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Psychosomatic Medicine The Clinical Application Of Psychopathology To General Medical Problems SeconPDF电子书下载

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作者：
出版社：W.B.Saunders Commpanhy
出版年份：1949
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页数：803 页

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《Psychosomatic Medicine The Clinical Application Of Psychopathology To General Medical Problems Secon》目录

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PART Ⅰ GENERAL ASPECTS OF PSYCHOSOMATIC MEDICINE 1

CHAPTER Ⅰ PSYCHOSOMATIC MEDICINE 3

Psychosomatic Problems in the Practice of Medicine 4

The Present Management of Psychosomatic Problems 5

The Illness is＂Functional＂ 5

Suspicion of Physical Disease 6

Pathologic Curiosities 7

The Organic Tradition in Medicine 7

Diagnostic Problems in Psychosomatic Medicine 8

The＂Either-Or＂Concept 9

Functional and Organic 11

The Nature of Emotional Problems 12

Psychosomatic Study in Illness 12

Organ Language 14

Sexual Factors 15

Psychotherapy 16

What is Psychotherapy？ 16

Major and Minor Psychotherapy 17

Cost of Psychotherapy 18

Emotional Illness and Public Health 18

Summary 19

CHAPTER Ⅱ PERSONALITY DEVELOPMENT AND PSYCHOPATHOLOGY 21

Personality Development 21

Psychopathology Established Early in Life 22

Anxiety 22

The Compulsive Personality 27

Organ Language 28

Sexuality 29

Formation of a Phobia 32

Other Manifestations of Anxiety 32

The Hysterical Personality 32

The Normal Personality 33

Capacity for Love 34

Adolescence 35

Psychopathology 37

Neurasthenia 37

Hysteria 38

Obsessional and Compulsion Neurosis 41

Mental Elation and Depression (Manic-Depressive Personality) 43

Schizophrenia 44

Paranoia 45

Differential Diagnosis 46

Psychopathology of Psychosomatic Disorders 47

Physiological Responses to Emotions 47

Relation to Illness 49

The Adaptation Syndrome 50

Organ Neurosis 51

Specificity 51

Personality Trends 52

The Lessons of Military Experience 53

Incidence of Psychosomatic Reactions 54

The Concept of Maturity 56

Summary 58

CHAPTER Ⅲ PSYCHOSOMATIC DIAGNOSIS 59

The Psychosomatic Point of View 60

Postulates for Psychosomatic Diagnosis 62

Halliday＇s Six-Point Formula 64

Some Background Factors 68

Organ Neurosis 68

Pseudoheredity 70

Emotional Age 70

History Taking 71

Physician＇s Qualifications 71

The Social Worker and Psychosomatic Diagnosis 71

Criticism of Clinical Records 72

The Person in the Patient 74

Chronologic Development of the Life History 77

Explaining＂Body Language＂to Patients 77

The Case Illustration 78

The Autobiography 78

The Associative Anamnesis 79

Definitive Psychosomatic Diagnosis 79

Correlation of Life Situation and Symptom Formation 80

The System Review 82

The Past Medical History 89

Family History 97

The Summing Up 98

Diagnostic Aids 98

Casual Remarks 98

The Patient＇s Ideas of the Illness 99

Dreams as Diagnostic Aids 100

Psychological Testing 101

The Forces which Favor Psychotherapy 106

Importance of Physical Examination 108

Evaluation of the Findings 108

CHAPTER Ⅳ TREATMENT－GENERAL PRINCIPLES OF PSYCHOTHERAPY 109

Emotional Growth is Painful 109

Emphasis on Organic Disease 111

The Personality of the Physician 111

Preparation for Psychotherapy 112

The Physician as Educator 113

Presentation of the Problem of Psychosomatic Illness to the Patient 114

The Conversion of Emotion 114

Discussion of Personality Disorders 115

The Severity of the Neuroses 115

Transference 116

Psychopathic Personality 116

Conversion Hysteria 117

Neurasthenia 118

Looking for Satisfaction 119

The Meaning of Symptoms 119

Anxiety Hysteria 120

Compulsion Neuroses 122

What Precipitates a Neurosis？ 125

Period of Life 125

The Single Woman 125

The Married Woman 126

Relatives 126

Career 126

Menopause 126

Neurosis in Men 126

The Subtlety of the Onset of Neurosis 127

Manic-Depressive Psychoses 127

Depressive Phase 127

Differential Diagnosis 128

Suicide 129

Convulsive Therapy (Shock Therapy) 129

Childhood Background 129

Personality Structure 130

Treatment 130

Schizophrenia 131

Hypochondriacal Phase 132

Treatment 132

Psychopathic Personality 133

Direct Expression of Hostility 134

Surface Friendliness 134

Clinical Considerations 135

Ascetics and Eccentrics 136

Neurotic Characters Who Cannot Stand Success 136

Narcissistic Characters 136

Alcohol and Drug Addicts 136

Neurotic Criminals 137

Character Disturbances in Parents 137

Transference 139

Repetition of Child-Parent Relationship 139

Ambivalence 140

Dynamic Factors in Psychotherapy 141

Case Illustrating Transference 141

National Health Problems and Psychosomatic Illness 143

＂Fixing＂the Neurosis 143

The Orthodox Approach to Psychosomatic Problems 143

The Physician as a Pathogenic Agent 144

The Cost of Psychotherapy 144

The Cost of＂No Psychotherapy＂ 145

The Role of the General Physician 145

General Principles of Management 146

The Role of the Social Worker 147

The Psychosomatic Concept in Social Case Work 147

Cooperation of Physician and Social Worker 148

Practical Suggestions 149

Social Work as a Career 150

CHAPTER Ⅴ TREATMENT－＂NORMAL＂PROBLEMS IN PSYCHOTHERAPY 151

Problems of Growth and Adjustment 151

Feeding Problems 152

The Importance of Nursing 152

Treatment 153

Thumb Sucking 154

Bowel and Bladder Training 155

Management 155

Enuresis 156

Treatment 156

Tantrums 157

Treatment 157

Sexuality of Childhood 158

Genital Differences 158

Infantile Masturbation 159

Nightmares 160

Treatment 160

Other＂Normal＂Problems of Childhood 161

Adolescence 161

Masturbation in Adolescence 162

Prestige 162

Emancipation from Parents 163

Struggle with Religious and Ethical Concepts 164

Codes for Sexual Behavior 164

The Necessity for Cautious Management 165

Parents＇ Concern over Adolescents 165

Work Adjustment 166

Counseling in Industry 168

Courtship and Engagement 170

Emotional Immaturity 170

Marital Adjustments 171

Incompatibility 172

Hostility in Marriage Relationship 172

Marriage for＂Therapeutic＂Reasons 173

Education in Marriage 174

The Sexual Relationship in Marriage 175

Divorce 176

Research on Divorce 176

Marriage Counseling 177

Psychotherapy 179

Parenthood 180

Emotional Background for Invalidism 180

The Father as a Contributor to the Child＇s Emotional Growth 181

Education 181

Convalescence after Illness or Operation 182

Unconscious Wish to Remain Ill 182

The Authority of the Physician 183

Psychology of Pregnancy and Parturition 184

Vomiting of Pregnancy 184

Pseudocyesis 185

Delivery and Convalescence after Delivery 185

Failure in Accomplishment 186

Acknowledging Frustration 187

Psychosomatic Problems of Aging 187

The Role of Chronic Disease 188

Old Age and Industry 190

Mental Changes in Old Age 190

Treatment 191

CHAPTER Ⅵ TREATMENT－SPECIAL PSYCHOTHERAPEUTIC PROCEDURES 193

Resistance to Treatment 193

Suppressive Therapy 194

Terrorism 194

Placebos 194

Rest 195

Suggestion and Persuasion 196

Hypnosis 196

Religious Assurances 198

Expressive Therapy 198

Psychoanalysis 198

Hypnoanalysis 205

Transference and the Physician 205

Mental Catharsis 206

Psychiatric Counsel 207

Group Psychotherapy 213

Technic 214

Group Psychotherapy as a Community Experiment 215

CHAPTER Ⅶ TRAINING IN PSYCHOSOMATIC MEDICINE 217

Ward Round Instruction 217

The Psychosomatic Approach in Teaching 219

Further Training in Psychosomatic Medicine 224

The Specialist 224

The General Physician 225

PART Ⅱ．SPECIAL APPLICATIONS TO GENERAL MEDICINE AND THE SPECIALTIES 227

CHAPTER Ⅷ THE CARDIOVASCULAR SYSTEM 229

Anxiety and the Heart 229

Anxiety and the Normal Heart (Cardiac Neurosis) 230

Precipitating Factors 230

Symptoms 231

Treatment 240

Practical Suggestions 245

Case 1．Cardiac Neurosis 246

Case 2．Cardiac Neurosis 247

Low Blood Pressure (Hypotension) 250

＂Neurocirculatory Asthenia＂ 250

Incidence in Military Service 251

Clinical Picture 251

The Development of the Syndrome 252

＂Neurocirculatory Asthenia＂in Civil Life 252

Differential Diagnosis 256

Treatment 259

Case 3．Neurocirculatory Asthenia 262

Case 4．Neurocirculatory Asthenia 265

CHAPTER Ⅸ THE CARDIOVASCULAR SYSTEM－EMOTIONAL FACTORS IN ORGANIC HEART DISEASE 273

Importance of Emotional Factor 273

Evaluating the Emotional Factor 274

Problems of Coronary Occlusion 275

Psychosis in Cardiac Disease 276

Case 5．Congenital Heart Disease and Anxiety Neurosis 277

Case 6．Mitral Stenosis and Anxiety Neurosis 281

Case 7．Coronary Occlusion 285

Case 8．Coronary Occlusion Preceded by Psychic Trauma 288

Case 9．Cardiac Neurosis with Bundle Branch Block 291

Case 10．Hypertensive-Arteriosclerotic Disease 293

Case 11．Somatic Disease (Gastrointestinal and Cardiovascular) 300

CHAPTER Ⅹ THE CARDIOVASCULAR SYSTEM－ESSENTIAL HYPERTENSION 303

Importance of Hypertension 304

Pathogenesis 304

Psyche and Hypertension 305

Experimental Observations 306

Summary of Pathogenesis 307

Clinical Picture 309

The Problem in Medical Practice 309

Psychosomatic Symptoms 310

Treatment 313

Psychosomatic Aspects of Treatment 314

Personality Studies 315

Hostility and Aggression 316

Psychosomatic Observations 316

On＂Bringing the Blood Pressure Down＂ 318

Redefining Objectives 318

Some Practical Points 318

Conclusions 320

Case 12．Early Essential Hypertension．Recurrent Attacks of Acute Hypertension with Hypertensive Encephalopathy 321

Case 13．Hypertension and Anxiety 327

Case 14．Moderately Advanced Hypertensive-Vascular Disease 330

Case 15．Advanced Hypertensive-Vascular Disease 334

Case 16．Hypertension and Anxiety 336

Case 17．Hypertension and Anxiety－Hypertensive Encephalopathy 344

Case 18．Hypertension and Anxiety－Spontaneous Subarachnoid Hemorrhage 347

CHAPTER Ⅺ THE GASTROINTESTINAL SYSTEM 351

Functional Digestive Disturbances 351

False Sense of Accuracy 351

Organic Treatment 352

Organ Language 352

Emotional Trends 353

Gastric Problems 353

Bowel Problems 354

Incidence of Functional Disturbances of the Gastrointestinal Tract 355

Chronic Dyspepsia 356

Psychosomatic Study 358

The Approach to a Digestive Problem 359

The Clinical Picture of Gastric Dysfunction 361

Case 19．Constipation 362

Case 20．＂Nervous Indigestion＂ 364

Case 21．Syphilis of the Central Nervous System Thought to be＂Nervous Indigestion＂ 367

Nervous Vomiting 369

Case 22．Nervous Vomiting 369

Mental Depression with Digestive Symptoms 372

Case 23．Two Attacks of Mild Depression with Digestive Symptoms 372

Case 24．Castrointestinal Symptoms；Character Problem．Unsuitable for Psychotherapy 374

Case 25．Pain Right Lower Quadrant；Extreme Fatigue；Low Fever of Obscure Origin 377

CHAPTER Ⅻ THE GASTROINTESTINAL SYSTEM (Continued) 383

Chronic Appendicitis 383

Chronic Invalidism 383

Significance of Acute Attack 384

Case 26．＂Chronic Appendicitis＂ 385

Case 27．The Chronic Gastrointestinal Invalid 395

Case 28．Mental Depression 402

Case 29．Chronic Dyspepsia 407

Case 30．Mucous Colitis (＂Irritable Colon＂) 412

Ulcerative Colitis 417

Emotional Factors 417

Personality Study 418

Dependency 418

Relation to Psychosis 419

Bereavement as Precipitation Factor 419

Combined Therapy 420

Physical and Emotional Immaturity 420

Case 31．Ulcerative Colitis 421

CHAPTER ⅩⅢ THE GASTROINTESTINAL SYSTEM (Concluded) 424

Cardiospasm 424

Prevailing Ideas of Etiology 424

Personality Study 424

The Specific Psychic Situation 425

Psychosomatic Approach 425

Case 32．Cardiospasm 426

Anorexia Nervosa 428

Case 33．Anorexia Nervosa 428

Peptic Ulcer 433

Prevailing Views 433

Theories of Etiology 434

Clinical Observations 435

Experimental Observations 435

Conscious Emotional Factors 436

Unconscious Mental Forces in the Etiology of Peptic Ulcer 438

Case 34．Duodenal Ulcer 440

Case 35．Duodenal Ulcer 442

Summary of Case Material 445

Conflict over Marriage 446

Relation of Psychic Forces of Ulcer Formation 446

Principles of Psychotherapy in Ulcer Patients 446

CHAPTER ⅩⅣ ENDOCRINE SYSTEM AND METABOLISM 449

The Emotional Life and Ovarian Function 450

Scientific Psychosomatic Study 451

The Menopausal Syndrome 453

The Menopause and the Climacteric 453

Estrogenic Treatment 454

Suggestion from Treatment 455

Previous Personality Disturbances 456

Need for Further Study 456

Case 36．Psychic Factors in the Menopausal Syndrome 457

Waiting Too Long for Help 459

The Male Climacteric 460

All Ill-defined Syndrome 460

Need for Psychotherapy 462

A Period of Adjustment 463

Seeking Quick Cure 463

Psychosomatic Observations 464

Case 37．The Male Climacteric？ 465

Preadolescent Hypogonadism 465

Puberty 467

Case 38．Masturbation Problem in an Adolescent 468

Chronic Masturbation 470

Nightmares 470

Anxiety Develops Early 471

Case 39．Anxiety State of Puberty 471

CHAPTER ⅩⅤ ENDOCRINE SYSTEM AND METABOLISM (Continued) 473

The Relation of Disorders of the Thyroid Gland to the Emotions 473

Preceding Emotional Disturbances 473

Psychosomatic Observations 474

Psychological Invalidism in Thyroidectomized Patients 476

Case 40．Hyperthyroidism 477

Case 41．Nodular Goiter with Anxiety Symptoms 478

Case 42．Nodular Goiter；Thyroidectomy；Neurasthenia 486

Case 43．Early Schizophrenia (？)；Anxiety Attacks 491

Case 44．Neurotic Invalidism－Neurasthenia Following Childbirth 496

Addison＇s Disease and the Adrenal Syndrome 505

＂Low Blood Pressure＂ 505

Chronic Fatigue 505

Case 45．Neurasthenia with Somatic Disease 506

CHAPTER ⅩⅥ ENDOCRINE SYSTEM AND METABOLISM (Concluded) 511

Anorexia Nervosa 511

Simmonds＇ Disease 511

Differential Features 512

Functional Pituitary Depression 512

Psychic Traits 512

Clinical Findings 513

Principles of Treatment 513

Case 46．Anorexia Nervosa 514

Diabetes Mellitus 521

History 522

Emotional Factors 522

Expereimental Studies 523

Personality Studies 523

Psychologic Problems in Children 528

Psychotherapy 529

Case 47．Diabetes Mellitus 531

Spontaneous Hypoglycemia (Hyperinsulinism) 534

Psychic Manifestations 535

Case 48．Diabetes with Anxiety Attacks，Thought to be Hypoglycemia 535

Case 49．Functional Hypoglycemia 536

Obesity 539

Intake of Food 539

Personality Studies 541

Psychological Aspects of the Treatment of Obesity 542

Case 50．Obesity and Reduction Problem 545

CHAPTER ⅩⅦ THE GENITO-URINARY SYSTEM AND THE SEXUAL FUNCTION 552

Instinctual Forces 552

Genital Functioning 553

Education in Sexuality 553

Frigidity and Impotence 554

Thwarted Sexual Development 554

Marriage and the Sexual Function 554

Psychosomatic Background of Impotence and Frigidity 555

Orgastic Pleasure 556

Causes of Frigidity and Impotence 560

The＂Clumsy Male＂ 562

Hostility Toward the Partner 562

Conflicting Loves (Usually Unconscious) 564

Psychosomatic Problems of Frigidity 566

The Abuse of Surgery 566

Emotions and Menstruation 567

Menstrual Taboos 568

Anxiety and Superstition 568

Childhood Fantasies 569

Effect on Children 569

Hostility 570

Dysmenorrhea 570

Clinical Aspects 570

A General Problem 571

Psychological Study 571

Nature of Sexual Fantasies 572

Premenstrual Tension 572

Case 51．Premenstrual Tension 573

Amenorrhea 574

Unconscious Influences 575

Leukorrhea 575

Psychological Factors 576

Functional Urinary Disturbances 576

A Substitute for Sexual Activity 577

Aggressive Component 577

Lack of Emotional Control 577

CHAPTER ⅩⅧ THE GENITO-URINARY SYSTEM AND THE SEXUAL FUNCTION (Concluded) 579

Treatment 579

Disturbances of Sexual Functioning 579

Eliciting History 579

Physician＇s Attitudes 580

Contraception 581

The Fallacy of Pregnancy as a Cure for Neurosis 584

Reeducation 584

Psychological Factors in Urological Disorders 587

Dysmenorrhea 589

Case 52．Dysmenorrhea 589

Case 53．Frigidity in a Patient without Deep Conflicts 591

Case 54．Frigidity with Severe Neurosis，Demanding Longer Therapy 593

Case 55．Impotence 595

Case 56．Impotence 597

Case 57．Premature Ejaculation 600

Case 58．Premature Ejaculation，Needing More Intensive Therapy 601

CHAPTER ⅩⅨ THE RESPIRATORY SYSTEM 603

The Effect of Emotions on Breathing 603

Analogy to Gastrointestinal Tract 603

Neurosis and Respiratory Tracings 604

Sighing Respirations in Anxiety States 605

Physiological Mechanisms 606

Functional Respiratory Disorders 607

Case 59．Neurotic Dyspnea 607

Case 60．Anxiety Attacks；Hyperventilation 610

Emotional Factors in Common Colds 612