Showing papers in "International Journal of Psychiatry in Medicine in 1974"

Psychological stress and coping in adaptation and illness.

Abstract: Research and thought in psychosomatic medicine must seek understanding of the psychological processes making a person's encounter with the environment stressful, and how these encounters lead to a variety of coping processes, emotional states, disease precursors, and stress disorders. One major theme of this paper is that every instance of adaptive commerce between a person and the environment is appraised cognitively as to its significance for the person's well-being. Such appraisals underlie the ebb and flow of emotional states, their quality and intensity. A second theme is an analysis of the debate about whether the bodily response to stress emotions is specific to the psychodynamics of the stressful encounter or general and non-specific. Third, it is argued that self-regulatory processes as well as cognitive appraisals are key mediators of the person's reactions to stressful transactions, and hence shape the somatic outcome. Two types of self-regulatory processes are distinguished: 1) direct action, ...

The concept of "stress" in the biological and social sciences

Abstract: The concept of “stress” was applied to biological and social systems in the first half of this century because it appeared to provide an explanation for the apparently “non-specific” effects of bio...

Management after myocardial infarction: a controlled trial of the effect of group psychotherapy.

Abstract: A controlled clinical trial was conducted to determine the feasibility of offering group psychotherapy to post-myocardial infarction patients for one year, and to test its effects upon prognosis. S...

From the symbolic stimulus to the pathophysiologic response: immune mechanisms.

Abstract: Indirect evidence from a variety of sources, particularly clinical studies of emotional and stress factors in the onset and course of diseases associated with dysfunction or hypofunction of the immune system (infectious, allergic, autoimmune and neoplastic), support the notion that experiential factors can influence the functions of the immune system, presumably via neuroendocrine mediation. We dissect the immunologic system into its components in order to find identifiable targets within disease processes that are stress-responsive. The immune system can be divided into three limbs: afferent, comprising presentation of antigen; central, in which different classes of cells give rise to immune responses; and efferent, concerned with the sequelae of immunization. We must also consider sites in which the immune reaction occurs. We try to defend the assumption that emotional factors lead to small alterations in “immune balance” that can convert latent or mild illness to manifest or severe illness. We consider...

Body Image and its Disorders

Abstract: The body image is not a body organ, a psychological picture, or a little-person-in-the-head. It is best described in terms of the functions it serves and the levels at which it is experienced. The body functions as a sensory register, an instrument for action, a source of drives, a stimulus to the self and others, a private world, and an expressive instrument. The four levels of body experience are schemata, self, fantasy, and concept. A complete description of a body image disorder identifies the source of the disorder and its effects on the functions and levels of experience. Behavioral treatment for body image disorder may develop basic sensory-motor capacities, teach specific skills, promote interpersonal relations with others having similar problems, or use traditional psychotherapeutic techniques, depending upon the needs of the individual patient.

Family process and psychosomatic disease

Abstract: This is a review of psychosomatic literature which touches on the relationship between patterns of illness and aspects of family interaction. An attempt is made to reconstruct the links in the chain which lead from family patterns of interaction to the occurrence or intensification of physical illness in family members. The central construct proposed is that of the “family emotional system.” The influence of emotional factors and certain types of critical events on the family system is traced in relation to the precipitation of both psychological and physiological patterns of disruption. The nature of the family system and its functioning are discussed and questions are raised in areas requiring further study and elucidation, particularly relating to the process of symptom distribution and specificity of illness.

Physical illness and psychopathology

Abstract: The writer discusses the relationship between physical illness and psychiatric disorders. He points out the relativity of the “psychosomatic” and “somatopsychic” concepts and the dynamic interactio...

From the symbolic stimulus to the pathophysiological response: neurophysiological mechanisms.

Abstract: The neurobiological basis of psychopathology is surveyed with emphasis upon reciprocal balances between opposing ergotropic and trophotropic systems with their central nervous system (CNS), autonomic nervous system (ANS) and neuroendocrine components. The anatomical sites, neurophysiological interconnections, and neurochemical transmitters which subserve functions of arousal, attention, perception, motion, emotion, memory, and learning are outlined. Mechanisms whereby disorders of psychophysiologic, somatopsychic and classically organic type may be triggered through such neurobiological pathways are suggested.

Neuropsychiatric complications in burn patients.

Abstract: The neuropsychiatric problems which burn patients experience may occur either during hospitalization or after discharge. Some of these may be considered “normal” in that they occur in many patients and are not pathological or life-threatening if handled appropriately. Others tend to interfere with the recovery process and are associated with a poor prognosis. Normal reactions which occur during hospitalization include anxiety reaction, mild depression, fear of deformity, and a steadily decreasing pain threshold. Potentially pathological reactions during hospitalization, which occur in 20 to 30 per cent of all patients, include severe depression, severe regression, and delirium. After discharge most patients, especially those with severe burns, face further adjustment problems. Follow-up study indicates that during the first year many patients continue to have symptoms of depression, anxiety, and phobic behavior. Most patients who have a normal adjustment prior to injury, however, eventually learn to deal ...

Historical perspective of contemporary psychosomatic medicine.

Abstract: The great triumphs of 19th century scientific medicine in the fields of morbid anatomy, microbiology and biochemistry resulted also in a narrowly organic orientation which fostered increasing specialization and a neglect of the psychological aspects of medicine. Freud, Pavlov and Cannon paved the way for the introduction of the psychosomatic approach to medical practice and research. Their methods and theories offered potential tools for the measurement of emotions and access to repressed, unconscious, psychological content.The psychosomatic movement which started in Germany and Austria was further elaborated through the psychosomatic research of American psychiatrists and particularly psychoanalysts, with psychologists increasingly entering the field. Gradually, interest in the psychodynamics and psychoanalytic treatment of patients with psychosomatic disorders yielded to a growing exploration of the place of environmental stress, consultation psychiatry and pharmacotherapy in psychosomatic disorders. As...

The current status of the concepts of physiological response specificity and activation.

Abstract: The history of concepts of activation and specificity in psychosomatic medicine is briefly reviewed. The limitations of current definitions of activation are discussed and a broader definition whic...

The attitudes of physicians toward prolonging life.

Abstract: A brief questionnaire concerning the care of terminally ill patients was distributed to all physicians in the state of Iowa. The response to it suggests that Iowa physicians believe that terminal patients often realize that they are dying, though they rarely speak of it. Nearly half of those physicians revealed that they frequently omitted life-prolonging procedures or medications in the care of these patients. Likewise, close to half indicated that with some increased sharing of responsibility for decisions in this area, they might increase the frequency of this particular practice. In contrast, the vast majority expressed opposition to change in social attitudes which would permit physicians to hasten death. An analysis of responses to the questionnaire revealed the influence of experience upon the attitudes and practices of Iowa physicians. With greater exposure to terminal patients they more readily discussed a patient's prognosis with him, more often received requests for interruption of treatment, a...

Observations of psychosocial factors and their relationship to organic disease.

Abstract: Psychosocial factors can be important to the development, modification and chronicity of a given organic disease. Such factors are not “all powerful” in the sense that dealing with them will cure disease, but they are factors which the wise clinician will include in his therapeutic armamentarium. Their recognition and control will increase the clinician's ability to practice scientific medicine and to care more adequately for his patients. Psychosocial events, psychophysiologic and physiologic change, emotions and disease are discussed in theoretical terms. Observations and specific examples taken from several organ systems are discussed to show the possible complex interactions between some of the above variables in specific disease entities.

Notes on a contextual approach to medical ward consultation: the importance of social system mythology.

Abstract: The psychiatric consultant requires a broad understanding of the context of consultation to supplement his knowledge of psychodynamics. The authors propose viewing the medical ward in the model of a “quasi-open community,” in which a culture is transmitted from one generation of personnel to the next through a ward mythology-which embodies ideals, for example, for the roles of Nurse and Doctor. Requests for psychiatric consultation often result from the partial breakdown in this mythology; the consultant's immediate task is to reconstruct group ideals and facilitate community re-unification in order to promote the recovery of patients. Later on, when the staff has had a chance to distance itself from the threat to its solidarity, the consultant can help the ward community understand both the adaptive and non-adaptive aspects of its own mythology. Case examples illustrate how respecting the quasi-open character of the medical ward and giving credence to its mythology can promote the reconstitution of ward ...

The current state of the concept of a psychosomatic disorder.

Abstract: In general usage, the concept “psychosomatic disorder” is taken to refer to a category of somatic illness that has certain proposed characteristics. The viability of this category is examined by evaluating the supportability of its proposed characteristics. The conclusion is reached that the category is a very tenuous one at best. It is suggested, however, that it is possible and useful to distinguish between the core concept “psychosomatic,” which represents an approach to explanation, and the elaborated concept “psychosomatic disorder,” which is a nosological concept. Finally, two systems are described that attempt to systematize the relationship between psychological and somatic variables in the context of somatic illness.

Determinants of physiological responses to symbolic stimuli: the role of the social environment.

Abstract: Recent studies indicate the importance of settings or environmental variables in accounting for individual behavior. Measurement of the perceived social climate is a particularly promising way of i...

The role of developmental factors in susceptibility to disease.

Abstract: An attempt is made to provide a perspective within which to view the role of developmental processes in the pathogenesis of disease. Given the presence of potentially pathogenic stimuli, conditions...

Etiologic factors in ulcerative colitis: birth, death and symbolic equivalents.

Abstract: The incidence of life crises occurring prior to the onset of symptoms was documented in fifty patients with ulcerative colitis and was found to be significantly higher in the patient group than in a matched group of normal control subjects. The gain or loss of psychic object to the individual patient has been emphasized as relevant in the etiology of this illness. Birth and death–actual, threatened, symbolic or fantasied-occurring within the previous twelve months preceded illness onset in 94 per cent of cases.

Operant conditioning: a new theoretical approach in psychosomatic medicine.

Abstract: Recent advances in behavioral psychology have disproved the notion that autonomic responses are involuntary. New techniques based on operant conditioning have shown that when given the proper feedback and motivation, animal and human subjects can learn to control a wide variety of physiological responses. These new data suggest a behavioral alternative to present theories of psychosomatic medicine which rely heavily on psychodynamic formulations for their therapeutic technique. Such a behavioral approach would, like other forms of behavior modification, treat the symptom directly through the use of learning techniques based on operant conditioning. Experimental and clinical examples of these techniques as applied to problems of muscle tension and blood pressure are presented.

The Integration of Psychosocial Care in a General Hospital: Development of an Interdisciplinary Consultation Program

Abstract: The problems of multiple competing psychosocial services led to the development of an interdisciplinary consultation program in a university-affiliated Veterans Administration Hospital. The need for integration of services is frequently recognized but difficult to achieve. Representatives from Psychiatry, Psychology, Social Work, and Nursing worked out and carried through a coordinated plan to provide psychosocial consultation to the general hospital. Description of the initial experience focuses on the process of change within a traditional system. A case example which reflects the role and interaction of the disciplines is included. We found that the psychosocial system improved communication, established a pattern of interdisciplinary teaching and stressed preventive work.

Adapting to illness through family groups.

Abstract: Counseling for medical patients and their families which focuses on the emotional adjustment to long-term hospitalization, illness and disability is relatively new to the medical setting. Only in recent years have hospitals begun to recognize their responsibility in responding to the emotional and social components of illness through structured programs geared specifically to this process of adaptation to illness.Based on the assumption that families as well as patients experience emotional stress upon hospitalization of a family member, medical counseling groups were developed at St. Mary's Hospital and Extended Care Center in an effort to more effectively and efficiently support the patient and others in his family network.This paper describes some practical measures for assuring family involvement in physical rehabilitation and discusses some possible methods of establishing such groups in a hospital setting. Case examples in the areas of stroke, cancer, diabetes, and coronary care illustrate the encou...

Quantification and psychological indicators of emotions: the content analysis of speech and other objective measures of psychological states.

Abstract: Reliable and valid measurement of affects, emotions, and moods has posed a problem for psychiatric and psychophysiological research as the demand has grown for more sensitive, precise, and objectiv

The role of aggression in somatic symptom formation.

Abstract: In searching for an operational definition of aggression, five different aspects of the concept of aggression are described: aggression as an instinct, as a behavior pattern, as an emotion, as a trait of character and as a defense. Discussion of the role of aggression is made very difficult because there still exist a great many unsolved fundamental problems in quantifying each aspect of the concept. Behaviorists and psychophysiologists have made important contributions toward solving the problem of quantification. The meaning of aggression for psychosomatic disorders has been intensively studied by psychoanalysts. The psychoanalytic model poses two hypotheses which are subject to critical consideration, namely: 1) the therapeutic meaning of the abreaction of repressed and suppressed strangulated affects [1] and 2) the pensee operatoire [2]. Psychotherapeutic practice is often disappointing in providing answers, but we can look for clarification by studying the specific meaning of patient-doctor relations...

Neuroendocrine mediating mechanisms: from the symbolic stimulus to the physiological response.

Abstract: Hypothalamic releasing factors are reviewed in the context of their importance to an understanding of neuroendocrine mediating mechanisms in psychobiology and psychosomatic medicine. Recent developments in research relating to corticotrophin, thyrotropin and gonadotropin releasing factors are the main focus of the discussion.

Intrusions of Territory and Personal Space: An Exploratory Study of Anxiety-Inducing Factors in Hospitalized Patients

Abstract: To test the hypothesis that hospitalized patients will experience anxiety when intrusions of territorial and personal space occur, seventy-six patients in four metropolitan Chicago hospitals were asked twenty-seven questions. Mean scores for all situations were calculated and responses compared on the following variables: type of hospital; length of hospitalization; and patients' age, sex, nationality, birthplace, and size of family. Patients were found to have feelings of anxiety when intrusions of territory occurred, but personal space intrusions seemingly were viewed with indifference. Results of chi-square and t tests revealed no significant differences in the groups compared, suggesting that these variables have no influence over how patients feel with regard to territorial and personal space intrusions.

Biosocial Resonation: A Conceptual Model of the Links between Social Behavior and Physical Illness

Abstract: If sociomedical research is to move beyond the stage of repeatedly reporting correlations between social variables and disease, a viable conceptualization of the connection between social and physiological variables must be developed. We suggest that subjective interpretations of information perceived in a situation as congruous or incongruous with learned expectations is the key point of articulation. Each individual has an information repertoire derived from social interaction and direct contact with the non-social environment. If the individual's perceptions of the situation are not congruous with his information repertoire, he is likely to experience activation of the autonomic nervous system and related neuroendocrine and somatic processes. If these physiological processes are intense and/or prolonged enough, they may alter the body's resistance to infectious organisms, temporarily or irreversibly damage the body or reduce behavioral efficiency, increasing the likelihood of accidents. At the same tim...

Laboratory studies of psychological stress.

Abstract: This paper reviews current methods of studying psychological stress in contrived settings. Stress may be operationally defined in terms of stimuli, responses or both. On the stimulus side, types of stressors are classified on the basis of stimulus characteristics or kinds of threat involved. On the response side, various indicators of stress are discussed including measures of changes in affective state, adaptive functioning and physiological arousal.

Psychotherapy of a suicidal, terminal cancer patient.

Abstract: Psychotherapy of a terminal cancel patient who had attempted suicide is described. The suicidal attempt occurred when she was unable to ventilate her sad feelings to either her doctors or family. Immediately after the suicidal attempt, psychotherapy while on the medical floor opened a channel of communication between the patient and the psychiatrist, resulting in a trusting relationship. Second phase, outpatient therapy, was characterized by the patient's insistence to find psychologic meanings of her illness, in addition to dealing with feelings of jealousy regarding healthy acquaintances and mourning over her health and youth. By identifying the cancer as an introjected bad mother, she began to see it as an alien object, thus gaining a sense of psychological control. The final phase was characterized by increasing signs of metastases and increasing efforts on her part to “psychologize” the illness, without neglecting medical treatment. There were few signs of “acceptance” of death in this patient who was once suicidal. Some terminal cancer patients can use exploratory psychotherapy to make remaining life more gratifying. This presupposes a close collaboration between the psychiatrist, oncologist, and the patient's family.

Conversion: fact or chimera?

Abstract: For nineteenth century psychiatrists, especially in France, dissociation was viewed as the basic mechanism responsible for the formation of hysterical symptoms. To explain how dissociation occurred, Freud advanced the concept of repression and proposed that hysterical symptoms arose from the conversion of repressed psychic excitations into somatic symptoms. The notion of conversion has since become synonymous with hysteria and has been extended to include processes mediated over the autonomic as well as the sensori-motor nervous system. It is suggested that conversion is an unnecessary hypothesis involving untestable theories of energy transformation, that preoccupation with the concept has diverted scientific attention from the phenomena of dissociation, and that through renewed investigation of the latter will come further understanding of brain-behavior correlations and the genesis of psychosomatic symptoms.

Self-induced abscesses: a diagnostic and treatment enigma.

Abstract: This conference deals with the case of a 22-year-old woman whose left leg had been amputated following the spreading infection of subcutaneous abscesses. When similar abscesses later developed on her right leg, the possibility that her recurrent abscesses might be self-induced was considered and eventually verified. Her subsequent medical and psychiatric course is discussed, and the perplexing problem of how to treat the patient with factitious disease is considered.