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Diagnosing Psychosomatic Situations

  • Chase Patterson Kimball

Abstract

Since Franz Alexander (1950) gave prominence to the Holy Seven Psychosomatic Diseases, the field of psychosomatic medicine has come a long way. While Alexander’s emphasis on essential hypertension, thyrotoxicosis, bronchial asthma, rheumatoid arthritis, peptic ulcer, ulcerative colitis, and neurodermatitis may have been inadvertent, it nevertheless established in the minds of several generations of physicians that these were the psychosomatic diseases, while implying that other diseases were not so or less so. Their designation as diseases in which psychological determinants could be identified implied that they could be treated by psychotherapy. Although there are some studies suggesting that some of these diseases at some stages in some individuals in specific circumstances can be ameliorated if not cured with psychodynamically oriented psychotherapy, there has not been overwhelming success with this approach (Karush, Daniels, O’Connor, et al., 1969). Alexander’s work is perhaps more notable in his identification of other factors involved in the precipitation of disease processes. His emphasis on the occurrence of an environmental event proximal to the disease onset has been an invaluable concept for those of us studying and treating disease. It is a hypothesis that motivates much of the research in psychosomatic medicine and psychiatry today (Holmes & Rahe, 1967; Paykel, Prusoff, & Uhlenhuth, 1971). His further suggestion that the environmental event serving to precipitate disease reevokes latent, unresolved conflicts derived from early infantile childhood experience remains an intriguing hypothesis. The idea that the nature of the conflict has specificity for the specific disease process is more difficult to substantiate. Nevertheless, this suggestion has continued to intrigue researchers over the past quarter century (Engel, 1956; Nemiah & Sifneos, 1964).

Keywords

Ulcerative Colitis Essential Hypertension Psychosomatic Medicine Altered State Illness Experience 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Alexander, F. Psychosomatic medicine. New York: Norton, 1950.Google Scholar
  2. Alexander, F., and French, T. M. Studies in psychosomatic medicine. New York: Ronald Press, 1948.Google Scholar
  3. Anthony, E. J. The impact of mental illness on family life. American Journal of Psychiatry, 1970, 127, 138–146.PubMedGoogle Scholar
  4. Bahnson, C. B., and Wardwell, W. I. Parent constellation and psychosexual identification in male patients with myocardial infarction. Psychological Research, 1962, 10, 831–842.Google Scholar
  5. Bridger, W. H. Sensory discrimination and autonomic function in the newborn. Journal of the American Academy of Child Psychiatry, 1962, 1, 67–82.CrossRefGoogle Scholar
  6. Brown, F. Childhood bereavement and subsequent psychiatric disorder. British Journal of Psychiatry, 1966, 112, 1035–1041.PubMedCrossRefGoogle Scholar
  7. Cannon, W. B. Bodily changes in pain, hunger, fear and rage. New York: Appleton, 1920.Google Scholar
  8. Cassell, J., Heyden, S., Bartel, A. G., et al. Incidence of coronary heart disease by ethnic groups, social class and sex. Archives of Internal Medicine, 1971, 128, 901–906.CrossRefGoogle Scholar
  9. Cassem, N. H., and Hackett, T. P. Psychiatric consultation in a coronary care unit. Annals of Intermediate Medicine, 1971, 75, 9–14.Google Scholar
  10. Descartes, R. Les meditations metaphysiques. D. Mouchet, Paris, 1724.Google Scholar
  11. Deutsche, F., Thompson, D., Pinderhughes, C., et al. Body, mind and the sensory gateways. New York: Karger, 1962.Google Scholar
  12. Dunbar, H. F. Emotions and bodily changes: A survey of literature on psychosomatic interrelationships. New York: Columbia University Press, 1954.Google Scholar
  13. Engel, G. L. Studies of ulcerative colitis. IV. The significance of headaches. Psychosomatic Medicine, 1956, 18, 334–346.Google Scholar
  14. Engel, G. L. Psychological development in health and disease. Philadelphia: Saunders, 1962.Google Scholar
  15. Engel, G. L. Anxiety and depression-withdrawal: The primary affects of unpleasure. International Journal of Psychoanalysis, 1962, 43, 89–97.PubMedGoogle Scholar
  16. Engel, G. L. A reconsideration of the role of conversion in somatic disease. Comprehensive Psychiatry, 1968, 9, 316–326.PubMedCrossRefGoogle Scholar
  17. Engel, G. L., and Schmale, A. Psychoanalytic theory of somatic disorder: Conversion, specificity and the disease-onset situation. Journal of the American Psychoanalytic Association, 1967, 15, 344.PubMedCrossRefGoogle Scholar
  18. Erikson, E. Childhood and society ( 2nd ed. ). New York: Norton, 1963.Google Scholar
  19. Feinstein, A. R. Clinical judgment. Baltimore: Williams and Wilkins, 1967.Google Scholar
  20. Freud, S. The justification for detaching from neurosthenia a particular syndrome: The anxiety neurosis (1894). In E. Jones (Ed.), Sigmund Freud: Collected papers. New York: Basic Books, 1959.Google Scholar
  21. Friedman, D. G. Human infancy: An evolutionary perspective. Hillsdale, N.J.: Lawrence Erlbaum Assoc., 1974.Google Scholar
  22. Friedman, M., and Rosenman, R. H. Overt behavior pattern in coronary disease: Detection of overt behavior pattern A in patients with coronary disease by a new psychophysiological procedure. Journal of the American Medical Association, 1960, 173, 1320–1325.PubMedCrossRefGoogle Scholar
  23. Friedman, M., and Rosenman, R. H. Association of specific overt behavior pattern with blood and cardio vascular findings. Journal of the American Medical Association, 1969, 169, 1286–1296.CrossRefGoogle Scholar
  24. Gaddini, R. Transitional objects and the process of individuation: A study in three different social groups. Journal of the American Academy of Child Psychology, 1970, 9, 347–365.CrossRefGoogle Scholar
  25. Gamow, G. Expanding universe and the origin of galaxies. Copenhagen: Munksgaard, 1953.Google Scholar
  26. Gardner, H. The quest for mind. New York: Knopf, 1973.Google Scholar
  27. Garma, A. The unconscious images in the genesis of peptic ulcer. International Journal of Psychoanalysis, 1960, 41, 444.PubMedGoogle Scholar
  28. Gellhorn, E. The tuning of the nervous system: Physiological foundations and implications for behavior. Perspectives in Biology and Medicine, 1967, 10, 559–591.PubMedGoogle Scholar
  29. Greene, W. A., Jr. Psychological factors and reticuloendothelial disease. I. Preliminary observations on a group of males with lymphomas and leukemias. Psychosomatic Medicine, 1954, 16, 220–230.PubMedGoogle Scholar
  30. Greene, W. A., Jr., Young, L. E., and Swisher, S. N. Psychological factors and reticuloendothelial disease. II. Observations on a group of women with lymphomas and leukemias. Psychosomatic Medicine, 1956, 18, 284–303.PubMedGoogle Scholar
  31. Grinker, R. R. Toward a unified theory of human behavior: An introduction to general systems theory ( 2nd ed. ). New York: Basic Books, 1967.Google Scholar
  32. Groddeck, G. The book of the it. New York: New American Library, 1961.Google Scholar
  33. Groen, J. J. Die klinisch-wissenshaftliche Unterschungmethodik in der psychosomatischen Medizin. Verhandlungen der Deutschen Gesellschaft far Inneres Medizin, 1967, 73, 17–27.Google Scholar
  34. Hamburg, D., Hamburg, B., and deGoza, S. Adaptive problems and mechanisms in severely burned patients. Psychiatry, 1953, 16, 1–20.PubMedGoogle Scholar
  35. Harburg, E., Schutt, W. J., Erfurt, J. C., et al. Method for estimating heredity and stress. I. A pilot study of blood pressure among Negroes in high and low stress areas, Detroit, 1966–67. Journal of Chronic Diseases, 1970, 22, 69–81.CrossRefGoogle Scholar
  36. Hinkle, L. E., Whitney, L. H., Hehman, E. W., et al. Occupation, education, and coronary artery disease. Science, 1968, 161, 238–246.PubMedCrossRefGoogle Scholar
  37. Holmes, T. H., and Rahe, R. H. The social readjustment rating scale. Journal of Psychosomatic Research, 1967, 11, 213–218.PubMedCrossRefGoogle Scholar
  38. Jackson, D., Yalom, I. Family research in the problem of ulcerative colitis. Archives of General Psychiatry, 1966, 15, 410–418.PubMedCrossRefGoogle Scholar
  39. James, W. What is an emotion? Mind, 1884.Google Scholar
  40. Janis, I. L. Psychological stress: Psychoanalytic and behavioral studies of surgical patients. New York: Wiley, 1958.CrossRefGoogle Scholar
  41. Kahn, R. L., Goldfarb, A. I., Pollack, M., and Peck, A. Brief objective measures for the determination of mental status in the aged. American Journal of Psychiatry, 1960, 177, 326–328.Google Scholar
  42. Karush, A., Daniels, G. E., O’Connor, J. F., et al. The response to psychotherapy in chronic ulcerative colitis. Il. Factors arising from the therapeutic situation. Psychosomatic Medicine, 1969, 31, 201–226.PubMedGoogle Scholar
  43. Kasl, S. V., Cobb, S. Blood pressure changes in men undergoing job loss. Psychosomatic Medicine, 1970, 32, 19–38.PubMedGoogle Scholar
  44. Kellam, S., Branch, J. D., Agrawal, K. C., and Ensminger, M. Mental health and going to school. Chicago: University of Chicago Press, 1975.Google Scholar
  45. Kimball, C. P. Psychological responses to the experience of open-heart surgery. I. American Journal of Psychiatry, 1969, 126, 348–359.PubMedGoogle Scholar
  46. Kimball, C. P. Techniques of interviewing. I. Interviewing and the meaning of the symptom. Annals of Internal Medicine, 1969, 71, 147–153. (b)PubMedGoogle Scholar
  47. Kimball, C. P. Techniques of interviewing. III. The patient’s personality and the interview process. Medical Insight, 1972, 4, 26–40.Google Scholar
  48. Kimball, C. P. A liaison department of psychiatry. Psychotherapy and Psychosomatics, 1973, 22, 219–225.PubMedCrossRefGoogle Scholar
  49. Kimball, C. P. The experience of cardiac surgery. V. Psychological patterns and prediction of outcome. Psychotherapy and Psychosomatics, 1973, 22, 310–319.PubMedCrossRefGoogle Scholar
  50. Kimball, C. P. Delirium. In Howard F. Conn (Ed.), Current therapy 1974, 1974, 833–835.Google Scholar
  51. Kimball, C. P. Medical psychotherapy. Psychotherapy and Psychosomatics, 1975, 25, 193–200.PubMedCrossRefGoogle Scholar
  52. Kimball, C. P. The ethics of a personal medicine. Medical Clinics of North America, 1977, 61, 867–877.PubMedGoogle Scholar
  53. Kimball, C. P. Psychosomatic theory and its contribution to chronic illness. In G. Usdin (Ed.), Psychiatric medicine. New York: Brunner/Mazel, 1977, pp. 259–333.Google Scholar
  54. Kimball, C. P. The languages of psychosomatic medicine. Psychotherapy and Psychosomatics. 1977, 28, 1–12.PubMedCrossRefGoogle Scholar
  55. Kimball, C. P. Teaching and training of psychosomatic approach: The education of the medical student. Presented at the World Psychiatric Society, Honolulu, Hawaii, August 29, 1977. (d) (in press)Google Scholar
  56. Klein, R. F., Kliner, V. A., Zipes, D. P., et al. Transfer from a coronary care unit. Archives of Internal Medicine, 1968, 122, 104–108.PubMedCrossRefGoogle Scholar
  57. Koch, R. Die Aetiologie der tuberkulose physiologischen Gesellschaft Berlin 24 Marz cr gehaltenen Vortrage. Berlin, A. Hirschwald, 1882.Google Scholar
  58. Kohlberg, L. A cognitive-developmental approach to moral education. The Humanist, 1972, Nov./ Dec., 13–16.Google Scholar
  59. Kokkedee, J. The quark model. New York: Benjamin, 1969.Google Scholar
  60. Kuller, L., and Reisler, D. M. An explanation for variations in distribution of stroke and arteriosclerotic heart disease among populations and racial groups. American Journal of Epidemiology, 1971, 93, 1–9.PubMedGoogle Scholar
  61. Levine, R. A. Culture, behavior and personality. Chicago: Aldine, 1973.Google Scholar
  62. Lindemann, E. Symptomatology and management of acute grief. American Journal of Psychiatry, 1944, 101, 141–148.Google Scholar
  63. Manusco, T. F., Coulter, E. J., and MacDonald, E. J. Migration and cancer mortality experience—a study of native and southern born non-white Ohio residents. In D. D. Hemphill (Ed.), Trace substances in environmental health. VI. A symposium. Columbia. University of Missouri, 1973.Google Scholar
  64. Marty, P., and d’Muzan, M. La pensée operatoire. Revue Francaise de Psychoanalysis, 1963, Suppl. 1345, Vol. 27.Google Scholar
  65. McGough, J. L. Psychobiology: Behavior from a biological perspective. New York: Academic Press, 1971.Google Scholar
  66. McIntyre, J. S. St. Anselm and his critics: A reinterpretation of the Cur Deus Homo. Edinburgh: Oliver and Boyd, 1954.Google Scholar
  67. Mechanic, D. The concept of illness behavior. Journal of Chronic Diseases, 1962, 15, 189–194.PubMedCrossRefGoogle Scholar
  68. Miller, G., and DiCara, L. Learning of visceral and glandular responses. Science, 1969, 163, 434–445.PubMedCrossRefGoogle Scholar
  69. Minuchin, S., Baker, L., Rosman, B., Liebman, R., Milman, L., and Todd, T. A conceptual model of psy chosomatic illness in children. Archives of General Psychiatry, 1975, 32, 1031–1038.PubMedCrossRefGoogle Scholar
  70. Mirsky, I. A. Physiologic, psychologic and social determinants in the etiology of duodenal ulcer. American Journal of Digestive Diseases, 1958, 3, 285–314.PubMedCrossRefGoogle Scholar
  71. Nemiah, J., Sifneos, P. Final report on NIMH Project No. M-262(c). A study of the specificity of current psychological factors involved in the production of psychosomatic disease, each suffering from two psychosomatic illnesses, 1964.Google Scholar
  72. Nemiah, J., and Sifneos, P. Affect and fantasy in patients with psychosomatic disorders. In Hill (Ed.), Modern trends in psychosomatic medicine. II. London. Butterworth, 1970, pp. 26–34.Google Scholar
  73. Olin, H. S., and Hackett, T. P. The denial of chest pain in 32 patients with acute myocardial infarction. Journal of the American Medical Association, 1964, 190, 977–981.PubMedCrossRefGoogle Scholar
  74. Parsons, T. The social system. Glencoe, Ill.: Free Press, 1951.Google Scholar
  75. Pavlov, I. P. Conditioned reflexes (trans. by G. V. Anrep ). London: Oxford University Press, 1927.Google Scholar
  76. Paykel, E. S., Prusoff, B. A., and Uhlenhuth, E. H. Scaling of life events. Archives of General Psychiatry, 1971, 25, 340–347.PubMedCrossRefGoogle Scholar
  77. Potter, van R. Bioethics: Bridge to the future. Englewood Cliffs, N.J.: Prentice-Hall, 1971.Google Scholar
  78. Pratt, J. H. The “home sanatorium” treatment of consumption. Boston Medical and Surgical Journal, 1906, 154, 210–216.CrossRefGoogle Scholar
  79. Rahe, R. H. Stress and strain in coronary heart disease. Journal of the South Carolina Medical Association (Supplement), 1976, 72, 7–14.Google Scholar
  80. Reiser, M. Theoretical considerations of the role of psychological factors in pathogenesis and etiology of essential hypertension. In M. Koster, H. Musaph, and P. Visser (Eds.), Psychosomatics in Essential Hypertension. Bibliotheca Psychiatrica, 1970, 144, 117–124.Google Scholar
  81. Ruesch, J. The infantile personality. Psychosomatic Medicine, 1948, 10, 134–144.PubMedGoogle Scholar
  82. Sapira, J. D., Scheilp, R., Monaity, B., et al. Differences in perception between hypertensive and normotensive populations. Psychosomatic Medicine, 1971 33, 239–250.PubMedGoogle Scholar
  83. Selye, H. The stress of life. New York: McGraw-Hill, 1956, pp. 128–148.Google Scholar
  84. Selzer, H. S., Fajans, S., and Conn, J. W. Diabetes, 1956, 5, 437.Google Scholar
  85. Seubert, K. Das naturliche System der chemischen Elemente (Abhandlungen von Lothar Meyer and D. Mendeleev). Leipzig: W. Engelman, 1895.Google Scholar
  86. Shekelle, R. B., Ostfeld, A. M., and Paul, O. Social status and incidence of coronary artery disease. Journal of Chronic Diseases, 1969, 22, 381–394.PubMedCrossRefGoogle Scholar
  87. Sifneos, P. E. Two different kinds of psychotherapy of short duration. American Journal of Psychiatry, 123, 1069–1074, 1967.PubMedGoogle Scholar
  88. Sifneos, P. E. A reconsideration of psychosomatic symptom formations in view of recent clinical observations. Psychotherapy and Psychosomatics, 1974, 24, 151–155.PubMedCrossRefGoogle Scholar
  89. Skinner, B. F. Operant behavior. American Journal of Psychology, 1963, 18, 503–515.CrossRefGoogle Scholar
  90. Thomas, C. B., and Greenstreet, R. L. Psychobiological characteristics in youth as predictors of five disease states: Suicide, mental illness, hypertension, coronary heart disease and tumor. Johns Hopkins Medical Journal, 1973, 132, 16–43.PubMedGoogle Scholar
  91. Uhlenhuth, E. H., and Paykel, E. S. Symptom intensity and life events. Archives of General Psychiatry, 1973, 28, 473–477.PubMedCrossRefGoogle Scholar
  92. Visotsky, H. M., Hamburg, D. A., Goss, M. E., and Lebovits, B. Coping behavior under extreme stress. Archives of General Psychiatry, 1961, 5, 27–52.CrossRefGoogle Scholar
  93. Voth, M. M., Holzman, P. S., Katz, J. B., et al. Thyroid “hot spots”: Their relationships to life stress. Psychosomatic Medicine, 1970, 32, 561–568.PubMedGoogle Scholar
  94. Weiner, H., Thaler, M., Reiser, M. F., et al. Etiology of duodenal ulcer. Psychosomatic Medicine, 1957, 19, 1–10.PubMedGoogle Scholar
  95. Williams, R. B., Jr., Kimball, C. P., and Willard, H. N. The influence of interpersonal interaction upon diastolic blood pressure. Psychosomatic Medicine, 1972, 32, 194–198.Google Scholar
  96. Wilson, E. Sociobiology: The new synthesis. Cambridge, Mass.: Harvard University Press, 1975.Google Scholar

Copyright information

© Plenum Press, New York 1978

Authors and Affiliations

  • Chase Patterson Kimball
    • 1
  1. 1.Department of PsychiatryUniversity of ChicagoChicagoUSA

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