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
More Complex Psychological Problems 613
Anxiety and Depression 614
＂Feeding to Cold＂ 614
Relation to allergy 614
Emotional Factors in Pulmonary Tuberculosis 615
High Incidence of Neurosis 615
Personality Study 616
Social Work and Tuberculosis 617
Case 61．Tuberculophobia－Healed Tuberculosis 618
Case 62．Tuberculophobia－Fatigue and Slight Fever 625
CHAPTER ⅩⅩ THE RESPIRATORY SYSTEM (Concluded) 627
Bronchial Asthma 627
Diagnosis 627
Etiology 627
Emotional Factors in Bronchial Asthma 628
Personality Structure of Children Suffering from Asthma 629
The Site of Selection for Organ Neuroses 631
Parent-Child Relations 632
Further Psychoanalytic Observations 632
Summary 634
Case 63．Asthma 635
Case 64．Bronchial Asthma 640
CHAPTER ⅩⅪ THE CENTRAL NERVOUS SYSTEM 645
Insomnia 645
Insomnia and Anxiety 645
Insomnia Not an Isolated Symptom 646
Treatment 646
Case 65．Insomnia 647
Weakness and Faintness 649
Significance of the Symptoms 649
The Mechanism of Syncope 650
Vasodepressor Syncope 650
Hysterical Fainting 651
Case 66．Hysterical Fainting 651
Case 67．Weakness and Fainting 652
Headache 653
Etiology 654
Mechanism of Headache 656
Intracranial Pressure 657
Arterial Pulsation 657
Muscular Contractions 657
Character of Pain 658
Diagnostic Test 658
Case 68．Headache of Emotional Origin 661
Migraine 663
Clinical Features 664
Mechanism 664
Personality Features 665
Emotional Immaturity 665
Relation to Hypertension 666
Psychoanalytic Observations 666
Rorschach Tests 667
Medical Observations 667
Case 69．Migraine；Thought to Be Allergic；Good Response to Psychotherapy 668
Case 70．Migraine；Childhood Asthma；Psychological Conflict in Regard to Mother 670
Epilepsy 672
Predisposition 673
Treatment 673
Marriage in Epilepsy 674
Heredity 675
Case 71．Epilepsy 676
Delirium 677
Symptoms 678
Electroencephalographic Study 678
Treatment 678
Organic Brain Disease Simulating Neurosis 679
Case 72．Brain Tumor and Functional Symptoms 679
Case 73．Organic and Psychic Disease Coexisting 685
CHAPTER ⅩⅫ EAR AND EYE 688
Psychosomatic Aspects of Ear Disorders 688
Vertigo 688
Case 74．Vertigo 689
Case 75．Vertigo 697
Ocular and Visual Disturbances 698
Anxiety and the Eyes 698
Asthenopia 699
Night-blindness 699
Miners＇ Nystagmus 700
Central Angiospastic Retinopathy 700
Glaucoma 701
Treatment 702
CHAPTER ⅩⅩⅢ SKIN DISORDER AND ALLERGIES 704
Psychosomatic Aspects of Skin Disorders 704
Attitude of Dermatologists 704
Concepts of Multiple Causation 704
Neurodermatitis 705
Case 76．Neurodermatitis；Good Response to Psychotherapy 708
Case 77．Severe Acne－Improvement with Psychotherapy 710
Urticaria 712
Pruritus 712
Pruritus Ani 713
Hostility and Skin Disorders 713
Necessity for Psychotherapy 714
The Relations Between Emotion and Allergy 715
The Psychosomatic Point of View 716
The Common Cold 716
Hay Fever 717
Asthma 719
Urticaria 719
Exhibitionism 719
General Theory 719
The Child＇s Longing for the Parent 720
Personality Trends 721
Cooperative Therapy 723
Conclusions 723
CHAPTER ⅩⅪⅤ DENTISTRY，ARTHRITIS AND ORTHOPEDIC PROBLEMS 725
Psychosomatic Aspects of Dentistry 725
Dental Problems of Childhood 725
Thumb-Sucking 726
Relation of Dentistry to Emotional Aspects of Surgery 726
Psychologic Preparation for Surgical Operations 728
Atypical Neuralgia 729
Personality Structure 729
Chronic Arthritis 731
Focal Infection 732
Polypharmacy 732
Social Implications of Chronic Arthritis 734
Clinical features 734
Sociological Factors 735
The Social Worker and Arthritis 737
Emotional Factors 738
Personality Studies 738
Rorschach Studies 739
Summary 740
Osteoarthritis 740
Nonarthritic Rheumatism (＂Fibrositis＂) 741
Clinical Findings 741
Psychological Symptoms 741
Psychodynmaics 742
Previous Studies 742
Orthopedic Problems 743
The Low Back Problem 744
Intractable Pain Syndromes 746
The Accident Habit 748
Case 78．A Purposeful Accident 749
Case 79．Low Back Problem 751
Psychosomatic Aspects of Physical Medicine 752
Spas 753
Physician Relationships 753
Practical Suggestions 754
APPENDIX (Orientation Chart for Teaching Psychosomatic Medicine) 755
REFERENCES 759
SELECTED REFERENCES 770
INDEX 773