The Psychosomatic Concept in Psychoanalysis

In discussing "psychosomatic medicine" we are thinking of this concept in relation to psychoanalytical thinking. We are not discussing disease entities from the medical point of view, but elements of psychophysiological functions which begin with fetal life, and which continually remain active during normal psychic and biologic development throughout life. Thus we are not dealing with the problem of psychogenesis, but rather with the problem of "specificity of the psychosomatic process" and of "the choice of the organ." If one views this in the light of current psychoanalytic theory it is in terms of ego psychology. We must at the outset accept the fact that a psychophysiological process cannot be initiated de novo in the mind. Mental events in both health and disease have become links in the psychosomatic chain of events. Thus a structural, functional continuum exists between the mind, body and environment which contains nodal points at which occur transformation of energy. This special class of sharply defined clinical entities are then viewed as syndromes which have a variety of pathogenic mechanisms. Idealistically, all bodily states in health and disease are psychosomatic in that a psychological factor of varying intensity is present. It has become customary to apply this term to a group of diverse clinical entities such as asthma, ulcerative colities, hypertension, neurodermatitis, duodenal ulcer and a host of functional disturbances without fixed anatomic pathology. These illnesses have in common the fact of psychological features which appear to be significant as etiological factors. All of the psychosomatic disturbances, when observed clinically and experimentally, appear to have at least two phases. The first is functional and consists of reversible disproportionate or inappropriate motor, secretory and vascular responses in an organ or in its constituent tissues, e. g., hyperfunction, hypofunc tion, perversion of function, and synchrony or asynchrony. The second