal disorder was presented.

Brief psychotherapy (sixteen interviews) was used with good results. During the course of therapy induced regression was brought about by the use of a baby bottle, and this seemed to be an important factor in helping the patient overcome his emotional disturbance.

(Vol. 11, No. 5)

1.   Marcussen, Robert M. and Wolff, Harold G. A Formulation of the Dynamics of the Migraine Attack.

2.   Stevenson, Ian P., Et Al. Life Situations, Emotions, and Extra systoles.

3.   Gildea, Edwin F. Special Features of Personality Which are Common to Certain Psychosomatic Disorders.

4.   Modell, Arnold H. and Potter, Howard W. Human Figure Drawing of Patients with Arterial Hypertension, Peptic Ulcer, and Bronchial Asthma.

5.   Dunbar, Alvin, Et Al. Atopic Dermatitis.

7.   Seguin, C. Alberto. A Note on the Concept of Cure.

8.   Linn, Louis and Goldman, Irving B. Psychiatric Observations Concerning Rhinoplasty.

1.   Marcussen, Robert M. and Wolff, Harold G. A Formulation of the Dynamics of the Migraine Attack.

1.   In two individuals it possible experimentally to induce psychologic stress which led to the predictable physiologic phenomena of a typical migraine attack. For some time these subjects had been gradually accumulating fatigue, tension, and resentment. When confronted with a situation which produced intense anger and frustration, they developed a typical high-intensity vascular headache. These headaches were interrupted by the administration ergotamine tartrate which abolished the painful vasodilatation.

2.   Decrease in frequency and ultimate cessation of migraine attacks was observed as a man exhibited progressive deterioration due to paresis. The resulting cerebral damage produced personality changes which eliminated

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the need for compulsive behavior which had previously led to his headaches. Similar though less dramatic changes which occur with aging are likewise followed by disappearance of headache.

3.   The migraine attack may be considered one of the phases of an inappropriate protective or adaptive reaction involving cranial circulatory apparatus which is manifest when the subject has reached the limit of his capacity to tolerate tension, frustration, and fatigue.

2.   Stevenson, Ian P. Life Situations, Emotions, and Extrasystoles.

1.   In a group of 12 unselected patients with extrasystoles, the life situation and emotional state of the patient were found to be relevant to the occurrence of the arrhythmias in each patient.

2.   Extrasystoles and associated anxiety were observed in these subjects experimentally during a discussion of topics to which they were known to be sensitive or which had previously been associated with extrasystoles.

3.   The excitability of the heart may be significantly altered by prolonged hyperactivity of the cardiac muscle during anxiety with tachycardia and increased stroke volume. Structurally diseased hearts are less able to stand the strain of such hyper-activity and more readily develop an altered excitabity than do normal hearts. Extrasystoles are therefore particularly common in patients with structural heart disease who exhibit prolonged anxiety and the associated reaction of cardiac mobilization.

4.   The treatment of subjects with extrasystoles should include attention to the life situation and the patient's adjustment to it, not only for its effect on the arrhythmia but in relieving the stress on the heart, of which the extrasystoles are an indication.

3.   Gildea, Edwin F. Special Features of Personality Which are Common to Certain Psychosomatic Disorders. Evidence derived from psychiatric interviews and a consideration of comparative responsiveness of patients to psychotherapy has been assembled to support the hypothesis that certain patterns of personality malfunction are common to specific psychosomatic disorders.

An attempt has been made to indicate some of the behavior patterns which are sufficiently clear cut to be susceptible to rating on the basis of two to three psychiatric interviews, each of approximately one hour duration

The responsiveness of patients to psychotherapy of various kinds also has been utilized in evaluating the nature and intractableness of personality malfunction.

In the future reporting of studies of psychotherapy in patients with psychosomatic disorders, special attention should be paid to these differences in syndromes and to specific personality maladjustments as well as to detailed psychodynamic formulations. In presenting the results of

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psychosomatic studies to our medical colleagues, psychiatrists should be careful in pointing out the types of disorders that are particularly resistive to psychotherapeutic measures and to avoid the past tendency to imply that practically all these cases recover under psychotherapy.

4.   Modell, Arnold H. and Potter, Howard W. Human Figure Drawing of Patients with Arterial Hypertension, Peptic Ulcer, and Bronchial Asthma. In this study, the human figure drawing was used as a projective method in an attempt to further delineate characteristic personality traits and conflict problems of 32 patients with arterial hypertension, peptic ulcer, and bronchial asthma.

Drawings were obtained from ten patients each of the hypertensive, asthmatic, and peptic ulcer groups. The remaining two presented combined syndromes, one with hypertension and bronchial asthma and the other with hypertension and peptic ulcer. In addition, all but three of these patents were interviewed extensively.

The drawings were interpreted in accordance with certain formulations proposed by Machover which have been verified by extensive psychiatric clinical studies.

In spite of the small number of patients in each group, there was a much greater than chance recurrence of certain drawing features. The interpretation of personality based on the Machover drawing test, although tentative, is in close agreement with the observations of other workers who studied patients with similar psychosomatic problems.

Some of the psychopathologic features seen in the drawings occurred in all three disorders to about the same extent. This was especially true of graphically evidenced disturbances in psychosexual organization and of drawing elements indicative of wariness and suspiciousness of the environment.

Other features, such as those indicative of obsessive-compulsive controls and expressions of resentment and hostility, were expressed in characteristic fashion within each group.

5.   Dunbar, Alvin, Et Al. Atopic Dermatitis. This case deals with a single white man who has suffered from atopic dermatitis since infancy. His emotional conflicts are centered about his relationship to a rejecting, dominating, and controlling mother with whom he still lives in a child like relationship. The psychodynamic forces evident in the patient's relationship to his mother are unsatisfied dependency needs and repressed and suppressed hostility. Marked sexual conflicts are another evidence of the patient's psychopathology.

The patient has utilized his chronic dermatitis and scratching to discharge tension associated with his psychologic conflicts. His skin has become “erotized” as an “organ of expression” of hostile, masochistic, and exhibitionistic trends in his personality. Repressed genital sexuality

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has been displaced to the skin with scratching occasionally representing a masturbatory equivalent.

During the interview with the patient it was learned that the longest period his skin had been in remission was when he lived with his grandmother who was more giving and permissive than his mother. There has been a decrease in the patient's anxiety with a concomitant decrease in the skin symptomatology during the course of psychotherapy, which has been primarily relationship therapy with the therapist assuming a permissive and giving role. Patient has gradually been able to openly verbalize hostility to his mother whereas initially the hostility was suppressed and repressed. As his sexual anxiety has diminished he has been able to release sexual tension through genital activity. There have also been recent evidences of strivings for independence on the part of the patient.

6.   Szasz, Thomas S. Factors in the Pathogenesis of Peptic Ulcer.

1.   In a recent paper Mahl suggested that the most important factor in the pathogenesis of peptic ulcer was “chronic anxiety or fear.” The purpose of this paper was to present a critical re-examination of Mahl's findings.

2.   It is concluded that the evidence from the literature on the subject does not warrant the conclusion that “fear” is a significant etiologic factor in peptic ulcer.

3.   Fear and anxiety are terms which cannot be used interchangeably, according to the present author. It was further emphasized that anxiety is a nonspecific and ubiquitous reaction on the part of the organism and that in order to make meaningful psychosomatic correlations, it is not sufficient to refer to an emotional state as being characterized by “anxiety.”

4.   Mahl's experiments were aimed at producing “chronic fear” in dogs. According to our views, these experiments did not produce fear, but instead resulted in a massive disorganization of the animals' behavior. The experimental results are thus explained by regression, the latter being the result of overwhelming stimuli which the dogs could not master in any adaptive manner.

5.   Reference is made to the occurrence of peptic ulcers in animals. The development of this syndrome in young calves prematurely weaned, and the relief of these ulcers by permitting the calves to continue on a milk diet, provides striking evidence for the correctness of the psychoanalytic theory of ulcer formation.

7.   Seguin, C. Alberto. A Note on the Concept of Cure. After a discussion, it is said, a cure can only be declared when all stimuli altering the psychosomatic equilibrium of the organism have been taken into account and the total situation has been favorably modified, thus restoring the equilibrium.

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8.   Linn, Louis and Goldman, Irving B. Psychiatric Observations Concerning Rhinoplasty.

1.   Data are presented based on a psychiatric study of 58 rhinoplasty patients.

2.   With few exceptions the patients who presented themselves for rhinoplasty were ill from a psychiatric point of view. This illness varied from minor neurotic disturbances to overt schizophrenic psychoses.

3.   Along with the basic psychiatric disorder there was present a special group of symptoms which we have designated as the syndrome of the rhinoplasty patient. As a result of an excessive self-consciousness relating to the nose these patients become constricted in their bodily movements, in their dress, in the flow of their attention, in their ability to relate warmly to other human beings, and in their capacity to concentrate on their work.

4.   In the immediate reaction to rhinoplasty the foregoing syndrome is reversed and a period of marked psychiatric improvement occurs. This is a temporary change. It is followed by a period of stabilization during which fundamental changes of a beneficial character may occur in the basic psychiatric disorder.

5.   The theoretical basis for the observed psychologic changes is presented in terms of the body-image concept. The special significance of the nose in the structure of the body-image is discussed.

6.   The psychologic changes following plastic surgery were contrasted with those seen as “magical” effects following other surgical procedures.

7.   Contrary to general opinion, rhinoplasty is not a hazardous procedure from a psychiatric standpoint. The danger of precipitating a psychosis, for example, where none existed before is minimal.

8.   Rhinoplasty is an adjuvant to psychotherapy. Every patient should be told to expect new psychologic problems following rhinoplasty. Every patient should have psychiatric assistance during the period of personality reorganization following rhinoplasty. Many patients will require deep and prolonged psychotherapy in addition to the rhinoplasty to achieve maximal happiness and effectiveness. It is our belief that the psychologic changes initiated by rhinoplasty facilitate psychotherapy.

(Vol. 11, No. 6)

1.   Vaughan, Warren T. Jr., Et Al. Immunity and Schizophrenia.

2.   Gottfried, Sidney P. Serum Protein Fractionation Studies on Schizophrenics.

3.   Maclean, Paul D. Psychosomatic Disease and the Visceral Brain.

4.   Gottschalk, Louis A., Et Al. Handwriting in Rheumatoid Arthritis.

5.   Saul, L. J., Et Al. Psychologic Correlations with the Electroencephalogram.

6.   Sperling, Melitta. The Role of the Mother in Psychosomatic Disorders in Children.

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1.   Vaughan, Warren T., Jr., Et Al. Immunity and Schizophrenia.

1.   A group of 22 male schizophrenic patients and a group of 17 health male control subjects have been given a course of hyperimmunization to pertussis Vaccine.

2.   A statistically significant different (p = .003) exists between the abilities of these two groups to develop high serum antibody titres.

3.   Internal examination of the patient series reveals that duration of hospitalization and blood nitrogen level may in some way be related to this difference. In the patient series there is a slight negative correlation between antibody titre and duration of hospitalization (r = −.34), and a positive correlation between antibody titre and total serum nitrogen (r=+.45).

4.   There is a higher and more significant negative correlation between duration of hospitalization and total serum nitrogen (r = −.58). This suggests a faulty protein metabolism in this group of patients, which may have in some part an exogenous nutritional origin.

5.   We wonder, however, whether we are not witnessing relative defects in protein synthesizing mechanisms which may in some way be related to the general “sluggishness” of the hormonal and metabolic mechanisms commonly found in schizophrenic patients.

2.   Gottfried, Sidney P. Serum Protein Fractionation Studies on Schizophrenics.

1.   Serum protein fractionation studies were performed on young, male schizophrenic patients upon admission and during and after insulin and electric shock treatment.

2.   The mean total protein, albumin, globulin, A/G, and euglobulin values of the schizophrenic patients before treatment agreed closely with those obtained for the normals. Only the mean pseudoglobulin level differed from the normal, being slightly higher.

3.   Insulin treatment exerted no marked effect on the serum proteins, except for the pseudoglobulin which was elevated during coma.

4.   During coma induced by electric shock, a rise of 0.21 to 2.46 Gm. per cent was obtained in the total proteins. Both the albumin and the globulin were elevated in a majority of the cases, the former more so than the latter. The euglobulin was also elevated, but the pseudoglobulin and A/G varied in either direction.

5.   After electric shock treatment had been terminated, the total proteins remained elevated in most of the patients. This time the increase appeared due to the globulin, the albumin dropping almost to the pretreatment level. This rise in the globulin was due to the euglobulin fraction which remained close to the elevated level obtained during coma.

6.   Electric shock differed from insulin shock treatment in that during the coma induced by the former, a rise in the total serum proteins occurred which did not take place in an insulin induced coma. Secondly, electric

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shock therapy produced an elevation in the serum euglobulin which insulin shock therapy did not do.

7.   Views are presented as to whether the increase in euglobulin during electric shock was due to a pituitary-adrenocortical stimulation.

3.   Maclean, Paul D. Psychosomatic Disease and the Visceral Brain. A notable deficiency attendant on psychosomatic theory at the present time is the inability to point to a mechanism of emotion that would account for the variety of ways the effective qualities of experience may act on autonomic centers. The first part of this paper reviews certain neurophysiologic and neuroanatomic evidence now at hand that contributes to the understanding of emotional mechanisms. There are indications that the phylogenetically old brain (classically known as the rhinencephalon and arbitrarily referred to in this paper as the “visceral brain”) is largely concerned with visceral and emotional functions. This region of the brain appears to be so strategically situated as to be able to correlate every form of internal and external perception. In other words, the possibility exists in this region for bringing into association not only oral (smell, taste, mouth) and visceral sensations, but also impressions from the sex organs, body wall, eye, and ear. And in contrast to the neopallium, the rhinencephalon has many and strong connections with the hypothalamus for discharging its impressions.

These relationships and alleged functions of the rhinencephalon have far-reaching implications for psychiatry. For they indicate that though our intellectual functions are carried on in the newest and most highly developed part of the brain, our affective behaviour continues to be dominated by a relatively crude and primitive system. This situation provides a clue to understanding the difference between what we “feel” and what we “know.”

In the remainder of the paper it is suggested how the mechanisms referred to may be related to “oral” and visceral factors that are brought into play in the experience and expression of emotion by the patient with so-called psychosomatic disease.

In view of recent developments in electronics and cybernetics and the light these sciences have shed on neurophysiology, one can no longer be content to think of dynamic psychologic phenomena as existing apart from the restrictions of ordered neural mechanisms.

4.   Gottschalk, Louis A., Et Al. Handwriting in Rheumatoid Arthritis.

1.   Measurements were made of the point pressure and speed of handwriting of 15 rheumatoid arthritics, 15 control patients with other diseases, and 15 control subjects with no disease.

2.   Variations in the frequency, amplitude, and wave-form of the point pressure tracings were markedly more prominent in the records of the two groups of subjects with disease than of the “normal” control subjects.

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3.   No significant differences were found in the average of the highest writing pressure or the average amplitude of pressure changes. No significant differences were found in the frequency of oscillations, except that the patients with diseases other than rheumatoid arthritis wrote significantly slower with forced pressure than the “normal” control subjects.

4.   No quantitative differences could be established at this time between the tracings of patients with rheumatoid arthritis and other patients with symptomatic disease used as controls. The majority of these controls were patients suffering from hypertension (9 out of 15). Further control studies are required to distinguish which disease conditions are reflected in disturbances of neuromuscular performance similar to those noted in the rheumatoid arthritics tested.

5.   Further studies are desirable to establish the relative importance of such variables as age, sex, educational level, and occupation on speed and point pressure and the variations in regularity of point pressure of handwriting.

6.   The specific value of this technique would appear to lie in its simple application of a mechanical means to measure the impairment of expressive muscular performance.

5.   Saul, L. J., Et Al. Psychologic Correlations with the Encephalogram.

1.   Very “passive” individuals have A type EEG's with high alpha indices. “Passive” implies dependence, submissiveness, desires to receive from others, and readiness to retreat from danger, efforts, and responsibility. The associated A type of EEG typically shows a clear regular alpha rhythm (usually between 8.5 and 10.5 per second) on frontal and precentral as well as occipital areas.

2.   Women with strong masculine trends have B type or low-alpha EEG's. With “masculine trends” are included independence, dominance, and a drive to activity and leadership. All of the women in our series with low-alpha EEG's show either strong masculine or very active maternal trends.

3.   Frustrated, demanding, impatient, aggressive, hostile women have the mixed (M, MF, MS) types of EEG. The irregularity of EEG pattern, particularly in the precentral region, is the most distinctive feature separating these types of EEG from A and B. The irregularity depends on the prominence of waves other than the alpha waves. The more overtly hostile, aggressive, impatient, and demanding an individual is, the more likely is her EEG to show very prominent fast-frequency waves and only a small amount of alpha activity. The alpha rhythm is usually faster than average. The more repressed and inhibited are the feelings and manifestations of hostility, impatience, etc., the more likely is the EEG to show (1) less prominent fast frequencies, (2) a high alpha index,

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(3) a slower-than-average alpha rhythm and/or (4) prominent slow (6 to 8 per second) waves.

6.   Sperling, Melitta. The Role of the Mother in Psychosomatic Disorders in Children. From the psychoanalytic study of twenty couples (mothers and children), certain features seem to emerge as characteristic for these mothers of children suffering from various psychosomatic disorders:

1.   The carry-over of an unresolved emotional conflict from childhood and the acting out of this conflict with the child. The child may represent an unconsciously hated sibling or parent.

2.   Projection of part of the mother's own person onto the child.

3.   A need for control over the child, so intense that in some of these cases the child is regarded and treated as if he were a part of the mother's own body (a phenomenon described as appersonation by Otto E. Sperling).

This specific relationship of mutual dependence and (magical) control existing between mother and child, I consider an important predisposing factor in the development of a psychosomatic disorder in a child. I have limited myself in this study to demonstration of this one factor-the child's relationship with the mother-in the genesis of a psychosomatic disorder because, in my cases, the mother was the important person and her neurosis decisive for the reactions of the child. The choice of symptoms, the somatic compliance, and other factors operating in such conditions have not been overlooked but could not be dealt with here.

Treatment of the mother and child as a unit is rewarding practice, both for research and therapy in spite of the technical difficulties.

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Article Citation

(1951). Psychosomatic Medicine. Psychoanal. Rev., 38(3):276-296

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