PRIVATE CASE-BOOK OF AN M.D.
by Curt S. Wachtel, M.D.
Amazing true case histories which detail cures of the ills of the body through the magic of the mind.
is a complete reprint of the $5.00 hardcover edition. The Psycho-Medical Guide, Parts I & II, published by special arrangement with the author.
BELMONT BOOKS First Printing June 1962
To my wife
ELIZABETH WACHTEL whose cooperation and assistance made this work possible
BELMONT BOOKS I published by Belmont Productions, Inc.
66 Leonard Street, New York 13, N. Y. © 1956 by Curt S. Wachtel, M.D., all rights reserved
PRINTED IN THE UNITED STATES OF AMERICA
Preface to the Belmont Edition
PART ONE: THE MEDICAL DETECTIVE
1. Between Illness and Health
The Woman Who Denies her Soul
If I Could Only Have a Child
Upside-Down Routine Sickens Four
Pride and Pain
"Sweating It Out"
Always the Boss
Female by Mistake
3. Accidents and Incidents
Guilt and Self-Punishment
A Belated Conscience
One Buyer's Ego
A Grave Digger
The Baseball Fan
PART TWO: THE VOICE OF THE ORGANS
5. The Skin
Rash Marriage Produces Rash
The Skin Speaks Out
Warts Yield to Courtship
Occupational Skin Reactions
Frail of Mind
Humility Arrests Illness
7. Heart and Circulation
Hearts Break for Loved Ones
The Eternal Triangle
Business Over All
Appearance Above Value
The Colon Rules
The Fat Cellist
Mother Eats and Dies
Daughter Starves and Lives
The Unsuccessful Businessman
10. Cancer and Introspection
Last Years of Happiness
Two Years of Panic
PREFACE TO THE BELMONT EDITION
The word "private" places emphasis on the secret, unconscious urges, thoughts and desires of the sick person, thoughts and urges which the patient generally refuses to divulge to anyone, including himself. Without the knowledge of these hidden motivations the patient remains an enigma to himself. As long as this enigma is not solved, the process of healing or cure is prevented and/or the sickness will tend to recur, as long as the hidden motivation is not understood.
The doctor has many ways and means to uncover hidden motivations within the patient Why does any person hide his motivations? For the same reason that you, the reader, do not want to admit certain things which you have done once or often, because you do not entirely agree with what you do or did. It need not be a crime which you hide. Suppose you are a woman with a beautiful bust. There is on your left breast what we doctors call an angioma. For the sake of simplicity you may call it a birthmark. You got so used to keeping it secret from everybody that you try to hide it even from your doctor, wearing slips high enough to cover your birthmark.
One of my patients who needed to reduce never took off her undergarments, but never took off weight either. Once she stayed away from my office for longer than one year. When she returned, she was proud to report that eventually she had lost a considerable amount of weight She did not only look slender but sick. Therefore, I insisted that she give up hiding her breasts during my examination. I found a cancer which needed immediate amputation of that breast. The "private" reservation of this patient almost had destroyed her life. Had she given up this "private" reservation in time, she might have saved her breast and enormous amounts of anxiety and fear.
Private Case-Book of an M.D. contains more secrets than "confessions" of sin and sex which fill the fiction magazines and books. In Private Case-Book of an M.D. you can trust that the reports are true, in the sense of correct and factual. A doctor has good reasons to be realistic, as only realistic interpretation of facts can help the patient.
Psychosomatic cure is based upon the correct psychology of the patient, eliminating self-deceit and false justifications. The only sin in medicine is to act or live in contradiction to the law of nature. Of course we know that virtue or sin, good or evil practices in life are facts which influence health by way of the spirit. Spiritual medicine is one of the oldest forms of medical practice. The spirit controls the body by way of the inner process, the forces of the soul and conscience.
The patient in the doctor's office preserves his privacy under all circumstances. It makes no difference for the medical truth whether the woman with the angioma and the cancer lived in Europe or in Los Angeles, whether she lived in any of the many places where I gained my medical experience, in Europe or in this country, whether it happened in 1914, 1941 or yesterday. The patient may have come from New York, from Canada or Mexico or elsewhere. As long as the name and address are not given you can look for the needle in the haystack and be certain that any similarity in a case of your acquaintance must be accidental.
Every case is different, every inner process is different from the other one. There are no two cases or two persons alike, which makes this kind of medical practice so interesting. Every case is a new challenge to find the correct working of the inner process, otherwise there would be no cure.
While every case is different, certain typical ways of thinking occur again and again. Every excitement may cause an increased output of adrenalin and more or less sudden increase of blood pressure. You can be certain to find this phenomenon in your own behavior, but from here on things vary. If your stomach is the weakest organ in your body, you may develop an indigestion. If your nerves are the weakest organ, you may show a tremor or tensions. According to circumstances, your tremor or tension may show up in your head, hands or face. Or the tension may be in the parts of the body which are commonly covered by clothing, for example, in your chest. Then your breathing may be affected and further influence the way you speak, the disturbance of your speech may handicap your efficiency in business. The realization of this effect may cause you to become depressed.
This book has been very helpful in the past in enhancing the mutual understanding between the patient and his physician. I hope it will continue to help many more persons who wish to discuss their problems with the doctor.
Every reader will be interested to learn the good reasons why one does not need to be sick in order to profit from the psycho-medical insight which results from the psychosomatic understanding of one's emotional shortcomings. It is just for this reason that so many successful people in the field of journalism, literature, the arts and professions, who are not sick, undergo psychosomatic guidance.
—Curt S. Wachtel, M.D., F.N.Y.C.S. New York City April 1962
WHY PSYCHOSOMATIC MEDICINE?
A Word to the Patient:
Psychomatic medicine is the medicine of the future practiced today—but only as yet by a small number of specialists. The time has passed when a pat on the shoulder, a little psychology added to the traditional bedside manner can be mistaken for this new branch of medicine.
The psychosomatic physician uses and controls both the known as well as the hidden forces of nature which work upon body and mind of the sick person. Psychosomatic medicine is still a pioneering field and has not yet become part of the regular curriculum of medical schools. It may, therefore, be helpful that I explain the correct meaning of the word, "psychosomatic," and the relations between soma, psyche, and soul before I start to discuss individual patients' life experiences.
Persons who are seriously ill and others who live between illness and health are overcrowding institutions and hospitals. Many of them who do not respond to the traditional methods of treatment can be cured by psychosomatic medicine.
Soma is just another word for body. Bodily injuries cause the person to become apprehensive, anxious, fearful, concerned with his immediate and distant future and possible disability. There is a point, or surface of contact inside the person, where bodily injury is transformed into psychic suffering. If this process is reversed, psychic and mental apprehension cause physical symptoms or psychosomatic illness.
The psyche, broadly speaking, is the mental and emotional setup of the person. The psyche comprises the functions of the brain and nervous system and also certain functions of the endocrine glands. The psyche acts similar to a communication system with a central switchboard and interconnecting wires. This system by itself, no matter how ingenious and perfect it may be, never creates ideas. It can only transmit ideas and messages. The psyche is not identical with the soul.
The soul in medicine is the source of creative thinking and spiritual understanding. It is responsible for vital energy, judgment, free will and consciousness, for faith, hope and charity, spirituality and for all the motivations which distinguish man from animal. As long as these forces cannot be attributed to specific body organs or organ systems, they are to be related to the human soul.
The soul is the carrier of mental and other functions in the same way that the atom in physics, the molecule in chemistry and electricity in engineering, though never directly observed, are known by their effects. Only that psychosomatic medicine which takes into consideration the soul, together with the psyche and soma, treats the whole man.
Psychosomatic treatment embraces all known methods of modern diagnosis and therapy. Whenever these methods of traditional medicine are needed, they are combined with the active correction of the deep-rooted psychological motivations of the sick person.
To take advantage of the curative power of the subconscious, we proceed from the surface into the deeper layers of consciousness. We locate the disease-producing process in the subconscious sphere and start the curative process at the same time. We establish the liberation of the soul through psychological guidance and counselling and, thereby, transform the new and healing motivation into a permanent force.
Psychosomatic practice has profited from psychoanalytical and psychiatric research and experience. But psychoanalysts do not apply medicinal treatment. Psychiatry, on the other hand, takes advantage of the entire knowledge and apparatus of scientific medicine and is definitely on its way, ahead of all other specialties, to adopt and absorb the psychosomatic approach.
The psychosomatic physician studies and knows what is going on inside the patient and what forms the chain of inner causes and effects between the origin of a disease and the resulting clinical signs and symptoms and the pains and sufferings of the patient.
Accordingly, psychosomatic treatment does not rely on the imposition of therapeutic measures alone, but also appeals by specific methods to the intellect and will of the patient and obtains his understanding cooperation. Thus, the patient's mind is persuaded to act as the strongest health-producing force and, thereby, mobilizes all the restorative powers inside his personality.
Psychosomatic illness, it has been estimated, may be found in as many as 80 percent of all patients who enter any doctor's office. When traditional methods fail, these patients need psychosomatic treatment. No doctor can afford to ignore this new approach to medicine. No patient needs to continue on the desperate sufferer's merry-go-round, going in circles, switching doctors, juggling drug jars, and trying to find a miracle cure in a capsule.
Psychosomatic medicine holds out a two-fold promise for all patients:
For Today: Cure for many more individuals suffering from disease which they believe to be incurable.
For The Future: An increase in the number of physicians, surgeons and specialists in all branches of medicine, who will have absorbed the psychosomatic approach as an essential and integral part of their medical thinking and skill as well as medical practice.
It is my firm belief, after many years of research and study, that the world, at large, is now ready for the acceptance of psychosomatic medicine.
A Word to the Doctor;
Psychosomatic medicine is a highly complex specialty to which all other branches of medicine contribute detailed information. It involves physical, chemical, physiological, psychological, psychiatric and environmental factors.
The fact may be stated that, in psychosomatic research, experimental conditions can seldom be established at the will of the researcher, as in the case in physics, chemistry and some branches of medicine. Only life itself creates the situations which we may analyze. Whether the solution of a patient's problem is final and successful can often be ascertained only when the doctor is kept informed about the patient's development for a long time after the treatment has been completed.
It is obvious that psychosomatic medicine is not confined to the restoration of a temporary or transitory disturbance such as a diseased gall bladder, a duodenal ulcer or a heart ailment. Psychosomatic treatment is always directed towards the complete and permanent adjustment of the total person of the patient to his life situation and towards the establishment of the patient's ability to face any future life situations successfully. The final outcome of a cure always depends upon the patient's effort and ability to acquire control of his emotional system as well as of his mental and spiritual judgment and will.
In this book I deal with individual patients and their problems which have been followed up for as long as was necessary so that it is possible to judge the phenomena and outcome of these experiences retrospectively. The psychological workings and motivations which lead into and out of psychosomatic illness in the narratives of patients' stories are condensed in order to bring out into the open what is going on inside the patients. In so far as many of the psychosomatic phenomena have not been described elsewhere in scientific literature, this study has not been planned as a popular simplification, still less as a collection of success stories. Nor do I promise or wish to give the impression that any reader, merely by reading the book, will be enabled to cure his own psychosomatic illness.
The scope of the book comprises the study and observation of the inner process by which emotional and mental activities are transformed into bodily symptoms and illness. Or, in the opposite direction, the inner process may become somatopsychic, when bodily phenomena and suffering affect the emotional thinking and other mental functions of the patient.
The biological internal link between somatic, psychic and spiritual phenomena is the essential part of psychosomatic illness.
It serves the purpose to proceed from the simpler psychosomatic developments towards the complex interrelations which occur between conscious and subconscious motivations on the one side and bodily phenomena on the other side.
The first part of this volume deals with transitory symptoms of suffering and disease which are caused by emotional, mental and spiritual problems of the individual.
The second part presents experiences of causal relations observed between apparently physical conditions and mental tendencies of which the person is mostly unaware. It is obvious that situations become more complicated as we proceed to deal with psychosomatic conditions at different periods of life. Th,e psychosomatic approach will become part of all the specialties which are limited to certain periods of life, such as pediatrics, obstetrics or geriatrics. A volume of limited size cannot nearly exhaust this subject.
Psychosomatic medicine is today a specialty in its own right. The day will come, however, when all the special branches of traditional medicine will feel the need to integrate their striving for practical efficiency with the psychosomatic conception of the patient and his problems.
THE MEDICAL DETECTIVE
CHAPTER ONE: BETWEEN ILLNESS AND HEALTH
Proceeding on the premise that truth is stranger than fiction and that what interests most people most—are other people, their fortunes and misfortunes, I have selected from my records and recollections the life-experiences of patients whom I have treated in the course of more than thirty years of my practice in psychosomatic medicine, long before this modern day appellative became the subject of popular interest.
Truth Is Stranger Than Fiction
There are many physical conditions which are directly brought to the doctor's notice and recorded as more or less stereotyped "case histories." Actually, all of them form psychological situations in the lives of human individuals. And so, in this book, I report them as true life-experiences which affect the entire personality of the individual patient Each situation may be experienced by more than one, even by many persons. Not the situation, but the individual character and reaction pattern of the patient—no two of them are ever alike—cause the variations and singularity of life-experiences.
I have carefully disguised the personalities of the patients, not only their names, but also the incidental and environmental circumstances. However, I have not allowed these minor changes to alter the true and essential motivations and actions of my patients. Any resemblance to any situation or person, whether living or dead, will be purely coincidental. Some of these experiences are touched with tragedy, some with malice, some have an element of humor, others are humdrum, still others lurid; but all have one common denominator—they occurred in the lives of real people. It is ray sincere hope that this book will induce the reader to glean from its pages the message that we are largely responsible for our own fate.
When Traditional Medicine Fails
After the methods of traditional medicine have been exhausted without bringing relief to the patient, psychosomatic medicine may bring results. When this happens, the psychosomatic physician appears to these sufferers as the specialist for patients in despair. A despairing patient needs both organic and psychic restoration for bis "dis-ease" or "dis-order." These everyday words portray the lack of harmony in the make-up of the person who lives between illness and health.
I have tried to keep these pages uncluttered and free of technical phrases and terminology. I have also tried to prevent their becoming choked with theory and prolonged explanation. I have felt, however, that a certain amount of preliminary explanation at the beginning and a summary at the end of each chapter was necessary. For this I beg the reader to bear with me and to keep in mind always that I am not a story-teller. I am- a doctor who reports medical experiences.
The Screen Within Yourself
Patients with problems often live for considerably long periods of time between illness and health. What is or has been going on inside their personalities is the inner process by which the psychic experience of thought and emotion is linked to the physical phenomena in the body. Normally, we are not aware of these very complex developments at the borderline between body and psyche or between body and soul.
The ancient recommendation, "Know Thyself," and certain modern experiments and methods in child psychology and in the education of elementary and college students are directed toward the same goal. When individuals fail to control their self-awareness and become the victims of their own emotional thinking, they begin to reach the borderline of illness. Therefore, long before a person becomes obviously ill, ill enough to consult a physician, a long line of emotional thoughts and sensations has passed through mind and body. This entire chain of psychosomatic phenomena remains subconscious or unconscious behind the curtain which separates these spheres of the human mind from our conscious living.
The subconscious sphere behind the curtain is not merely a dead storage place of unpleasant memories. Every experience goes on living in that sphere like a ghost or gremlin in an underworld. When our self-control is distracted by vivid emotion or by fatigue, the gremlins sneak out from behind the curtain and disturb our conscious behavior—against our will. The psychosomatic approach brings these gremlins and their tricks to the awareness of the patient. This process becomes clearly apparent in the first interview I had with Lydia.
The Woman Who Denies Her Soul
Lydia W. was in her late thirties, married and mother of an eleven-year-old child. If one were to describe appearance in terms of color, she would be called a "gray woman." Everything about her was soft and gentle, her hair, her skin, her clothes, her voice were almost—but not altogether—colorless. She was a refined and intelligent person, obviously of good family and scholastic background. Though she had been married for twelve years to a strong, healthy man and was a mother, she gave the same impression of being changeless and untouched that pervades our memories of our spinster aunt.
Sex Life at a Standstill
The following interview with Lydia is slightly edited in order to spare the reader the repetitions which occur in conversations:
Tell me your complaints.
P.: My skin looks terrible, my face looks abominable and I suffer an intense itching of the skin.
Dr.: What else is wrong?
P.: I have a severe headache almost all the time.
Dr.; You say that with a rather smiling face. What else is wrong?
P.: I have a very annoying congestion in the upper part of my chest, just below the neck. (While she elaborates on this complaint, she takes a cigarette out of her purse and proceeds to light it.)
Dr.: I would suggest that you do not smoke in my office, especially not if you have a congestion in your chest. Of what else do you complain?
P.: I have a pain in my back, mostly on the left side. The pain radiates downward and forward into the lower part of my abdomen. I do not have it all the time, but very often.
Dr.: Is there anything else?
P.: I am tired. I am disgusted with life. I am very sick.
Dr.: What do you think is the cause of your complaints?
P.: I do not know!
(The doctor tells the patient to undress and gives her a general examination, during which the interview is continued.)
Dr.: You are married and have children?
P.: Yes, I am married. Three years ago you sent my daughter to the hospital when she had a severe infection.
Dr.: I do remember now—your daughter and your husband, but not you.
P. I was separated from my husband at that time, but not for too long. He is not so good; he is very irritable. We live together for the child's sake.
Dr.: Tell me, in whom are you more interested, in your husband or your daughter?
P.: I am most interested in my health.
Dr.: You did not answer my question. In whom are you most interested?
P.: (After some hesitation): I am most interested in myself.
Dr.: In what part of yourself are you most interested?
P.: In my headache.
Dr.: That is not what I mean. Your person includes body and soul.
I Have No Soul—I Have a Headache
P.: I have no soul and I want to get rid of my headache.
Dr.: Do I understand that you live only for your body?
Dr.: You said that you have no soul. Have you never felt love, or experienced love in your life?
Dr.: Have you never loved your parents?
Dr.: Your father?
P.: I don't remember him.
Dr.: You must know something about your father.
P.: All I know is that he was a mining engineer. I have no memory of him and I don't know whether he is alive. He left my mother just before I was born.
Dr.: What about your mother?
P My mother died, when I was eleven years old. She was ill for a long time. She ran a small boarding house in Arizona. She was thirty-eight years old when she died.
Dr. Of what did she die?
P. She coughed and she had pain in her stomach, just as I have now. My girl is also eleven years old, as I was, when my mother died.
Dr. You are about the same age as your mother was when she died. She had a chronic cough, perhaps tuberculosis? Your lungs are fine. You are well-nourished; as a matter of fact, you are almost overweight. Aren't you a good mother to your girl?
P. I would like to be, but I cannot think of higher duties as long as I have so much pain and discomfort.
Dr. You really mean that you are exclusively interested in your body and you do sincerely insist that you have no soul?
P. I think so.
Dr. You have intelligence; you have sympathy with your child, if not motherly love. You can understand that life without love is a void.
P. That is exactly what I feel.
Dr. Why do you deny your soul?
Dr. But I have no soul.
Dr. Perhaps your soul is buried in the rubble of everyday confusion. Could we say that your soul is repressed?
P. You may put it this way.
Dr: Let us assume that your soul exists and is unable to function. What good can come to you from all the ointments and liniments that the largest drugstore in this city could supply? Let us make an effort to find that love which you have never received in your life. You have never given love to anybody. Up to this day you have never unbent to give real love to anybody, neither to your husband nor to your child.
P. How can I give love to my husband? When he comes home, he doesn't speak to me. He doesn't even answer me.
Dr. Your daughter?
P: She has been away at camp for two months.
Dr: Try to give love to your husband anyway! I will not give you any medicine. Go home and make up your mind to give love. If you cannot love your husband, go and try to cheer up somebody who is poor and in need of help. Return to my office a week from today to tell me what you have accomplished.
Denying Love and Pregnancy
Eight months later she returned to my office. She had followed my advice in her own way. She had given love to her husband and she was now an expectant mother. Yet against reason and factual evidence, she refused to admit that she was pregnant. An X-ray was taken. She saw with her own eyes the picture of the embryo, twenty inches in length, with spine, head, arms and legs clearly visible in the film.
"No," she said, "I'm not pregnant; it may be a tumor." She refused to make arrangements for the impending confinement and went on a trip from New York to the West Coast during the ninth month of her pregnancy. In the Burlington Express, between Chicago and Minneapolis, she was delivered of a healthy baby by the attendants of her Pullman car.
Lydia returned home and took good care of the newborn. Her peculiar behavior had caused no actual harm, except that her husband was severely criticized by neighbors and friends because he had permitted her to take a trip at that time. What else could he have done? The blame fell upon him because she wanted it so.
Resents Father—Loves Baby
Because of her many and varied complaints, Lydia came again to my office at regular intervals. After a few sessions she began to understand that she resented her father, that she had to give love in order to be loved. She did not find it too difficult to give love to the newborn baby. She found it more difficult to give love to the father of her baby instead of hating him because she identified him with her own father. She could be persuaded to let her motherly love take its natural course. In time, she learned to give her husband his legitimate share of affection beyond the physical relations. As this return to normality progressed, Lydia discovered with surprise that the itching and blemishes of her skin, the headaches, the congestion of her chest, the pain in her back and left side and her fatigue and disgust with life had disappeared for good.
Lydia's complaints had been real pains, her suffering had been real. Each physical symptom had been an expression of her emotional reaction to her life situation. To call such pains imaginary would not only be unjust but harmful. It would never help any patient, but could rather aggravate the neurotic situation which transforms emotional experience into physical suffering.
Lydia identifies herself with her mother and projects her resentment or hate against her father upon her husband— perhaps upon all men. She feels a satisfaction of revenge in creating life situations that are embarrassing to her husband. She has repressed her emotional reasoning into the subconscious sphere. She has just started to symbolize her emotions in subjective complaints, but has not yet transformed them into objective symptoms. She lives between illness and health. All the time Lydia acts mischievously, but avoids serious barm because she is not completely unaware of her inner process. I made her see more clearly what went on within her. After a few sessions, she began to understand that she was lacking a spiritual background She learned to accept the fact that spiritual values are a necessity in practical life. Many persons today deny that a soul exists. They are always ready to admit that intellectual understanding, judgment, will, conscience, consciousness, subconscious forces and the lilce are real factors in life. It is a matter of definition, if not of fact, to them that these human faculties are some of those attributed to the human soul in the field of common-sense philosophy.
Confusion of Soul, Love, and Sex
For the purpose of healing, it is irrelevant to discuss with the patients the existence of the soul. They agree very easily that, as the case may be, their father or mother or both, have withheld from them another function of the soul—the love to which they feel entitled. They do not always realize that the parents' love for the child is not identical with their own physical love for a husband. They confuse physical and spiritual love and apply a neurotic but false logic to their situation. In the course of treatment, the physician will guide them towards a rational solution of their neurotic problem. Lydia has demonstrated the fact that life without spiritual values or without a soul leads into psychosomatic illness. Not every person who denies these values becomes a patient, yet we do recognize that uncontrolled repression of emotional thoughts and their uncontrolled return from the subconscious sphere of thinking into the conscious sphere of action may still be another element conditioning the person for psychosomatic illness. The third and most important factor in the formation of neurotic disturbances is the absence of self-awareness on the part of the person so afflicted.
False Identification with the Sick or Dead
Awareness is further prohibited by the formation of symbols in the patient's thinking. Lydia substituted herself in the position of her own mother. Lydia's daughter symbolized Lydia far back when she was only eleven years old. Lydia's husband became the symbol of Lydia's father. The real, fatal illness of Lydia's mother supplied most of the clinical somatic symptoms for Lydia's recent complaints. The more the psychosomatic illness progresses in time, the more complex will be the chain of psychosomatic mechanisms. Accordingly, it becomes apparent that the psychosomatic process is never explained by any one of the widely publicized and oversimplified "complexes." Nor is the environment alone ever the cause of illness. What goes on inside the person is most essential.
Persons who are not sick but who complain of many pains and symptoms and ask the doctor to help them have concrete and well-defined reasons for their seemingly illogical behavior. They are really in need of an understanding psychosomatic physician to help them solve the problem of their life-situation.
The problem of the next patient, Ursula D., can best be expressed in seven words:
If I Could Only Have a Child
Standing on the threshold between illness and health is the unmarried woman who longs to have a child and yet fears the embarrassment from pregnancy out of wedlock. Keeping in mind that pregnancy is not a disease and that bearing a child has nothing to do with illness, it should be noted that Ursula was a normal person in every respect. When she consulted me, her complaints were of annoying abdominal pain, a feeling of nausea with occasional vomiting, especially in the morning before breakfast and a sensation of fullness occurring later in the day, followed by fatigue and headache. There had been no menses during the last two months. Physical examination revealed an enlarged abdomen and pigmented mammillas on full breasts. Ursula admitted some gain in weight.
I suggested that she might be pregnant. She responded with an outburst of weeping and pleaded violently for an abortion. When I told her that this was out of the question, she flung herself to the floor. With a pair of small scissors, which she had been hiding in her hand, she proceeded to slash ineffectually at her wrists. I quieted her to some degree and obtained her rather pathetic story.
Ursula was forty years old, the only child of a widowed mother. The mother had been invalided for the past twenty years. They lived together in a small flat in a crowded neighborhood, Ursula accommodating herself to her mother's need for care, companionship and financial support. She was a beautician by trade. Though her daily occupation was in the pursuit of beauty, it was beauty for other women. Ursula was hopelessly unattractive. With tact, she could at best be called a homely woman, heavy in face and body, almost bovine in her slow-moving manner. No man had ever taken the trouble to find the generous spirit beneath her listless, even indifferent exterior.
First Romance at Forty
Ursula had never been in love before. What opportunity had there been for romance? Now, suspecting her daughter's predicament, Ursula's mother aggravated the feeling of shame and embarrassment by silent and frequently not-so-silent criticism, only natural in the given situation, but adding further to the girl's torment.
The father-to-be had disappeared in the general direction of Australia with no intention of returning, and Ursula was abandoned in the third month of her pregnancy. Thinking of her future, she worried that her condition would soon be noticeable to her customers in the beauty salon. She could not face the shame of exposure.
I spoke to her until she regained her composure. From there, the interview continued essentially as follows:
Dr.: How do you feel about the father?
P.: I have no feeling for him. He left me. I must forget him.
Dr.: Do you like children?
P.: I love them. I've prayed for one all my life—but not under these circumstances.
Dr.: Ursula, if you were married, would you want to have a child?
P.: Oh, yes. If I could only have a child!
Dr.: It may be; you are expecting one now.
P.: Oh, no. I would rather die. The shame . . . the shame!
Dr.: I ask you again: If you were married, would you honestly and sincerely want to have a child, even if your husband died in the third month of your pregnancy?
P.: Yes, I still would
Dr.: Ursula, you realize that at your age of forty years, this may be your last chance to have a child. Another thing: you are not a pretty woman . . . you may never attract another man. You realize these things, don't you?
P.: I do.
Dr.: Have you faced the fact that your mother, now seventy-three years old and an invalid, will soon leave you alone in the world? At that time, your child will be the only, person to whom you will belong and who will belong to you for the rest of your days?
P.: I know what you mean, doctor. Perhaps you are right
Dr.: Do you still want to kill the child?
P.: But the customers .. . the shame!
Dr.: If this is all that worries you, could you not tell them that your husband died while on a trip to Australia?
P.: I could.
Dr.: Then the problem is solved. But before we go further, allow me to take a rabbit test in order to ascertain that you are really pregnant.
Ursula's tears had been dried for some time and when she left the office she looked at me with the innocent eyes of a child. Three days later she reappeared. Ursula had nothing to explain to her customers. The pregnancy test was negative. She broke into tears, a choked, painful sobbing—not tears of relief.
One and one half years later Ursula returned to my office. With a sheepish smile she announced that she was pregnant. She looked radiant. This time she was in the last month of a very real pregnancy. One month later she became the mother of a healthy little girl. She was still unmarried. No questions asked. Ursula had made her own decision.
To those who, reading this life story of a lonely woman, find it in their hearts to criticize her action, I should say in her defense that she was not promiscuous but rather a normal woman with a natural maternal instinct ungratified in her particular life-situation.
Motherhood Is No Illness
The longing for motherhood is a natural instinct in a normal woman. Pregnancy, confinement and motherhood are not illness. The fear of social exposure brought added confusion in which this patient, if she can be called a patient, asked the physician for help. Thereby, she considered herself a patient while she was objectively in good health. Conflicts with the standards and restrictions of society may produce emotional imbalance in otherwise normal people and thus upset their psychosomatic equilibrium to such a degree that symptoms of pregnancy may develop by the sheer force of emotional thinking.
We know from experiments that neurotic conditions can be induced in healthy animals when the routine to which they are accustomed is disturbed. For example, if a rat receives a mild electric shock each time he approaches his food, he will gradually become nervous and eventually reach a condition comparable to a neurotic human. Human beings surpass experimental animals insofar as they can forsee disturbances of routine before they are actually exposed to them. They may develop neurotic symptoms when they merely expect or foresee a danger to their routine life.
This is the way in which persons who are conditioned to an orderly existence react when their routine is upset, or even when they expect a disturbance in their routine. The physiological inner process which produces neurotic conditions by disturbance of routine is one of the best known psychosomatic phenomena, scientifically cleared by a large amount of experimental research and well founded on clinical observations. How easily persons are upset who feel secure in their daily routine is illustrated by the following experience:
Upside-Down Routine Sickens Four
I became acquainted with a family when the wife, Lucille K-, telephoned my office for a special appointment at an unusually late hour. On her arrival, she apologized, explaining that she was "too busy" to see me during my regular hours. She said she was thirty-one years old, married and the mother of two children, ages five and seven years. In appearance, she was of medium build, slightly overweigh and somewhat pale. She seemed listless and apathetic; chronic fatigue was expressed in her drooping posture. Her complaints were of a feeling of tiredness, near-exhaustion because, she said, her two children were ill most of the time with first one thing and then another, hardly a week passing by without one or both of them ill. Many times she had consulted her family doctor. Several specialists had diagnosed Lucille's complaints as different conditions; once, it was 'chronic sinusitis'; at another time, 'gall bladder disease'; at yet another, 'colitis.' Treatment had relieved the current ailment but had not brought her relief of her fatigue. She felt she could not carry on much longer.
The careful and thorough examination of this patient revealed no organic findings. Her menstrual and other personal history was normal. Consultation with her family doctor and the specialists who had treated her confirmed the negative outcome of all previous clinical and laboratory investigations. The pediatrician who took care of the children was also consulted, with the reassuring report that there was nothing essentially wrong with the children.
Thus we are confronted with a household in which three of its members are chronically ill in the absence of objective findings. It is at this point that traditional medicine ends and psychosomatic therapy begins.
The absence of organic changes, the presence of permanent fatigue—the patient feeling that she can no longer go on— and her serious insistence that she is always "so busy" are factors which suggest the possibility of a psychological basis for her condition.
In psychosomatic medicine, the doctor is not interested ; alone in the recorded illness of the patient and the members f of his or her family. Of greater importance than the his- | tory of previous diseases is the life situation of the patient and her family, the characteristic trends and behavior of all persons within the patient's environment, their daily routine, habits, harmony or conflicts.
Too Tired to Be the Father
Further conversation with Lucille disclosed that she was happy with her husband. There were no arguments or dissension in the home; her relations with her in-laws and own parents were agreeable; she was devoted to her husband and children. However (and this "however" is psychosomatically important), her husband did not feel too well, either, but had not yet found time to see a doctor. For years he had been working at nights and the family lived a sort of "upside-down" existence. After sleeping all day, her husband had his "breakfast" in the evening before starting out to work. The children had to be quiet during the day in order not to disturb daddy's sleep. Most of Lucille's household chores were done in the evening. There was little, if any, opportunity \ for entertainment. She could not remember when she had I last seen a movie. She had lost track of most of her I friends. She admitted to a feeling of tension when the children became boisterous and she had to scold them. She H "jumped a mile" when the doorbell rang during the day.
Lucille described this situation in a quiet, matter of fact way. She appeared to be perfectly accustomed to this daily routine. In no way did she express any dissatisfaction with her lot.
Offhandedly, I asked her whether her husband could not change to day work. She said that that would mean a considerably reduced income. Furthermore—and she was almost angry—she could not see how that could possibly relieve her exhaustion. . . Did I consider her a psychiatric case? She was quite right. She was not a psychiatric case, or any kind of "case." She was a human being and, as such, the victim of her family's situation. She was definitely unable to understand that this life-situation could be the cause of the illness of four persons. Her fatigue, yes, could be explained by the strain under which she had to run her household, her tension by the fear of economic change. But the children, to her, had been "very sick."
Too Busy to Be Sick
She came with her husband for the next consultation. He, it appeared, had also been too busy to see a doctor. A superficial examination revealed that this man had a number of obvious physical defects—an inguinal hernia, badly in need of repair, and varicose veins of both legs. Both these conditions were literally crying out for surgical treatment.
Without burdening the reader with further facts of Mr. K.'s physical condition, I shall merely state that he was the only person in that family who showed real organic illness. This man suffered from continual real pain during his work. He was objectively exhausted and he was patient. But he refused to admit the reality of his condition. It required considerable persuasion to make ths family of four understand that the unnatural order of their daily routine had brought symptomatic illness—dis-ease—to three members of the family and prevented the real patient from seeking the medical care he needed; that Lucille's tension reflected itself upon the children's lives; that the children, in spite of the loving care and devotion given them, did not enjoy the normal lives of children. In a practical sense, the extra income earned by the husband's night work was being spent on medical expenses.
Mr. K. was successfully operated on. During his convalescence, he and his family went up to the mountains for a well-needed rest and change. Later he had his working hours changed to day work. Eventually the family settled down to a normal life. It is a source of great satisfaction to me that I am able to report that this family has not needed medical care of any kind for the past five years. There is nothing dramatic or spectacular in this story, and yet, the happiness and normalcy of a family were involved. These people had actually lived "between illness and health."
The Pain of Indecision
The following experience illustrates the devious route by which a member of the so-called stronger sex may retreat into pitiable suffering when he is entrapped by the consequences of an unpleasant situation. He feels the pain, suffers from it and sincerely believes that he is organically ill. He is immediately cured when he sees a way out. It is common experience that a headache accompanies the strain of difficult emotional thinking. The proverbial headache stands for the metaphorical pain of indecision. Men and women are equally sensitive when they are forced to admit defeat.
Pride and Pain
Edward H. had suffered for several weeks from attacks of pain in his genital organs. There were no organic (somatic) symptoms, such as fever, swelling or infection. Physical and medicinal therapy had brought no relief. In his desperate round of specialists' offices, Mr. H. came to me, whether by chance or recommendation, I do not know. As the symptoms have already been described, we can proceed immediately to the emotional history.
In appearance, Mr. H. was the epitome of the successful businessman. He was truly a "man of distinction." As the interview progressed, it became apparent that he was also a person who is ever conscious of the impression he is making on the other fellow—a projection of charm, we might say, scattered generously on man, woman and child.
Perhaps he could not help his secretary's falling in love with him. At first he did nothing to discourage her. In fact, he accepted her admiration as his just due—and besides, she was a most efficient secretary! She learned his ways, his likes and his dislikes and, in time, did not conceal the fact that she was indispensable. Her position in the office became more firmly entrenched and her attitude more domineering; for, by now, the friendship had found an intimate footing.
Mr. H. squirmed under this stranglehold, but could not extricate himself. The situation continued in this manner for quite some time, until, one morning, he received a letter: "You . . . you . . . you belong to me. You will be mine—or else." With good reason, he believed that she might take his life.
This woman was strong by a peculiar sublimation of savage possessiveness which passed under the guise of devotion and love. The more she was willing to sacrifice for him, the more he relied on her and the greater became her hold over him. The slowly brewing conflict in Mr. H. reached a climax. He did not want to marry her, yet he was afraid to discharge her. His rational judgment was thrown into turmoil. He was unable to separate the fact of his sexual involvement with this woman from his fear of her and his desperate desire to be freed of the unwholesome entanglement. He believed his escapades to be at the root of his troubles. The somatic expression of his conflict was logically, but subconsciously, projected into his sex organs and symbolized by pain which was not accompanied by any symptoms of infection.
At my suggestion Mr. H. did some reading on the subject of psychosomatic medicine. He learned that psychosomatic phenomena serve subconscious purposes. Armed with this knowledge, he was guided to the understanding of his own condition. Later, he took his cure into his own hands. He convinced his secretary that he was unfit for her intentions. She resigned—and his illness vanished.
The people who have appeared in this chapter are regular persons with problems and have one thing in common: they carry the mask of sickness and do not know that they do so. They are under stress. Stress causes pain and discomfort. The result is dis-ease. Persons who live between illness and bealth need a better social adjustment and a better emotional balance. Through insight into their own intellectual and ethical make-up, they become aware of themselves and effect the disappearance of their bodily pains and aches, which are the symptoms of their disease.
CHAPTER TWO: SYMPTOMS
Symptoms are more or less alarming phenomena which warn the person of illness, impending or present. Symptoms may be physical or mental. The symptom is not the illness. A toothache is a symptom. Its disappearance does not indicate that the tooth is cured. Abdominal pains may be warning signals of very different diseases. Redness of the skin, sweating, fatigue, even pain may merely indicate stress and strain in the absence of illness. Symptoms are elementary expressions of bodily or mental conditions, of ease or dis-ease. Red skin may be a symptom of exposure to heat, or of fever, or inflammation. The same symptoms for themselves or in combination with other phenomena may or may not mean disease.
It is the interpretation of symptoms which counts. Profuse perspiration may result from any such various causes as tuberculosis of the lung, acute heart failure, endocrine disorder, change of life, psychoneurotic anxiety or many other conditions which occur between illness and heafth. The patient's interpretation of the symptom often aggravates the leal situation. The doctor's interpretation will usually be more realistic.
Hypersensitive persons may sweat profusely when they believe themselves to be the subject of criticism or discussion. Over-ambitious individuals may likewise sweat excessively when they are faced with situations of real, fancied, or exaggerated importance to their progress. Such people "break out in cold sweat"
"Sweating It Out"
One of my good doctor friends, whom I shall jokingly, but affectionately call "Dr. Sweatt," came to me as a patient. He suffered, he said, from attacks of sweating, which were violent and profuse in character and occurred unpredictably several times a day. They were so drenching that he had to carry several changes of linen with him at all times. It caused him not only embarrassment, but had also become a great inconvenience in his professional and private life. He had reached a point, where he felt that he needed help. An extensive examination and laboratory survey revealed him to be in good physical condition. There were no objective findings, and, to quote him, he was "disgustingly healthy." Yet, what had caused the sweating?
His emotional history led back many years. He also recalled that his eyesight had always been poor. Yet, because he had large, brown eyes, his parents had foolishly refused to believe that he needed glasses. He stumbled along somehow, having much difficulty in school, where he missed answers because he could not see the blackboard. Eventually, his teacher changed his seat to the front row, normally reserved for backward students. The fact that he could now see the blackboard and what was written on it helped him tremendously in his lessons. His marks improved, yet he was still kept in the front row.
He Sweats in School
In his small-boy way, he bitterly resented the humiliation and grew to dread his school day. Self-conscious, he imagined that the other children were looking at and poking fun at him, which some of them did. He assumed a show of bravado he did not feel in order to overcome their ridicule. Every question asked by the teacher became a challenge, every correct answer a victory. A current of emotional tension found its beginning during his formative years, flowing inward to be hopelessly accumulated and stored within his psyche. Deep, unreasoning distrust of authority was thus established in his mind. That early experience, together with the emotional tension, started a true somatopsychic chain.
He Sweats on Dates
In later years, as a young man and student, he had his vision properly corrected with eyeglasses. He had no further difficulties in his studies. He enjoyed the normal social life of the young college man. But when he found himself alone with a girl, for instance, on the way home from a dance, the repression of sexual emotion often caused outbreaks of perspiration. This was, in itself, a normal reaction, but he exaggerated its significance m his mind and thereby superimposed it as an additional factor on the childhood tension. In this way, every episode of sweating formed another link in the somatopsychic chain.
He Sweats in His Practice
As his work became more important and as he became responsible for his adult and professional activities, the attacks of perspiration became more frequent. In his medical specialty he had to give many intravenous injections. In female patients it is not always easy to find the cubital vein, especially when the arm is not slender. Whenever he had the slightest difficulty seeing, either in his professional work or elsewhere—for example, when he entered a darkened theater—he suffered his violent perspiration.
"Dr. Sweatt" was not hampered by an ego which refused to acknowledge a psychological basis for somatic symptoms. He was an ideal patient and it was interesting and rewarding to retrace with him the incidents which had directly contributed to forming the subconscious chain of emotional tension. It was like fitting a jig-saw puzzle together and he was able to recognize that each time, when a difficult situation arose in which a decision was his sole responsibility, or when he stood alone in performing a duty, even when he entered a room or public hall, the attacks of perspiration were his inescapable automatic response.
Psychotherapy enabled this intelligent patient to recognize the false connection which emotional thinking of many years had established between his sense of vision and his sweating apparatus. He was cured within a short time. The attacks of sweating disappeared and have not, to my knowledge, returned.
I recall another patient who reacted in a similar manner, with excessive perspiration, over certain difficulties which are apt to arise in the course of one's daily work. His trouble became most marked whenever anyone ventured to disagree with him. The chief difficulty seemed to be a personal obsession that he was:
Always the Boss
Phillip B. was fifty-nine years old and a manager of a jewellery store. His background and training did not enable him to understand the psychological situation as clearly as did "Dr. Sweatt." Phillip was unwilling, perhaps unable, to admit that the cause of his condition could lie in his personality. He refused to acknowledge the neurotic mechanism which caused his sweating. For this reason, his treatment had to be different. He was given ample opportunity to complain about his symptoms and grievances.
It soon became apparent, however, that he was unable to consider himself as inferior to anyone in any situation. His conviction that he was always right, that his opinions were always correct, made it impossible for him to admit to any of his own faults or errors. Consequently, in his daily life, any contradiction by or disagreement with his superiors was sufficient to cause him to "break out in a sweat." When I had to remind him of his myocardial damage and requested an electrocardiogram to be taken, he responded with a violent attack of sweating because he was immediately resentful of my request.
His Sweat Indicates Frustration
His emotional block was primarily removed by a talking cure. I encouraged him to talk freely and agreed with him as far as I reasonably could. Insidiously the consultations were interspersed with small, cautious doses of corrective therapeutic suggestions, delivered in sugar-coated conversation. He was never able to understand, in a rational way, why his attacks of sweating had disappeared.
In comparing Phillip B. with Dr. Sweatt, we cannot but realize that no two people are ever alike. Some are cured by one method, some by another. Medically speaking, the end justifies the means.
Pathological sweating is a neurotic symptom occurring in persons who are consciously intent upon preserving their superior positions and concealing their weakness from themselves and from their environment. These persons are literally "sweating out" the fears which they cannot master, hoping that the true meaning of their perspiration, as an expression of their actual or imaginary inefficiency, will not be understood by those who observe them.
Pruritus of the skin may be a psychosomatic symptom. Itching and tickling
sensations of the skin are often due to somatic causes, to external irritation
caused by parasites or to exposure to irritant vapors or dusts. However, it is
also a well-known fact that merely the suggestion that an insect, a flea or a louse is
in the room is enough to cause one to feel j an itch and to start scratching.
Pleasant sensations of the skin result from petting and other bodily contacts of sexual meaning. They are closely related to itching. Therefore, sexual stimulus or thought can affect the nerve paths and centers which conduct the sensation of itching. Such itching which originates in the mind of a person can be very intensive and cause the patient to scratch and thereby to injure his skin. In time, by irritation and subsequent infection, objective skin disease may result, such as impetigo, eczema and many forms of dermatitis. In this way, skin disease is truly psychosomatic. Psychosomatic diseases of the skin will be discussed later on in this volume. Here, we deal merely with one symptom of skin disease:
Helen A. was thirty-five years old and the mother of one child. She was happily married and had a nice home in a suburb. For many months, she had suffered an intolerable pruritus of her vulva, had applied every known remedy, had consulted her family doctor and skin specialist. She had received the maximum number of X-ray treatments without improvement. The psychosomatic history revealed that Helen's husband had decided that they could not afford having another child. Although his economical considerations were not at all justified, nevertheless a regime of continence was accepted, to which Helen had reluctantly consented.
The Itch on the Skin May Be Thoughts Within.
There was no doubt that Helen's pruritus was definitely psychosomatic and the result of a life situation which was at least partially self-inflicted. The abstinence from marital relationship was objectively unnecessary in view of the fact that her husband held a fine position with good income.
Her pruritus persisted, as I felt it would until a change in her life situation occurred. When, at last, I persuaded Helen's husband to return to regular marital relations, Helen's cure became permanent.
Symptoms are phenomena which appear when the life situation of a person is conflicting with nature. Symptoms stand out, when the person is unaware of the unnatural element in the situation. Symptoms without illness are especially embarrassing when they are related to one of the basic characters of the person, as in the following case:
Female By Mistake
To the casual observer, there was nothing conspicuous to the appearance of Martin G., who entered my office twenty-five years ago. He was a young man of medium height and build, fair complexion, neatly dressed. However, when he introduced himself to me, I knew instantly the reason for his visit. From the mouth of this "average young man" issued the soprano treble of a young girl.
Sensing his distress, I thought to place him at ease by saying that I gathered why he had come and that I would do my best to help him. In the series of consultations which followed, his unhappy story unfolded, Odyssey-fashion, and I retell it as follows:
She Preferred Girls
Until two months previous to his appearance at my office, he had been Martha G, a girl. As a girl, Martha had been employed by the Telephone Company as a switchboard operator. He (or perhaps we should now say "she" and, in so doing, follow the patient's experience) enjoyed her work, was efficient and well liked by her co-workers. After several years, it was noticed that she preferred the company of girls. She was much too friendly with the girls she liked. She found too many occasions to touch and fondle them. She, herself, was aware of this, but try as she might, could not control her impulses. She ran into trouble and was threatened with dismissal. Embarrassed and bewildered, she did not know why she did these things. At that time she was twenty-six years old. Men had never attracted her. She had remained unmarried by her own choice. She had been an orphan and greatly indebted to the relative who had brought her up. To be discharged from her position because of indecent behavior would have been disastrous. What was wrong with her? Why wasn't she like other girls?
Surgery Makes Her a Man
In her distress, she went to a doctor. A complete physical examination revealed good reason for her "unwomanly" behavior. She was by no means the attractive girl she appeared. She had the full sex characteristics of a man—but concealed within her abdomen. Operation was advised and performed with excellent organic results. Upon her discharge from the hospital, she was advised to change her outlook on life, to change her name, occupation and residence, in short, start life anew. Easier said than done!
She assumed the name of Martin, dressed in male attire and, with the cooperation of the Telephone Company, was transferred to the telegraphy department. In an all-male personnel environment, she was just another male employee. After this patient had lived as a girl for twenty-six years, unaware that she was not a female and after she had acquired girlish mannerisms, it was not easy to assume the characteristic behavior of an average male. The psychic reorganization could not be complete at once. The corrective surgery and new clothes could not cushion the shock and change the outlook of a lifetime from one day to the next. Gait, expressions, gestures and voice were still those of a girl. The voice was quite a problem as a high soprano was strangely out of place coming from a man, and caused more embarrassment to Martin than anything that had happened to Martha. He became the butt for office jokers, the "oddity" for shopkeepers and for that mass of human beings who constitute our necessary contacts.
Martin, at this point in our consultations, proffered many pained "whys?" Why, if he was normally male, had he passed through puberty without a change of voice? Why had he not grown a beard? Why his feminine mannerisms?
Before Martin had come to my office, he had consulted several specialists who were well versed in their respective fields and had come to the conclusion that the cause of his condition was organic (today we would say hormonal). They had decided that nothing could be done. They were partly correct, but only partly—they did not go far enough.
The factual explanation was more complex. Martin, naturally male, forced to grow up as a girl among girls, had continually struggled between his natural instincts, the unwitting acceptance of him as a girl in his home life and the cultural pressure of late Victorian mores. The struggle, inevitably, produced continual emotional upsets. True nature and emotions had not only to be hidden from environment and society, but had also to be repressed from his own awareness. Hence his adoption of feminine mannerisms. How could Martin successfully live the life of a girl if he did not repress his male tendencies into his unconscious? The answer is that he succeeded too well.
Hypnosis Answers How and Why
The disunion of Martin's consciousness was the result of the long struggle between physical nature and mind Surgical repair was not sufficient to achieve the cure of the whole person. How his life-experience could have persisted required explanation and Martin could give no explanation. It was at this point that I employed the classical method of light hypnosis which cleans the memory of repressed and hidden experiences in a "chimney sweeping" procedure and brings out "forgotten" facts more effectively than the so-called "truth drugs" of modern popular reporting.
Martin was born in a small rural community on the border between Germany and Bohemia. In later years his aunt told him that his mother had been attended by a midwife, as was the custom at that time. The midwife had decided that the baby was a girl because of the obvious absence of male genitalia. As the testicles were undescended and the penis of the new born was very small, the mistake about Martin's true sex was understandable since no doctor had seen him. He never knew his father. His mother, a sickly woman, died when he was four years old. He was placed in the care of his only living relative, a spinster aunt of middle age. She was a good woman, kindly and affectionate to the child, but discussion of personal hygiene or sex functions would have horrified her. Good girls in well protected families did not discuss such matters as menstruation. Martin grew up unenlightened. He had never been ill enough to require the attention of a doctor, periodic check-ups were unheard of and his aunt would have considered it unladylike to give more than the barest glance at his anatomy.
Under hypnosis, he reported in great detail about his early youth. The result was a convincing reconstruction of his life story. How he had always tried to be "as nice as" his favorite girl friend of the moment, imitating her tone of voice, her mannerisms, her games, her clothes. How he had never felt that he was as nice as the other girls, but tried very hard to become so. How, through the years, he had carried on the continual struggle to be what he was not, up to the time of the denouement at the Telephone Company. What had happened to this young man was that symptoms bad been produced by the conflict between instinct and cultural pressure. There had been no illness; he was not the victim of a neurosis. For a period of time, cultural pressure had subdued his normal instinct; but eventually his instinct could not be denied and broke into the open.
Martha Becomes a Father
Following the corrective surgery and with the passing of time, a light growth of normal hair distribution took place. It required eight therapeutic hypnoses before the patient was ready to accept the suggestion that the male pitch of voice was the right one for him. He was discharged, a male person in every respect and could now, without the slightest compunction, pay court to the attractive female of his choice. No relapse occurred. And, for the reader who may wonder, "Did he every marry?" . . . the answer is "Yes". . . . "Productive?" ... "Yes, two children."
Symptoms are not diseases. When a symptom is an expression or effect of illness, it should never be identified with the illness itself. The disappearance of such a symptom after or without treatment does not indicate cure or disappearance of the illness. Symptoms may occur long before organic illness has been established. As symptoms are not the disease, they should not be overestimated or exaggerated. On the other hand, symptoms may be alarm signals or alarm reactions to unrevealed pathological conditions. They often serve as guideposts on the way to recovery. Therefore, psychosomatic medicine attributes greater attention than traditional medicine to symptoms which may or may not be related to organic changes.
CHAPTER THREE: ACCIDENTS AND INCIDENTS
It is a well-known fact that carelessness and a lack of intelligent concentration on the work at hand are essential causes of most accidents. Very little progress would be made if all people concentrated their entire attention on the prevention of accidental injuries. However, as accidents do occur and will continue to happen, it is well to study some of the reasons behind the accidents in general. Accidents may be produced in many ways, but some of the most common causes are poor illumination of a place, poor vision of a person, defects of hearing and failures of the other senses, distraction of an individual's attention and certain mechanical failures which may or may not be avoidable. But whatever the cause, certain accidents are sometimes merely incidents in the course of psychosomatic disease.
In a superficial way, every accident can be "explained" by negligence of somebody. On the other hand, too little attention has been paid to the fact that accidents are also caused by and produce far-reaching psychological developments. The results of these studies should be kept in mind, lest we lose sight of the essential psychosomatic phenomena in accidents. Even a seemingly simple and localized injury is always part of a larger clinical picture in which complex psychic developments are again part of the entire condition. For example, an alcoholic person may fall and suffer some bodily injury. The alcoholic impairment of his consciousness is a cause of the accident. But the patient may fall on a divan and not be injured at all. Or he may fall into the pathway of a fire-engine and suffer severely. It is obvious that the injury which this patient may or may not suffer, depends upon external coincidence and is not biologically conditioned. On the other hand, a psychological chain of cause and effect seems to exist in the following experience:
Guilt and Self-Punishment
While Violetta F. was working as a clerk in a small real estate office, she suffered an accident: she slipped on the floor. She did not know, she said, how it had happened. Her typewriter, she continued, fell from the table as she clutched it in a vain effort to save herself from falling. In the melee, Violetta broke her right wrist.
This was a rather freak accident. I questioned her closely. Her answers were evasive, as is usual in such cases. I did not obtain a coherent story from her until much later, when she began to talk more freely. While another doctor took care of the surgical treatment, Violetta continued to consult me for various vague complaints. During these visits, I gained her confidence.
At the age of thirty-six, Violetta was still new to this country, having come here from Europe two years previously. She was a comely woman, always nicely dressed. Her air of quiet detachment gave an impression of maturity, which was decidedly attractive. She was unmarried. Since she was not qualified to follow her profession of teaching in this city, she had taken courses in English and general office work and had found a position in the real estate office. In her loneliness, Violetta had joined a rather militant religious sect, which required of its members that they become active missionaries in their daily lives.
She Heard the Voice of the Lord
How deeply her association with this congregation had affected her was not apparent, until one day, when she timidly offered me one of their tracts. I thanked her and assured her that I would read it. This simple act of courtesy on my part encouraged her, or perhaps the time had come when she was ready to talk. Be that as it may, Violetta confided in me that not long before the accident, she had heard the voice of the Lord. Watchfully following my reactions, she continued with her story, carefully explaining that it was neither a human voice nor a delusion, but rather a soundless order from deep within her, directing her, in clear terms, to go out and distribute the tracts of her church. She had devoutly promised to obey. But only once had she distributed the tracts.
On the morning of the fateful day, Violetta had awakened with a sense of uneasiness, a feeling of self-loathing for her failure to keep her promise to the Lord. This mood persisted. At the moment of the accident, she knew that this was retribution. ...
"For nine years I searched for God. I prayed until God spoke to me, saying that I should go out to distribute the tracts of my church. I disobeyed. That is why my arm was broken ... in punishment for my sin. Before God had spoken to me, I had only a 'head-religion.' Now, my religion is my true life."
After the fracture had practically healed and Violetta had not yet felt able to resume the distribution of the tracts, she said, "My wrist is better, but my throat aches. I have pains all over. I believe that demons, perhaps Satan himself, attack me."
Religion—A Real Force
Some psychiatrists might consider the entrance of demons and Satan into the clinical picture as evidence of psychosis; others, more tolerant of religious beliefs, might say that religion acted as a "shock absorber" in this patient's effort to face reality. There are also doctors who consider religion as a real force in the life of normal people, not related in any respect to the field of psychopathology.
In subsequent interviews, Violetta began to listen and to accept advice. I persuaded her that a compromise solution could include a wholesome attention to her daily life and needs and still leave her ample time for her religious duties. This would be more acceptable to the Lord than her broken arm. She agreed that God was able to exact punishment in His own way without waiting for her to give Him such opportunity.
Violetta had revealed not only her carefully concealed tendency towards religious fanaticism, but also her subconscious desire for the purging merits of self-punishment. Great delicacy and tact are required in the treatment of these patients. Supportive re-education is necessary, lest, in their discouragement with an unsympathetic world, they turn to repeat acts of self-punishment, only to end in disaster. With the publication of each new tract, Violetta now either mails or brings one to me. In this way I keep in touch with her, always mindful that this type of person needs more sincerity of understanding than most of us.
When You Are Ready for an Accident
When a person is ready for an accident, he may be unaware of the fact that his mind is in an unusual condition. Depending upon a special life situation and the need for a solution, accidental injury may easily affect the patient's emotional thinking and lead him on to the road of illness. The state of mind which leads to accidents or which is the result of an accident is rather complex. The fractured bone and the feeling of guilt are only parts of a much broader clinical picture which comprises the general condition of the i patient, his reaction to pain, to the imposed bed-rest and to those many and various consequences which may follow or complicate the course of illness after any accident. It is always a mistake to oversimplify any problem. The reader should keep in mind the fact that I emphasize only one partial aspect of the problem as I present the following experience under the heading:
A Belated Conscience
Marian N., age fifty-eight, was widowed by the sudden death of her husband, who had been a doctor with a large general practice. She was acutely shocked by his death. Her sense of loss was great and several months had elapsed before she was able to accustom herself to his absence. Her thoughts circled continually around her late husband. Though outwardly composed, she merely "went through the motions" of daily life with only a small part of her conscious self.
Eventually, it became urgent that she face the reality of her situation and take the necessary steps to continue life without her husband. One of the first changes to be made was the rearrangement of his office rooms for other purposes. In the progress of alterations, furniture was moved, new lighting fixtures were installed and the place was a riot of confusion. Mrs. N. supervised the work and should have been aware of the hazards. But, when she walked through one of the darkened rooms, she forgot about it and stumbled over a lighting fixture which had been left on the floor. She fell headlong and fractured her left ankle. The injury healed without complications.
Too Selfish a Wife
Several months later she consulted me because of a "feeling of nervousness," sleeplessness and continual pain in her left leg. Having been a doctor's wife, she was somewhat familiar with the psychology of illness. In telling her story, Mrs. N. mentioned her preoccupation with thoughts of her husband. She felt quite certain that she had not always been a good wife to him. Only she could know the many occasions when she could have been more understanding, more patient and more helpful to him during his life. His sudden death had deprived her of any chance to make up to him for past selfishness, to let him know how much she loved him. The thoughts that he had died without the comfort of knowing tormented her days and haunted her nights. Self-recriminations of this kind occupied her mind continually and had not been absent when she walked through the darkened room and fell and fractured her ankle.
The errors of the past could not now be corrected, but Marian had to regain her emotional balance. I guided her to take up some form of social service work, which she did. Thus, in her care for orphaned children, she found great fulfilment. Mrs. N. is now leading a full, productive life; and I hear no complaints of pain or sleeplessness, no vain regrets when she phones me occasionally to say hello.
Conscience Acts in Many Directions
It would be an oversimplification and only partly correct to say that this accident was caused by a guilty conscience, followed by a subconscious act of self-punishment. It is normal for a widow to contemplate her married life retrospectively in the months following her husband's passing. It is natural for her to be more deeply engrossed in these thoughts than in her household chores. It is not unnatural for her, under these circumstances, to forget an existing hazard and to fall and suffer an injury.
It is not possible to establish one exclusive cause for Mrs. N.'s accident. It may have been caused either by the mechanical hazard or by the psychological impairment, or by a combination of both. That she fractured her ankle was the result of chance, not of biological conditions. At best, this accident can be considered as an incident related to her special life-situation at that time.
In psychosomatic studies it is frequently observed that accidents are incidental to certain psychical conditions of the patient. This fact is less well-known than the opposite experience that accidents initiate diseases, both physical and mental disorders of long duration. Some patients suffer repeated accidents because their minds are in a state which prevents them from judging their situation rationally and objectively. It is often the state of mind which causes a person to become:
I met Robert S. for the first time, while he was a patient in a hospital in Germany with his fifth accident in the course of two years. I had been called in for consultation by the surgeon in charge and found Robert's chart startling. He had been first admitted to the hospital some two years previously because while alighting from a railroad car, he slipped and fractured his right ankle. Six months later the chart noted: "While hurrying for streetcar, stepped in path of moving auto—multiple contusions and abrasions, fracture left shoulder." Four months later, there was another entry which showed that Robert had slipped from the step of a streetcar in motion, was thrown to the ground and suffered multiple contusions. The interval was five months before his next accident, which occurred in getting off a streetcar, this time with resulting contusions and abrasions. In the fifth accident, he fractured his right knee and sprained both ankles by falling down subway stairs in running for a train.
As to his personal background, Robert was a clerk in a haberdashery store, was forty-three years of age and still unmarried. He appeared to be a quiet, mild-mannered person, who at first refuted the implication that there was anything strange in the frequency of his accidents. As he began to regard me on a more friendly basis, he confided that his fellow-workers were jealous of him and often played tricks so that he would miss his usual car, going home. He also suspected his landlady of deliberately tampering with his alarm clock so that he would be late for work in the morning. There were a few more suspicions, each in itself possible. But taken altogether, they impressed me as highly improbable. Soon, I became convinced that Mr. S. suffered from mental delusions which caused him to flee imaginary persecutions.
In Love With His Brother's Wife
Eventually, Mr. S. revealed his delusive ideas more freely. His brother had married several years previously and had then left Europe for the United States. His brother's wife was a pleasant girl and Robert S. would have liked to marry her himself had he been less bashful. Robert was convinced that his brother was jealous of him and hated or feared him as a rival. Each time that Robert had an accident, he had seen his brother staring at him with fierce, ominous eyes. This "appearance" of his brother had literally scared the wits out of him and bad driven him into hazardous flight.
Robert S. knew and understood that his brother was six thousand miles away in San Francisco. Still the apparition had been his brother in person. Robert knew for certain that his brother, even while he was in San Francisco, without appearing to him, hated and persecuted him by hypnotic influence. The telepathic suggestions from his brother were intended to destroy him. Robert knew for certain that his brother would succeed.
He Was a Paranoiac
This patient was definitely insane. It is characteristic for this type of paranoiac sufferers that they are very careful to keep their delusive view of the outside world to themselves. After I had succeeded in gaining his confidence, it was clear that his accidents were merely incidents in his mental disease. To those who knew him this gentle, peace-loving man, capable of performing good work as a loyal employee, was just another of those accident-prone individuals who confront lawyers and judges with some of their most difficult problems.
Nobody could understand why this man should be permanently kept in the institution to which I had referred him. While in the State hospital, he believed that his brother had hypnotized him by long distance. However, since he had never attacked anyone, he was considered harmless and released after several months' observation. Only a few weeks after his discharge, he fell or jumped to his death into the Rhine River from a bridge which, twenty years later, became the gateway for the victorious youth of the American Army. Many paranoiacs are very shrewd and exhibit great skill in deceiving even experienced psychiatrists. Errors of this kind, as reported in this experience, are not confined to German institutions of 1925. They occur all over the world and will continue to occur in the future as long as political, economic and administrative interests are allowed to overrule medical considerations. Accidents are often incidents in a longer chain of psychical or psychosomatic developments. The true significance of the incident is often difficult to evaluate. The following experience is another illustration of the problem:
Every symptom of this patient and every complaint are related to his accident. There exists an entirely uninterrupted chain of thoughts and neurological and vascular effects. The clinical development is essentially psychosomatic.
My regard for Mr. Emory P. had been one of admiration for the extraordinary intelligence and alertness which he possessed at the age of seventy. Shortly after his seventieth birthday, while out riding with his son, their car collided with another car. It was a minor accident with no serious damages. The old gentleman had struck his head on the car window and, for a few brief moments, had blacked out. In addition to a bruise and a headache he felt a little shaky when he reached home. His family insisted that he go to bed. The next morning, he was himself again but remained off his feet to be on the safe side. The following day he felt as though the accident had never happened. Yet, when he tried to remember it, he felt not quite certain whether he had blacked out before the collision and thus struck his head, or had he blacked out because of it? In other words, Was his unconsciousness the cause or the effect of the bump on his head?
An Intelligent Old Gentleman
An intelligent old gentleman, schooled to keep himself well controlled at all times, he pondered this conundrum over and over. He began to notice things about himself that he had ignored before. When he became weary, he immediately feared another black-out. When he got an occasional cramp in his leg, he suspected it to be an apoplectic symptom. When he turned his head quickly and became a trifle dizzy, he thought of hardening of the arteries of the brain and expected to drop to the floor at any moment. When he was thirsty, he suspected diabetes; when he was not, he thought there must be something wrong too. In short, Emory P. developed a somewhat hypochondriac view of himself.
His self-awareness and introspection became more intense in time and led to actual attacks of fainting and dizziness. However, thorough physical and neurological examination revealed only the natural changes compatible with his age; and considering his seventy years, he was in remarkably good condition. As time passed, he became more incapacitated. He would not ride in an automobile, used a cane when walking, dared not cross a street unless someone was with him. His feeling of insecurity increased daily. Eventually, he refused to leave the house.
Thus, within a short period of time, Mr. P. had formed a pattern of pathological behavior which was a definite chain reaction to his consequential thinking since the accident. At the precise moment when he first propounded his conundrum, his illness began. The total process took place within the person and was a true somatopsychic syndrome.
Treatment had to be highly agressive and aimed at the total person. His education had been a detriment in some ways, since it provided the food for his morbid thinking. On the other hand, it made his treatment easier, as he could understand that at his age he could ill-afford to waste his time on thoughts of fear and anticipated disasters. Gentle guidance and re-awakening to spiritual values enabled him to accept his status in life with quiet equanimity.
Not Fate—But Intellect
Not fate, but a person's intellect and will determine the course of his life. Every event, every new life situation is a challenge which is either met with a superior, objective understanding of facts and desires or is seen through a blinding veil of emotional urges. No matter how eagerly many people blame the outside world, the social environment, their nearest friends and relatives or husband or wife for every mishap that occurs, the final outcome always depends upon the person's intelligence and decision. In psychosomatic medicine, the motivations of patients always reveal the combined effects of circumstances and self-determination. The last experience of Agnes R., who was forty-five years of age, married and childless. Her story is not a happy one, nor is there a tranquil ending. A combination of personal vanity coupled with an egocentric view of the world were contributing factors in producing a psychosomatic illness which was progressive and unalterable. She would have been much better off if she had allowed some liberty to her soul, if not in business, then at least in her personal affairs. I introduce her under the heading:
One Buyer's Ego
She was a buyer in women's lingerie for a large organization which operated a chain of department stores throughout the south-eastern part of the country. Her position was important and necessitated her traveling for about six months of the year. She spent the remaining time in the home office in a supervisory capacity. One might well call her a career woman.
She Always Knew Better
She was a large woman, without being obese, commanding in appearance, smartly dressed, but with a tendency toward nervous gestures and mannerisms, uncalled for laughter, which seemed strikingly out of character in this type of person. Her self-centered emphasis of her own importance was almost incredible. There is no doubt that she was unable to accept anyone's opinion or advice as better than her own. After she had effected a good business transaction, she would preen like a pouter pigeon to the point where she was insufferable to the onlooker. Yet, she was a most efficient worker and, it must be added in all fairness, some of her high opinion of herself was justified, but not all. No one is that good!
On one of her business trips, Mrs. R. was a passenger on a railroad train which came to a sudden halt when someone had accidently pulled the emergency cord. A small piece of luggage fell upon her head and shoulders. She was jolted in her seat, slipping forward and then backward While she clutched the back of the seat ahead for support. She was somewhat shaken, but able to continue her journey. When she arrived at her destination, she rested, ate a hearty dinner and retired for the night. The following day and thereafter she went about her usual duties.
She Would Benefit from the Accident
However, Mrs. R. was not unaware that her accident had claim possibilities, and, on her return home, she immediately contacted her lawyer. It may be that her business sense contributed part of the initial stimulus. She actually, however, began to feel ill. She complained of nausea, dizziness, headaches and an inability to walk straight. She could not get up from a chair without help. The family doctor examined her thoroughly. When he found no evidence of injury or organic pathology, he prescribed a sedative and gave reassuring advice. After a few days, she felt better and returned to work.
In discussing her accident with friends, she heard of settlements for fantastic sums having been awarded in cases similar to hers. Her attacks, thereafter, were repeated from time to time until, about one year later, while at home, she was found in bed, unable to move. Her husband again called the family doctor who, after careful examination, referred her to an orthopedic surgeon because he suspected a spinal injury.
Mrs. R. was hospitalized, and after prolonged consultations and examinations, a diagnosis of injury to a spinal disc was made and related to the accident in the railroad train, which had happened one year previously.
From that time on, for four years, there followed one continual series of hospitalizations, plaster casts and braces, ending finally in an operation for a spinal fusion, which in time enabled her to perform only very limited activities. She endured much suffering and her financial outlay was considerable. She, who had been a busy, productive and highly salaried individual, now faced a life of greatly reduced activity in every way.
No More Sex—No Hope for a Child
Yet, the interesting crux of this story is that none of this suffering had to be. Riding in the same train with Mrs. R. were two hundred other passengers. All sustained the same jolt, some even more, according to the position of their seats; but none suffered any after-effects. (In her law suit against the railroad company, the defendant's attorneys made this one of the prominent issues.) A psychosomatic or psychiatric examination would have uncovered some very pertinent facts. Several years previous to the accident, Mrs. R., always a tense and slightly neurotic person, had had a hysterectomy performed. Following the operation, her neurotic reaction pattern became definitely apparent. She realized the fact that hope for a child was gone forever. Never too interested in her housewifely duties, she became more and more unable or unwilling to cope with the daily problems in her personal affairs. Soon life between her husband and herself became intolerable. It was not long before they occupied separate rooms. She suspected him of infidelity and a host of other deviations from the path of duty. Her aim in life became the accumulation of more and more money and, as she plunged herself deeper into her work and was away from home most of the time, the breech became wider.
When, several years after these prior developments, the accident occurred, it produced no immediate injury. But, in consideration of the revealing facts of her personal life, it can be understood that the accident became a severe psychic trauma which occurred to a neurotic individual already predisposed to react excessively to any kind of trauma. Thus, this patient lived in a permanent state of highstrung tension and as a result of this general strain, a local muscular tension developed, stiffening her spinal muscle into a permanently spastic condition of such tenacity that it eventually produced the dislocation of a spinal disc and ultimate invalidism.
One might say that the accident, in itself, was an incident which functioned as that proverbial spark, kindling the fire which had been prepared long before. It is interesting to note, from my recollections of this patient, that she received only a "consolation" award from the jury, hardly enough to cover her medical expenditures. If one considers the miserable life which she had brought upon herself and her husband, one cannot escape the conclusion that we become such things as our thought has fathered.
Morbid thinking also influences the course of events in the following experience, which strikes a more sympathetic chord and illustrates how psychosomatic injuries transformed life into a macabre companionship with the dead for this engineer who became:
A Grave digger
Morton G., was a chemical engineer of great promise. He possessed an engaging personality, an eagerness and responsiveness, which endeared him to all who knew him. He was happily married and had not yet given up hope of becoming a father.
Though keenly interested in his work, he knew the dangers of daily contact with chemicals and constantly strove to better the working conditions, making them safer for the men under him. They had been working with carbon disulfide, a solvent largely used in the manufacture of artificial silk, when, one morning, one of his assistants fell from an elevated platform into an uncovered vat of chemicals. Whether the man had jumped or fallen, no one ever knew because when he was removed from the vat, he was dead.
Not the First—Nor the Last Victim
His fellow-workers were stunned and shaken, knowing too well that he was, not the first victim—and would not be the last. It was left to Morton to advise the dead man's wife and to express the sympathy so futile in these circumstances. Depressed and weary, he could not rid his mind of the impression which the death of this man had left with him that here v/as another victim of toxic psychosis, the mental form of the occupational disease caused by prolonged contact with this chemical.
Exposure to carbon disulfide, over a period of time, may produce organic damage to the liver, blood and other organs. When the nerve substance is injured by the inhalation of the evaporating solvent, one of the results may be toxic psychosis. This psychosis may develop gradually and, if treated in time, the final catastrophe can be prevented. But too often the warning signals of the mental disorder are neglected and the onset may appear so suddenly, with such disastrous effects, that the result is catastrophic, as in the case of Morton's assistant. The feeling of tragedy is deepened by the fact that these accidents can be prevented by the reasonable efforts of all parties concerned.
On the day following the accident, Morton was too ill to report to the plant. He complained of headache, dizziness and extreme fatigue. He was restless, irritable and out of patience with his wife. He was depressed, but reasoned that the experience of the previous day was the cause. When the following morning brought no improvement, he went to the doctor who advised immediate hospitalization.
A thorough clinical examination revealed that Morton, himself, was a victim of occupational poisoning. In view of the positive organic findings, Morton had to take a leave of absence from his work in order to regain his health. His progress was slow and, as the months passed, his depression became more marked. The feeling of fatigue was persistent; his general attitude was one of passive resignation. Eventually, he realized that he had become sexually impotent. At long last his health began to improve, he gained weight, most of his symptoms diminished and his appearance returned to normal; but the sexual impotency remained. It was then that his wife left him. And thereby hangs the tale!
Impotency Led to Melancholy
He had accepted his illness with reasonable courage, but he could not reconcile himself to his wife's desertion and the breaking up of his home. The emotional trauma was aggravated by the lack of human understanding which the patient had to face. With the disappearance of all symptoms except impotency, the compensation insurance carriers refused him indemnity, stating that sexual impotency does not retard or impair a worker's ability or earning capacity. The company further stated that the condition affected only the patient's personal situation and could not, therefore, be subject to compensation or liability insurance.
Under these circumstances, the patient's melancholy deepened still more. His appearance became slovenly, his speech sparse and he avoided even the few dear friends who had shared happier times with him and would not now pass him by in his present misery. This fine man, once an able and responsible industrial manager, became human wreckage in a world where wreckage of any kind is tossed aside.
Religious Training Prevented Suicide
In my efforts to reach through the flotsam of this once eager mind, I spoke with his former employers. They willingly offered to re-employ him, remembering his former ability. But he refused to accept this offer with a kind of passive obstinancy that could not be broken. His mind grew more and more preoccupied with thoughts of death, which appeared to him the only means of escape. Only his religious training prevented him from suicide.
Encouraged by this remnant of spiritual awareness, I spoke about him to the pastor of his church, one of his good friends who had weathered Morton's many rebuffs, yet still remained interested in his welfare. I was convinced that Morton's rehabilitation could only be realized through active employment—the type was not important. The pastor offered him the job of grave digger, inspector and supervisor of the small church cemetery. Morton accepted with a pleased alacrity, not shown toward more ambitious offers, and so, perhaps, more piteous. The cemetery was a quiet, secluded spot; and there Morton embraced his duties with a stolid, silent preoccupation. It encompassed his entire life.
Morton Found His Peace
Later, he told me, in the halting manner of those unused to speech, that here, caring for the graves of the dead, he had found peace. They asked and gave nothing, and their caretaker asked and gave as little. It was as though he had said:
"We are the dead.
Short days ago
We lived, felt dawn, saw sunset glow...."
He was often in my thoughts; and so, years later, while en route to another city, I made a detour in order to pass the graveyard. There, bending over the mound of a newly formed grave, was the familiar figure of Morton. He barely raised his head at my greeting, hardly interrupting his work. I drove on, saddened by the contact.
Ten million accidents occur every year in the United States, permanently disabling 370,000 persons. In view of these staggering figures, accident prevention should be one of the nation's foremost problems. It is a widely spread error to believe that every accident has a specific cause.
Material causes are found in the environment. Subjective causes are covered under the heading "Negligence." Whether a person slipping on a banana peel suffers a slight contusion or a fractured skull is often considered a matter of luck. From this state of mind originates the common quotation of the injured person: "Why did this happen to me?"
Popular psychology is quick with its answer: guilt and punishment. It draws the further conclusion that an accidental injury is the ill-conceived solution to an emotional problem. This, of course, is not the final answer. There are certain antecedents to every accident which need to be disentangled, until the relation of environmental and emotional causes of the accident and of the injuries is cleared by a thorough psychosomatic interpretation of all objective and personal factors.
All accidents may leave their traces in the memory of the person and thereby become incidents in the experience of the individual which influence not only the immediate, but also the more distant future of the patient.
CHAPTER FOUR: IMPRINTS
Imprints are permanent records of emotional experience. What we learn from childhood on through life, if it is at all adherent, is preserved in our memory. As more and more imprints are accumulated, our storage capacity becomes crowded. Like microfilm records stored in a bank vault, these imprints are shelved in the deeper strata of our consciousness. From there they come to the surface and influence our actions at different phases of our lives.
Many of our actions and behaviorisms in later life show childlike, infantile and even primitive or immature characteristics. These elements of behavior become equally more obvious when our self-control (censor function) is impaired during illness and in old age.
Any adult, honestly reviewing his behavior, will observe in his daily activities in business, at home, in the barber shop and certainly in the tavern, essentially the same mannerisms he displayed in school or at play when he wanted to impress his teacher or classmates. If he pursues his review, he may, to his surprise and chagrin, discover that he often invokes sympathy for minor ailments from his wife, children or friends by the same kind of behavior which he had found to be useful when he claimed help for his school homework. Keeping in mind that imprints acquired earlier can deeply influence the reactive pattern of the person later in life, this appears to be the case in the following experience of:
The Baseball Fan
Irwin R. was sixty years of age when he was stricken with an acute heart attack. There was no history of physical strain or over-exertion and no previous heart ailment. He was a retired bookkeeper, financially independent, and enjoyed a most comfortable existence. No anatomical pathology of his heart was found which would explain the acute illness. The patient was unable to blame any special event as an emotional cause for his condition. He mentioned casually, however, that he had always been an ardent baseball fan. In later years, what he lacked in performance was more than compensated by his enthusiasm. With the advent of television he could now, in the twilight of his life, enjoy his favorite pastime without even the effort of traveling to the ball park.
He Followed Each Play
On the evening before he fell ill, he had been deeply engrossed in a game, sitting quietly in his chair. On the television screen, he had followed each play as though it were his own. An excess of emotional energy had caused his sixty-year-old heart to pound as fast and strong as that of a young ball player—and the sixty-year-old heart was taxed beyond its capacity.
This man had never outgrown the imprints of sportive competition. So deeply was this imprint engraved into his psyche that the organic (somatic) heart failure was produced by the mental strain of Irwin's imaginary participation in the game.
An imprint is not always the result of a single experience, but may be formed as the emotional conclusion resulting from a complexity of circumstances. Most imprints are the effects of environmental pressures which, by their repetition or duration, become engraved and permanent. Emotional experiences of such complexity may lead to a situation in which an imprint is the cause of:
Alfred K., a veteran of World War I, came to my office when he was thirty years old. After weathering unharmed the hazards of the war in France, he was now extremely worried because he had noticed several small lumps in his skin.
Upon examination, these lumps were found to be so small that they could be felt only by most careful palpation. They Were of no significance. Al's family doctor and several other doctors had told him so. He was, however, unable to overcome his fear that these little growths might be cancerous. He worried continually about the misery which, he believed, would be in store for him. A considerable weight loss in a few months' time further confirmed to him the malignancy of his condition.
In order to allay his fears, one of these small nodules was removed. The pathologist reported the absence of malignancy, but the patient was still unconvinced and demanded that every single one of these normal lymph glands be removed. This I refused to do. In time, I obtained the following account of his life-situation:
A Child Must Be Loved
Alfred was the second son in a family in which a strongly patriarchal attitude prevailed. His father was strict and somewhat narrow in his outlook. His older brother, physically and mentally retarded, was the center of the parents' love and attention. During his childhood, Alfred was aware of his mother's interest only when he was ill. Then, at least, her concern was for him. But his illnesses were few, short and far between.
After his graduation from school, professional training was not even discussed. He had to take an office job at routine clerical work. Later, the Army, France, then his return home with an honorable discharge. He found his office job waiting, but held it without much interest. Then he met a girl and wished to marry her. He felt he should discuss this step with his parents, but, throughout his youth, he had become so accustomed to the impression that they lacked interest in him that he refrained from even mentioning her name.
Yet, he was now an adult and since his "illness" was disregarded by the family doctor, it failed to work as the device which had served so well in the past to attract the attention of his parents upon his person. His desire for married life was not the result of sexual unrest, but rather the unvoiced search for guidance, companionship and personal independence. He consulted his minister, who referred him to me.
His Subconscious Craved to Be Ill
The serious nature of the small lumps in his skin was ruled out, as previously described. No other organic disease was present. Neither was there a truly neurotic condition. A depressing life-situation had induced the patient to attract attention by something which he sincerely believed could be a disease. The emotional experience, that attention is the result of illness, had been so often and so efficaciously impressed upon him that it had become a permanent imprint in his psyche.
In subsequent consultations, many long hidden childhood events were brought to light. Although reared in a strict home, where most of the attention was devoted to the subnormal brother, Alfred was by no means neglected or unloved. On the contrary, he was well-cared for, sent to good schools and was brought up to adhere to the principles of good faith and morals. Yet, whenever he had a problem, it seemed to him that he was alone. What could not be realized by a small boy was the fact that a home in which one of the members is not healthy is not a normal environment. Of necessity, that member demands and receives more attention than the other, healthier members. It was not different in Alfred's family. Alfred, the child, resented his parents' preoccupation with the older brother and concluded that his parents did not really love him. Gradually, he built a walled-off area in his mind, wherein he kept his thoughts and problems to himself. The members of this family lived their daily lives with each other and yet did not know each other.
A Guide to Constructive Living
According to a wide-spread psychoanalytical misconception, a patient should be cured at the time when the psychological mechanisms have been explained to and understood by him. Yet, Alfred felt that in spite of all explanations, his problem had not been solved. He was right. For the complete solution, it was necessary to guide him farther on his way, out of the clerical job which was far below his. mental ability and on to academic training and a professional career. As soon as a plan for his schooling and career had been definitely established, he forgot about the 'growths' in his skin. His weight returned to normal and his thoughts of marriage were postponed until his training would be completed.
Alfred K. was freed from an infantile behaviorism which he had carried into his adult life. He not only understood himself, but had taken positive steps to supplement and complete his education in the true meaning of this word. He would, therefore, never again fall victim to the same mechanism. Psychosomatic treatment succeeded not only in clearing the understanding of a life-situation, but it had also laid the ground for a plan of constructive living.
There could have been a tragic ending if this patient had not been helped to
overcome the retarding effect of emotional childhood experiences which had
resulted in imprints upon his psyche. He might never have accomplished the full
development of his natural talents if his enlightened spiritual advisor had not
guided him on his way into psychosomatic care.
Imprints upon the psyche may be acquired and retained at any time during life. Imprints are also established in the adult psyche as the result of shocking experiences which may occur off the beaten path of daily routine existence. Usually we are not aware of the moment when a new imprint is established. Therefore, frequent self-examinations and reappraisals of one's state of mind can be more useful if they include a search for newly acquired imprints.
In the following life-experience, an imprint was established in the patient's mind, when he was seventy-four years old. It caused him fear and anxiety for three full years before another emotional experience had the original imprint removed.
Carl D., was under medical care for a mild, chronic bronchitis, which caused some coughing and slight discomfort. These complaints would not have been so hard on the patient if he had not lived in fear that something more serious, perhaps a cancer of the throat, was the undiscovered cause. On the one hand, a man is not easily ready to voice a fear of this kind; on the other hand, few people can live with this fear for any length of time without giving it indirect psychosomatic expression.
A Terrible, Gnawing Fear
Eventually, Carl D. presented the following history: Several years previously, he had been treated for a minor ailment by an eminent throat specialist. During one of the treatments, the patient believed that the instrument, a cautery, had accidentally slipped and touched another part of his throat. It had made him jump. With the instrument still in his mouth, he could neither protest nor yell. After the instrument was removed, Carl gasped for air and this, coupled with his respect for the doctor, prevented him from loudly denouncing that gentleman. Whether the instrument had really slipped is less important than the fact that the patient believed it. Unfortunately, the throat specialist departed this life before he could convince the patient of the ' harmlessness of the incident. From that time on, Carl lived with a secret, gnawing fear that the injury could cause a throat cancer. Eventually, he admitted this fear to me.
His fears were groundless. His throat was healthy, with no visible sign of malignancy. Yet, in justice to the patient and also because I felt that the imprint which had inadvertently been produced by the first specialist could best be eradicated by another, perhaps more eminent, specialist in the same field, I sent Carl to an excellent throat man for further treatment.
The Great Specialist
This specialist, the second one to whom he had gone, after careful examination of the patient, also came to the conclusion that there was no malignancy. In order to add further reassurance to the patient, he advised a direct laryngoscopy by a doctor who was known for his skill in this, at that time, very new method of diagnosis.
This well-intended advice had an unfortunate effect upon Carl and his family. They gained the impression that the possibility of a cancerous growth had not yet been discarded. Their emotional tension increased in direct proportion to the reputation of the next specialist—the third one. Before this eminent specialist himself looked at the patient, Carl had to face an examination by an assistant.
After another week, the patient went to see the assistant, Who looked into his throat and called in still another assistant, who also looked into the patient's throat with a regular laryngoscope. These two specialists saw exactly the same thing that the great specialist and the attending general physician had seen before. In order to be examined by the most eminent specialist, an appointment was made with the patient for his admission to the hospital ten days later.
For seventeen days, the suspense continued in the patient's home as to whether there was or was not a cancerous growth and whether the patient's larynx would have to be removed by operation; whether he would have the ability to speak for the remainder of his life, should he survive at all. Finally, the date arrived and a thorough examination was made by means of a direct laryngoscopy. The final result of this examination coincided in every respect with all of the prior specialists' findings and confirmed the original opinion of the attending general physician. This time the instrument was introduced into the larynx and removed without incident or harm. All that the final eminent specialist found was an indication of a chronic bronchitis producing some phlegm and a special sensitivity on one side of the larynx, caused by a slight scar tissue which was the aftermath of the cauterization of three years before.
The Greatest Specialist
The specialist prepared his speech for the patient and his family, who anxiously awaited his verdict. In these words the patient reported his experience:
"In a manner closely resembling a First Grade school teacher trying to impress the three R's upon the wayward minds of his class, the most eminent specialist addressed me in the presence of my family: 'My dear Mr. D., I have introduced this special instrument into your throat—far beyond the vocal cords. I have been able to see far more than any of the other doctors. I can assure you, I have not seen anything. You do not have a cancer. Neither do you have anything remotely resembling a cancer.' "
It is difficult to judge the value of this procedure. Had it been planned to increase the emotional tension of the patient in order to erase the original imprint, it would have been a dangerous method. The unfortunate series of appointments, re-examinations and reappointments was caused by external circumstances, such as the over-crowded schedules of the several specialists.
It would have been sufficient if one competent specialist had quietly and scientifically examined the patient without much ado and told him that no cancer had been found with the most advanced and safest methods of diagnosis. That was what I had planned for him. Anyway, the purpose of removing the original harmful imprint had been accomplished.
Eighty-three-year-old Patient Survives
Fate added an ironical ending to this experience. Three of the throat specialists, the first one, who had originated the imprint, and two of the others, including the most eminent one, died shortly after they had seen Carl. The patient survived. He is now eighty-three years old and assures me that he "never felt better in his life."
Imprints are acquired and accumulated by everybody. They are the lasting effects of memories of emotional experiences. While the word "imprint" may convey a certain passivity of the person who receives one, it should not be overlooked that the receiving individual, according to his intelligence, either permits or actively selects the emotional experience to remain as an imprint in his mind. The memory of emotional experience may go far back into the past, so far that it may be impossible to determine whether the experience was one of the individual himself or one that was acquired by his ancestors and came down to him by tradition or ancient beliefs.
Pregnancy is a special, though transient life-situation charged with emotional situations. It is therefore understandable that imprints which might be ineffective at other times become powerful motivations during this extraordinary period of life.
A Memorable Birthday Party
Jenny T. was in her fifth month of pregnancy, expecting her third child, when she celebrated her birthday with a supper party. As the guests were seated, one of them noticed that there were twelve at the table. Another, keeping the conversational ball rolling, said, no, there was another, unseen guest—the fetus—making it thirteen. Jenny slipped quietly to the floor in a dead faint. When she was revived, her first concern was that the baby was injured. She carried this fear through the remainder of her pregnancy. In due time, she gave birth to an eight-pound baby girl, well formed and apparently normal.
As time passed, it was noticed that the child was mentally retarded. A glandular malfunction was at the root of the condition. The child died at the age of four.
Jenny was convinced that the unfortunate incident at her birthday party was the cause of the child's condition. There were no other abnormal or mentally disturbed persons in her family. She and her husband were normal and healthy and they had two other healthy and normal children. What else but the incident could have been the cause?
Is Superstition Mind or Magic?
The mother could not forget her dead child. She brooded over it constantly, sometimes blaming the guest who had counted the unborn baby as the thirteenth person at the table. At other times she blamed herself for her superstitious fear of the number thirteen. These conflicting emotions and her feeling of personal guilt eventually produced a state of mind in which an overwhelming fatigue kept her unable to care for her family and household. In appearance she resembled a hunted fugitive as much in fear of herself as of anything else.
She resisted reassurance and persuasion. An examination revealed increased blood pressure and very mild diabetes. These findings, however positive, did neither cause nor justify the mental disorder. It was obvious that other motivations lived hidden in her subconscious mind. Cautious probing brought no results. The retrograde disentanglement of the patient's thinking brought to light another decisive imprint.
When the child had died, Jenny had held her in her arms. She had looked into the widening pupils of the dying child and had seen her own image in them. At that moment the memory of a century-old superstition had flashed through her mind the belief that the image of the murderer is retained in the eyes of the victim! This was the experience to which Jenny's changed behavior and melancholy could be traced. From that day she firmly believed that she had been guilty of her little girl's illness and death.
A painstaking reeducation began, uncovering and clarifying the false concepts. Slowly, she attained a new equilibrium after she had erased the disease-producing imprints from her mind. With patience and understanding Jenny was at last restored as a healthy member to her family.
Image or Reality
Only a few imprints and their effects upon individuals could be discussed in the limited space of this one chapter. In reality, we all live under the impact of innumerable experiences to which new impressions are added every day as long as our emotional life lasts and up to the moment of physical death. At all times the person evaluates, selects and stores emotional imprints in every experience and reaction. In health and disease the person acts under the influence of all the imprints available to him. Improper use of imprints causes illness. Some disease-producing imprints are part of every psychosomatic illness.
PART 2: THE VOICE OF THE ORGANS
Breakdown is what makes the organs speak at first with a low voice, then louder, eventually screaming so loud that nobody can ignore it.
Breakdown may be insidious, slow, developing within a few days or suddenly striking like lightning.
Whether slow or sudden, insidious or violent, psychosomatic breakdown begins with organic symptoms: with anything varying between a mild, but insidious, recurring or persistent fatigue, sinking spells, loss of consciousness, coronary attack, stroke or sudden death.
In every case, breakdown is the psychosomatic expression of gradually increasing or complete disgust and despair.
The form in which any one expresses this conflict with environment and the realization of defeat depends upon the person's physical make-up. Whatever organ or organ-system is least abje to resist the strain and stress caused by the situation will become the organ which raises its voice.
The breakdown, so proclaimed, may have its cause in any situation: conflict between husband and wife, between parent and children, conflict within the person himself, the inability to make a decision or to see any way out. The result of breakdown may be psychosomatic suicide.
It is understandable, therefore, that in time of stress, as in time of business and economic depression, many more people suffer from psychosomatic breakdown than ordinarily. Any black day on the stockmarket, if the day is only black enough, may fill the waiting rooms of physicians. The lower the stocks, the higher will be the blood pressure in some persons. In other people the blood pressure may come down Very low. Some persons react with increased tension, while others show sinking resistance and a passive form of suffering in their breakdown.
Any of the psychosomatic experiences discussed in the following chapters may primarily or ultimately be understood as different forms of breakdown. When the pressure from creditors becomes unbearable, separation and divorce threaten as results of economic failure. The loving eye of the mate may be drawn into a different direction toward a better-filled pocketbook.
Causes of Breakdown
Breakdowns affect big and little people alike. There is no relation between a breakdown of a person and the amount of money lost. The real cause of the breakdown is the emotional evaluation which a person applies to his life situation. The loss of money may mean nothing to one person, but he may break down because he feels, rightly or wrongly, that his failure in business has destroyed the respect which his wife or his community granted him in the past. The employee who is demoted from stock clerk to porter may suffer a more severe breakdown than the investment banker. The latter, after the loss of a few million dollars, may still be able to keep up his office in Wall Street and his apartment in Park Avenue, even if he cannot afford the electric bill and has to sit with his family all evening under one single twenty-five-watt bulb, as I have seen it occur with a patient when he started treatment.
CHAPTER FIVE: THE SKIN
The skin separates the physical person from his environment and serves as an organ of communication between the two spheres. The skin is the most important organ to receive and transmit erotic sensations. We know from experience that applications of heat and cold, massages, even the slight contact with carbon dioxide or other gases in a bath or with electric currents produce stimulating or quieting effects. The slight touch of human skin is felt as an erotic stimulus. The skin of, the sex organs, of the breasts and of certain other skin areas, is most responsive to erotic stimulation.
Ancient Hindu literature records the means of erotic stimulation and the reactions to erotic contacts. They are described with scientific objectivity and, in order of their increasing effect, form a system of erotic practice. This knowledge is part of the training for professional courtesans and reminds one, to some extent, of the rules and regulations which we establish for sportive activities in our civilization of today.
Love Is Practiced Like a Game
Love of this kind is practiced like a game. The Hindu courtesan is taught how to attract and reject, how to lure her partner into passion by one first kiss, which is followed by a long sequence of well-planned, orderly arranged kisses, each one differing from the last and from those still waiting for him. The contact between two bodies and the specific sensitivity of the different regions of the body are all described in a kind of textbook or code of love making.
The Sensitivity of Skin
The touch of skin produces and expresses some of the deepest and most mysterious feelings. It is thus rather astonishing that it took several thousand years for medical science to rediscover this knowledge. It is considered news, when the New York Times of Sunday, August 31, 1952, reports from a medical journal currently quoted that psychic factors were involved in 78 percent of patients with skin diseases, who had been selected at random. Among others, the fish skin disease (erythrodermia ichthyosiformis) has favorably reacted to psychosomatic treatment.
The skin reacts in different ways to touch, pain, temperature and friction. Most obvious are the vasomotor changes which produce paleness or redness of the skin. Swelling or contracting of the skin results when, instead of the blood stream, the current of lymph supply is either increased or decreased. When such changes persist over a long. period, trophic disturbances take place and the skin may then become either chronically undernourished, dry, pale, thin, wrinkled like parchment, or swollen and reddened, thickened and hypertrophic as in elephantiasis. Certain chemicals, such as histamine and acetylcholine, have marked effects causing conditions known as urticaria (hives) and other allergic reactions of the skin.
The skin gives expression to psychological changes in the person. A feeling of inferiority, of guilt, shame of fear produces blushing, flushing or pallor. These vasomotor reactions occur especially when the feelings produced are the result of sudden impressions or impulses. They are normally of short duration. In special conditions, such as psychotic elation or in recurrent anxieties, the elated or fearful emotions and their expressions by the skin may be of long duration and may become permanent and persist after the emotional changes have subsided.
Hypnosis Links Skin and Brain
We know how to interpret changes of the skin as expressions of emotions and of the state of mind. It is possible to suggest to a slightly hypnotized person or even to one who is entirely awake and in perfect health, sensations of the skin which are not caused by actual physically adequate stimuli but by the pure imagination of such. It is an easy matter to make a group of persons feel an itch by the suggestion that insects are around or that there is an irritating gas or dust in the atmosphere. Skill of the hypnotist and readiness on the part of the hypnotized person to respond must combine in order to produce a second-degree burn on the skin of that person merely by the touch of a coin of ordinary room temperature.
It is helpful for the understanding of the skin as the organ of surface expression to keep in mind that the skin is not one organ, but an extremely complex system in which practically all other organs of exchange and transmission have their specific receiving and sending elements. So many functions are involved that it is impossible to give a complete list of them. Mention of a few may suffice to illustrate the complexity: the nerve endings, the capillary system, the glands and other circulatory mechanisms which serve perspiration, respiration, the exchange of heat and chemicals and the production of specific fatty substances which protect the skin.
It can also be stated that many and various motivations may produce different skin diseases. If I were to attempt completeness, the subject of psychosomatic skin diseases would alone fill a volume. I may refer the reader to the skin symptoms which are mentioned elsewhere, especially in the second chapter of this volume. In the following pages of this chapter I shall confine the subject to a few life-experiences before I close with a brief summary of the most elementary factual knowledge of psychosomatic skin disorders.
The following life-experience of Mrs. Sophie C. illustrates the presence of the psychic factors which produced a dyshidrotic eczema of fourteen years duration.
Rash Marriage Produces Rash
Sophie C. came to my office with both hands encased in bandages. For fourteen years she had suffered from a dyshidrotic eczema for which she had been treated by many doctors. The condition had been intermittent. But now the periods of relief were becoming shorter and the attacks increasingly severe. During her well periods she worked as a stenographer in a law office. Once more she was forced to take a sick leave.
At a time when it seemed to be the fashion to attribute nearly everything to an allergy, Mrs. C. suspected that she Was allergic to (1) paper, (2) carbon paper, (3) typewriter ribbon used in her office and/or (4) her nail polish. Numerous careful tests for allergy had been found to be negative. Yet the condition had persisted and permanent cure failed to be realized.
With an air of "I'll try anything once," she eventually consulted me. Four days after her first visit, her condition showed signs of improvement. In seven days, the dermatitis had disappeared. The psychological effect of the contact with a different type of doctor was undoubtedly the cause of this rapid improvement. But it was equally obvious that this was not a cure—and I told her so—with the result that the patient began to understand that this skin disease was greatly influenced by psychic factors. Referring to her past experience, Mrs. C. could be convinced that the recent relief was not the end, but rather, the beginning of her treatment. With this first step accomplished, we proceeded to her "second history":
Mrs. C. was one of a family of twelve children in a home where a strict religious upbringing had dominated her daily life. Her parents were good, hard-working and pious and took very good care of the children. As the patient grew older, she felt that their goodness was overshadowed by their sternness.
She Escaped into Marriage
It may have been the unformed desire to escape the puritanical atmosphere of her home life that sent her headlong into marriage with the first boy who showed her some affection. Since he was an unskilled laborer who, at his best, provided only a meager living, Sophie went to work in order to augment the family income.
At first all went well. However, in an effort to coincide her work with her married life, she ran into difficulties. By mutual consent, the desire for children was postponed to that indefinite day "when they could afford to have them." Mr. C. was practical in matters of birth control; his wife was not. She was hesitant, inhibited and full of misgivings. Moreover, ! she feared the challenge of childbirth. The ensuing state of mind was a composite fear of pregnancy, a fear of her natural desire for motherhood and a fear of birth control as a breach of her religious tradition.
Eleven years of marriage founded on such a basis meant frustration for both husband and wife. These years were interspersed with numerous minor illnesses for Mrs. C.—a diarrhea, disturbances of menstruation, one or two miscarriages and, of course, the eczematous eruptions of her hands.
Eczema, Sprees, and No Children
During these years, her husband found an outlet in occasional "sprees," which ended in drunkenness and argument. After each of these episodes, all was forgiven and life went on as usual. His jobs and income eventually improved and with money difficulties overcome, Mrs. C. was obsessed by an apparently sincere and urgent desire for children. But after eleven years of birth control, she was convinced that she could not have a child of her own and filed application to adopt one.
The next three years held high hopes for the future—the adoption of a child, improvement of marital relations and the founding of a good home for the child and themselves. As it is not an easy matter to adopt a child, Mrs. C. soon learned that there were many obstacles to overcome. The adoption agency was inclined to doubt Mrs. C.'s inability to become a mother; they noted the difference in religion between the couple and objected vigorously to Mr. C.'s drinking bouts. Sophie's assertions that after they had the child "things would be different" were to no avail. The home in which a child is placed for adoption must be worthy before the child is placed there. The authorities obviously did not believe that Mr. and Mrs. C. had that kind of home.
Each time a new obstacle presented itself, Mrs. C. suffered a recurrence of the skin condition. At one time, abdominal colic and at another, a severe indigestion coincided with the attacks of eczema. Meanwhile, her husband's drinking sprees became more frequent. Sophie C. lived her broken, disordered life in relays of disappointment, sickness and so-called "health."
Tragedy Brings Healing
One day, nearing their fourteenth anniversary, on his beclouded way home after a spree, Mr. C. was killed in a traffic accident. This was a deep shock to Sophie. She sincerely mourned him as befits a good and loving wife. Let it be added, however, that she did not throw herself on his funeral Pyre. No, strange to relate, four weeks after his death, the last and final relapse of the dyshidrotic eczema healed.
The patient took care of her business matters with great dispatch and went to live in the home of one of her sisters, who was happily married and the mother of four children. There, within the circle of a harmonious family life, surrounded by her young nieces and nephews, she found satisfaction and contentment. No relapse of the skin condition has occurred in the past seven years.
It may appear to the reader that an "Act of Providence" contributed to Mrs. C.'s situation, and supplied her with that element which assured her of the required stability in order to eliminate any recurrences of the condition. Never can it be the doctor's domain to interfere directly with the environmental conditions of the patient. The doctor can guide the patient toward adjusting or accepting the existing circumstances. The psychosomatic patient always remains the person in his own right, who either accepts or rejects the doctor's advice or suggestions according to his (the patient's) own intelligent understanding and free will.
Some psychosomatically inclined specialists have said that these emotionally maladjusted patients are often the vain, the overly ambitious; those afraid of failure, of being hurt, of showing their fear, and afraid of their own impulses. But life and motivations are much more complex. I cannot accept any oversimplification of human motives or the standardizing of .individual persons.
Patients Are Individuals, Not Types
Two persons are never entirely alike. Not even identical twins are truly identical. They are never more than similar. The difference is decisive. When two most similar individuals face the same situation, their reactions will be different. Therefore, it is a strictly objective and scientific fact based on observation, not on a philosophical dogma, that individuality exists. Every individual patient is a singular individual, according to this special and unique bodily, mental and spiritual characteristics. Many people may face similar life-situations. Not the similarity is decisive, but the difference which exists between the individual persons. Every patient exists only once.
It has been said that "a change of places and a change of faces" is a good tonic for everyone. Certainly the reader will agree that, in Sybil O.'s life-situation, they contributed much to her peace of mind and happiness. And thus I introduce her under the title:
The Skin Speaks Out
Sybil O. resented the flat, oval, shining, light red spots which had disfigured her lovely skin for some time. In the throes of an attack, the patches covered the extensor surfaces of her legs as well as the inguinal and genital regions. They alternately oozed an unpleasant discharge or were dry and scaly. Each attack was sudden, accompanied by nervous irritability and wild dreams. It was a matter of conjecture whether these nervous symptoms preceded or followed the outbreaks which lasted for weeks, sometimes months. However, as these attacks persisted and increased Sybil became subject to spells of uncontrolled weeping, which left her limp and exhausted. In her discouragement of ever becoming permanently cured, she changed from the latest of a long line of skin specialists to a psychosomatic physician and came to see me. It has been my experience that patients in conditions of this type seem to sense that their emotions have something to do with their trouble. Otherwise they would not think of going to the office of a psychosomatic specialist. They are not seeking a general stereotyped diagnosis of their problem, but are looking for help and understanding. The specific emotional cause of the illness must be brought to light and a psychoanalytical approach, however condensed or shortened, is the first step, to be followed by encouragement and reassurance that absolutely nobody—neither father, mother, nor family— will ever be told about their personal fears and uncertainties. It took me three of these preparatory interviews before Sybil was ready to confess completely and without reservations the things which were preying on her mind. She revealed the following secret history:
The Cause of the Evil
The only daughter of a minister, Sybil had grown up in a harmonious home, somewhat over-protected by her parents and by the social restrictions which life in a parsonage imposed upon its inhabitants. In spite of her sheltered existence, temptation had found its way and once, Sybil had "sinned." She could neither forget, nor had there been anyone to whom she dared confess her transgression. The burden of her "sin" and her natural scruples were her constant companions by day and night.
A few weeks after the event, a small patch of eczema had appeared in her inguinal region. In panic, she feared that she had contracted a venereal infection. Yet, the simple matter of consulting a doctor who would have dispelled her fears was denied the girl because she, like Caesar's wife, had to be above reproach.
At first the inguinal eczema did not spread. It even disappeared at times. With each respite, hope soared, only to be downed by the inevitable relapse. The turmoil within her boiled fiercely. After a year of secret suffering, the eczema moved from the inguinal area and instead, broke out in ugly patches on her elbows and wrists. It could no longer be concealed. The family doctor was consulted and conscientiously labored with practically every remedy listed in the pharmacopeia, but without result. He then referred his patient to a dermatologist. The following two years saw a long succession of specialist after specialist with unvarying monotony—no result.
Sin and Secrecy
Sybil, meanwhile hiding emotional turmoil beneath an inexpressive surface, had kept her secret. The self-imposed secrecy, repressing emotions deeper and deeper into Sybil's personality, was bound to take its toll, until I could begin to disentangle with her the network of her confused emotional thinking. One must bear in mind that the complexity of her fear of exposure, the constant argument of an unrelenting conscience and the paradoxical bitter-sweet memories of her transgression inevitably produced emotional chaos. Her mind was like a stage on which her instincts, memories and judgment were as actors discussing the pros and cons of what had happened—the possible consequences, the considerations of religious and moral guilt and the conflicts between the law and the social demands. These arguments were often excited and jumbled. Particularly at night, when her defenses weakened by sleep, she became the tormented victim of her turbulent conflicts.
"The Doctor Confessor"
For the first time in years, Sybil was able to discuss her situation in the cool and objective atmosphere which is the characteristic premise of psychosomatic treatment. She learned to see her guilt with a sense of proportion; she could be told that her self-punishment served her mainly to relive her sinful experience over and over again; that her self-torment was not the kind of punishment that would relieve her conscience; that full repentance is a matter of the spirit and not of the autonomous nervous system alone; that I could help her to quiet down the latter by suitable medicine; but that her moral and spiritual equilibrium needed to be restored by insight and purification of her soul.
Eventually, I suggested a change of environment. Sybil welcomed the idea but her parents were against it. The helpful suggestion became a weighty problem to be discussed ad infinitum in and outside the family circle. Unsuspecting relatives and friends were drawn into the debate. It was truly a tempest in a teapot. In this new situation, Sybil, at long last, was able to give voice to her long pent-up emotions. It provided the pretext for the prolonged spells of weeping which were puzzling to the family physician who murmured something about "emotional instability," while the harassed skin specialist found these spells hopelessly unmanageable. Little, indeed, could be expected from dermatological treatment. Nor was there need for deeper psychoanalysis. Without giving away the true story, I found it not too difficult to explain Sybil's parents, both of them fine people desirous of their daughter's welfare, that their child's emotional outbreaks aggravated the skin condition and that a change of environment, rather than a change of climate, would be helpful.
Two months in a summer resort gave her time in which to readjust herself and to concentrate on her future rather than her past. She began to see the emotional experience which had been hers in a more realistic perspective. It was not long before the skin condition had completely disappeared and her peace of mind restored. Her medical confession had been her cure.
Warts Yield to Courtship
Warts have been treated for centuries by what we would today call superstitious or magical methods. In 1927 Bruno Bloch reported that 44 percent of common warts and 88 percent of the plain juvenile forms of warts have been cured by psychotherapeutic suggestion. It seems that a century-old experience is not pure superstition. It is now widely accepted that doctors can cure warts by suggestion.
I remember one patient, Elizabeth T., with warts cured by suggestion. Elizabeth entered my office on February 6, 1925, accompanying another patient who pretended to suffer from somnambulistic compulsions. This patient was not cooperative. I paid more attention to Elizabeth, who had introduced her. This lady had a number of small warts on the back of one hand. I looked at these warts without being asked to and mentioned that they should be removed. Elizabeth was offended because she believed that she had not made the good impression upon me which had been her desire. When she returned a few days later, her warts had become inflamed and, after another five days, every one had fallen off. The psychic shock caused by my critical and disapproving remark, together with the threat of surgical treatment, had produced this cure. Elizabeth later became my wife.
Occupational Skin Reactions
A chemist in the Kaiser Wilhelm Institute in Berlin, 1916, had only to pass the open door of a laboratory in which a technician worked with the smallest quantities of arsenic compounds in order to suffer immediately a violent attack of dermatitis of face and hands, i.e., the uncovered skin of his body. This was a true allergy. The reaction of this man was entirely different from that which more commonly occurs in occupational exposures to arsenic compounds. The reaction was specific in so far as none of the many other chemicals which this chemist used in his work caused him any discomfort.
If the Allergy Is of the Mind ...
This allergic reaction, of course, is a purely somatic process, comparable to the formation of antibodies in infections. Nobody considers smallpox vaccination as anything but a somatic process. It is not produced by psychic or psychological factors. The antigens, antibodies and specific reactions of the body proteins are strictly somatic. Many conditions which are called allergic in popular use and even in medical papers are not truly and specifically allergic. Different terms, such as pathergy, metallergy, idiosyncrasy, hypersensitivity and hypersusceptibility have been proposed to cover both non-allergic situations and ignorance with regard to the psychic factors involved.
I have seen many thousands of patients who sustained occupational skin reactions to physical and chemical exposures. For every individual patient a thorough systematic history was established, which included a complete list of the occupational and other exposures to which the person was subjected in his employment and in everyday life. Any possible predisposition toward eczema, dermatitis, asthma or other allergic reactions was investigated and the family history carefully taken into consideration. Among these several thousand patients with polyvalent sensitivity, there were only a very few showing specific hypersensitivities.
. . . Use Salve on the Soul
Many of them were men or women with unmistakable signs of general fatigue, caused by over-strain, family environment, monotonous working conditions or economic factors. Frustrated love, emotional inhibitions, psychological conflicts and mechanisms of the most diversified types and disappointments in their careers or professions were most often found to be present in addition to the industrial exposure. When the patients became aware of the influences upon their psyches and learned to face them, their skin conditions healed within a short time.
As many of these patients came to me after they had been treated unsuccessfully by skin specialists, it occurred from time to time that I had to face objections from members of the medical profession. They contended that I "had not done anything for the patient that they had not done before." They were only partly right. They had persistently ignored the psychic factors which, under my treatment, had been most carefully brought into effect.
Psoriasis resists almost every known method of traditional treatment. Certainly not many patients with psoriasis can be cured by psychotherapy or hypnosis. Nevertheless, it is not unreasonable to try the individual psychosomatic approach and to look for the cause in unconscious tendencies of guilt, fear or other complexes. If the psychosomatic approach does not produce the cure of this condition, it may remain an open question whether the doctor has been Unsuccessful in his efforts to uncover the psychic etiology, or whether the psychological motivation was not essential as the causal element. Improvement or cure of psoriasis by treatment under hypnosis has also been reported in scientific medical journals.
Psychosomatic phenomena of the skin cannot be experimentally and intentionally produced in all persons, but only in those so predisposed. Experimental research and clinical observations have contributed objective and convincing evidence for the effectiveness of psychological factors in skin diseases:
Chemistry Links the Skin to the Mind
Purely psychic suggestion may produce pruritus, delusions of parasitosis, phobias of syphilis or cancer, "goose-skin," sweating and changes of the circulation, paleness or redness of the skin and blisters filled with serous fluid. As mentioned previously in this chapter, it is possible to produce second-degree burns in certain individuals without the application of heat by hypnotic suggestion.
Psychic factors predominate in neurotic sores and dermatoses, in excessive perspiration which may or may not be accompanied by eczema, in hives and in other conditions which are often erroneously listed as allergic.
Emotional instability, resulting from psychic disorder or emotional shock, frustration or deprivation, is at least partly involved in pathological loss of hair, in the graying of the hair and in different forms of vesicles as in shingles (Herpes), as well as in the loss of the pigment of the skin appearing as white patches (vitiligo) surrounded by the darker colored healthy skin. Warts are known to disappear after suggestion therapy. This is correct for some types of warts and some individuals; not generally.
Experiments have proven that some of these phenomena are caused by the presence of histamme-like or other well defined (cholinergic) substances or by stimulation of certain areas of the cerebral cortex. As the skin may act as an organ of expression and of communication, both functions may be affected by nervous mechanisms, by substances such as histamine, adrenalin or acetylcholme, by the overactivity or lack of hormones, by metabolic disorders such as high or low blood sugar, by diabetes, obesity, leanness and otherwise.
If patients suffering from skin diseases knew of the significant promises inherent in psychosomatic treatment, they would undoubtedly apply much sooner for such treatment, especially when traditional methods have been without result.
CHAPTER SIX: RESPIRATION
The lungs of an adult human being weigh between two and three pounds. The respiratory surface of these lungs would cover the floor space of a large room measuring approximately twenty by forty feet. The intake of oxygen and the output of carbon dioxide and water in the form of humidity of exhaled air take place on this tremendous surface at the rate of four to ten quarts of air exchanged per minute. Under physical strain or during fever, the volume of air breathed per minute may reach a maximum of fifty-five to sixty-six quarts. This is one essential part of the inner surface of the human body.
Breath Is Life
The air we breathe was once as invisible and intangible to man as is the soul today. In fact, the air was believed to be closely related to the soul. The Greek' word "pneuma" was used for both the air of the atmosphere which we breathe and the spirit which penetrates all parts of the living body. This belief lasted for several thousand years. It is therefore understandable that modern man preserves in his mind the memory of the belief that breathing, life and soul are most close to one another. About two hundred years rpo, modern science discovered evidence of the material character of the atmosphere and the importance of oxygen for the maintenance of life.
Disturbances in respiration produce the most severe forms of anxiety. Immediately upon lack of oxygen, the functions of the heart, nerves and tissues are affected. The inner process, which connects the intake and transmission of oxygen to the organs and tissues with the anxiety which follows any disturbance in inhalation and exhalation is one of the most elementary psychosomatic mechanisms.
This inner process also works in the opposite direction (somatopsychic). Anxiety directly impairs the physiological function of breathing. We find it natural that our form of breathing changes when we feel anxiety. Therefore, any state of anxiety caused by external events alters the normal process of breathing.
Psychosomatic Effects of Breathing
Fear and anxiety lead to contraction and dilation of blood vessels of organs throughout the body, thereby impairing the normal flow of blood. Recurrent or permanent emotional tensions cause lasting interference with the internal respiration and are secondarily followed by changes in the frequency and depth of breathing. Accordingly, the ventilation of the lungs may become greater or less than normal. The direct physiological effects of anxiety upon respiration, circulation and metabolism may be extremely significant. What is true of anxiety applies to other emotions as well. Thus, the physiological relationship between emotional thinking and respiration explains the psychosomatic role of the respiratory organs. It can therefore be understood that mental and emotional motivations may directly produce acute attacks of "air hunger," or asthma, as well as other diseases of the respiratory tract.
Twenty-five years ago, most doctors denied the psychosomatic character of respiratory illness. It is hard to believe that even today, only a small number of practitioners and specialists will admit the possibility of the psychosomatic character of tuberculosis, bronchial asthma, bronchitis, hay fever and related affections. Many of them do so only with the greatest hesitation and reluctance. Many more are inclined to dismiss the psychosomatic character of these disorders as the belief of superstitious individuals and cultists. The point may be stressed that psychosomatic medicine is not a matter of belief. It is based upon the knowledge of the inner processes which cause illness. Time and further study of the inner process in respiratory disease will be required before the concept that emotional thinking can affect the respiratory organs is generally accepted.
Not every respiratory disease, but every individual illness may be psychosomatic under certain circumstances. Tuberculosis, bronchitis and asthma—all of which are related to infection by more or less specific germs, to exposures or to organic defects—may be essentially influenced or modified by psychosomatic factors. It is in this sense that I discuss these diseases in the following pages.
Spiritual Starvation Caused Tuberculosis
Tuberculosis: The fact that spiritual starvation of the soul can be a cause of disease and death was familiar knowledge to few physicians in the beginning of this century. It was neither accepted by the profession nor taught in medical schools. In 1923, the president of the Medical Society of Dresden (Germany), criticized me sharply for presenting psychosomatic ideas which, he said, should better be left to lay healers and quacks. The subject has at least been recognized as being worthy of the attention of scientific physicians today.
The following paragraphs are a condensed translation from one of my books, written in 1923, wherein the psychosomatic character of pulmonary tuberculosis was clearly portrayed in the life-experience of a young man, whose pitiable story I shall call:
Frail of Mind
A young man attracted the favorable attention of his teachers and friends because of his truly outstanding talents and his unusual depth of feeling. Unfortunately, the young man believed that this attention was not based on an accurate estimation of his personality and intentions.
When the time for him to choose a career arrived, the well-meant pressure and influence of his family's wishes, together with the equally well-meant misdirection of his teachers, forced him into a line of work to which his every instinct was alien.
At every turn he was frustrated in his longing for intimate understanding. A stronger personality would have fought back and would either have accepted or totally rejected the challenge of his environment. The boy was not of this calibre. He was sensitive and weak, ill-fitted for battle of any kind. Like a tender flower, he would have needed support and encouragement from those around him in order to put forth his best accomplishment.
The Path of Least Resistance Led to Death
Soon he began to ail, his illness progressing rapidly into tuberculosis. With no desire to fight back he succumbed and died at an early age. Such a pity, said everyone, that one so talented, with so much to live for, should die so young. Yet, in truth, the boy was lonely and misunderstood. Quietly he took the path of least resistance and passed from this life. His soul's longing had found somatic expression in pulmonary tuberculosis.
The fact that emotional factors and deep-rooted psychic conflicts play a considerable role in the etiology and recurrence of tubercular conditions and in their progress of recovery has been supported by considerable evidence through more recent research. We know today that we must look for that second history hidden behind the usual "case record" on tuberculosis of the lungs. The resistance of tubercular patients against treatment and preventive measures is part of the psychosomatic chain of tuberculosis of the lungs. The disease is the patient's morbid solution of his problem. Keeping this fact in mind, the reader will need no other explanation for the following experiences:
Another patient, Theodore L. had come to this country as a robust, ambitious youth of sixteen. With determination and hard work he raised himself to an enviable position in the real estate field. At the age of thirty, he married and, as the saying goes, was "all set."
Then came the depression of 1929. He lost his holdings, investments, his beautiful suburban home; everything. Still young enough and with characteristic determination, he started over again. No job was too menial—dishwasher, porter, laborer—anything that brought a dollar was welcomed. He was neither discouraged nor ill, when, four years after the depression, he was still struggling for a living.
His wife, however, felt cheated. She had married a successful businessman. She had enjoyed a comfortable existence in her beautiful home with her fine clothes and her well-to-do friends. Now the wife of a common laborer, she had nothing but work and hard times. She did not enjoy privation and, blithely overlooking her promise to stay "for better or for worse," deserted him.
His emotional props swept from under him, he suffered a nervous breakdown. Two years later, still unable to regain his emotional equilibrium, he was found to have tuberculosis.
One more patient, Bertram T., may be introduced here because his emotional background is an illustration of the psychosomatic motivation by which somatic symptoms may be disregarded (repressed into the subconscious) in the presence of an absorbing preoccupation with a life-situation. The recovery which he accomplished was accompanied by a psychological adjustment which might well suggest that.
Humility Arrests Illness
When Bertram T. came to my office he first gave me his physical history. There had been several bad colds during the previous winter which he had treated with home remedies and which had left him feeling "very washed-out." These colds had been the first symptoms of pulmonary tuberculosis, which had been diagnosed in a recent pre-employ-ment examination. As a result of this event, Bertram failed to get a very desirable position.
His disappointment with his situation had been the beginning of a deep and lasting mental depression, which did not improve under the reassuring sympathy of his wife nor in discussions with his family physician. The following is the psychosomatic chain of events, which can be traced to the accompanying motivation of his course from health to illness:
At the age of thirty, Mr. T. had been well-adjusted, successful in his position as salesman and happily married. When he was advised that the cause of his childless marriage lay with him, he willingly underwent hormone therapy but with no results. Supported by his wife's sympathetic understanding, he tried to accept his condition as God's will, but all the philosophy in the world could not pacify his innate sense of failure.
His attitude toward his wife became one of continual apology. With friends and business acquaintances he maintained an air of worried detachment from everyday matters, which they tolerated good-naturedly without knowing the real cause for his attitude. Brooding over his condition, he lost interest in his work with a consequent drop in his sales efficiency. After his masculine ego had suffered this further blow, he decided to look for another job. It was at this point that the above-mentioned pre-employment examination revealed an early pulmonary tuberculosis.
When Fertility Fails
What had happened to Mr. T. can be readily understood. During two years of almost exclusive preoccupation with a life-situation which denied him the fruits of his marriage, he had at first indulged in a refined self-criticism. Later, as the finality of his condition bore into his consciousness, he had been filled with a deep longing to compensate for his physical deficiency by unreasonable aggressiveness and ambition in his business dealings. The latter exceeded his abilities. In line with this tendency of emotional thinking, he ignored the frequent colds of the preceding season.
During the psychosomatic consultations, Mr. T. gained insight into the welter of sickly thoughts to which he had fallen victim. He realized that his former introspection had magnified the importance of his sterility beyond all proportion. His understanding brought relief to an emotional tension which had lasted for two years. With this advantage gained, the physical signs of increased temperature, night sweats and cough gradually subsided and he took a decisive turn for the better.
The organic history of a disease and the second history of emotional content are both essential in the effort to re-establish the harmony of the person. Each patient presents an individual problem and requires a specific effort to determine whether and to what extent the parallelism between the organic and psychic elements may be of causal significance or merely coincidental.
The same problem confronts the physical in cases of bronchitis and asthma. When these diseases respond promptly to traditional treatment, no psychosomatic problem need be suspected. But when all therapeutic efforts have failed to relieve the asthmatic attacks of the patient, when there are relapses again and again and again and when the diagnostic efforts do not reveal sufficient organic and somatic causes to explain the recurrences, then the attending physician cannot afford to ignore the psychosomatic aspect of his patient's condition. Just such a patient I may call the:
Bruno von der A. was a rather diminutive patient. He was four years old, small for his age and retarded—one of the most pathetic children I have ever known. When he was first brought to my office, he reminded me of a little animal, suspicious of my friendly overtures, turning his head quickly at the slightest noise and continually shrinking against his nurse as if for protection. In the report on the child's condition, it was stated that he neglected his food under the strain of his emotional imbalance. He cried for hours without apparent cause. Like a much younger infant, he took every object into his mouth. He spoke an unintelligible baby talk that defied comprehension. His sleep was interrupted by attacks of tremor and crying. The overall picture was one of illness and retardation. His general condition was explained as being the result of the frequent and severe asthmatic attacks from which he suffered and which had resisted the therapeutic efforts of several previous physicians.
A Small Child's Neurosis
The following psychosomatic approach brought forth evidence that the general condition of the child was not the result, but rather the cause of his resistance to traditional methods of treatment. The child was organically sound. The signs of bronchitis, occurring in the intervals between the attacks of asthma, and a minor irregularity of his heart appeared insignificant in proportion to the general impression of severe illness.
In the unfamiliar surroundings of my office, Bruno broke into terrified weeping, wildly clutching at his nurse when I attempted to continue my examination. Therefore, we decided that future visits would be in the patient's home. By following this plan, I expected to get a better opportunity to observe the child in his usual environment. From what I could gather in this first visit, the child appeared to be a member of a cultured, well-situated family.
Emotions Are Contagious
In several of my visits to the home of this patient, I gathered the information I needed in order to piece together the psychosomatic history of this family. A young child does not directly react, in every respect, to the challenges which come from his environment. He reacts, rather, to the emotional life of his parents. As emotions are contagious (everyone knows that laughter and sadness are also), a young child responds primarily to his parents' emotions. The child is not conscious of these experiences and still less able to report them. The diagnosis and treatment of a young child's neurosis must be accomplished through his parents. Slowly and painfully, the Baron and his wife related their experiences.
They were direct descendants of the German knights who, centuries ago, had opened the Baltic countries to Christianity and civilization. So secure were they in their heritage that their castle gates were left unguarded and the doors unlocked. Never did they fear that their safety, their position or their very lives could be endangered. To Americans, brought up in the spirit of democracy, they would have appeared arrogant in what they believed were their God-given rights. It was an arrogance acquired in centuries of rulership and plenty. In that outpost of feudalism, a deceptive atmosphere of security had dimmed their vision. There was only a faint awareness of the historical changes which were to come.
When Sickness Starts in the Womb
Before the child was born, the great upheaval of the Leninist Revolution shattered into a shambles the world as it had been. Almost at once the mother was forced to flee the Barony in the last stages of her pregnancy. She wrapped some one hundred thousand dollars in banknotes about her person and disguised herself in peasant clothing. Day and night she walked and ran through the countryside until her feet bled and she gasped for air, stopping only for a drink of water or a crust of bread at a farm house. Sometimes, overcome with fatigue, she stopped to sleep by the roadside, only to awaken in fright at the noises of the night or the terror of her own dreams. Eventually she crossed the border into Germany and found shelter in a hospital. There her son was born into an unfamiliar and strange environment of uncertain security.
Treat the Parents—And the Child Is Cured
Needless to say, the child's treatment and cure could be obtained only through the adjustment of his parents. They themselves needed encouragement and readjustment. The Baron and his wife had first to learn to "let the dead past bury its dead." They had to overcome their own anxieties and fears. They had to learn to face a new world, to realize that, however much they had lost, they still owned much more than the mass of people amongst whom they lived— that they were still privileged, not only by their property, but more so by the tradition and the spiritual heritage which was an indestructible part of their own personalities. They had to find a new balance between their urge for self-preservation and the more important survival of respect for ideals which we believe are permanent and true. This was not easily accomplished. The road was long and arduous, but parental love is a powerful stimulus. In her desire to help her child, the mother regained the emotional stability which had left her when she had fled her ancestral home.
Little Bruno von der A., at last finding the "shadow of a great rock," rested a while and then, slowly, rung by rung, climbed the ladder to a healthy childhood. The nightmares and outbursts of crying stopped, his appetite improved and he learned to play. Soon—and the parents were never aware of the precise moment—there were no more asthmatic attacks. Bruno no longer repelled my friendly overtures but ran to open the door at my knock. In time we became good friends.
It is, today, a widely accepted scientific concept that lack of oxygen during
pregnancy has detrimental effects upon the fetus. Some psychoanalysts may go
farther in assuming that the asthmatic attacks of this child were induced or
conditioned reflexes simulating the mother's experience. It may also be assumed
that the prenatal influence of the mother's emotional upset had affected the
fetus. It can, therefore, be safely assumed that the emotional condition of the
mother before, during and following her confinement cradled the child in a
harsh, unstable and insecure environment.
Any physician who has seen in his practice the psychosomatic aspects of respiratory diseases such as have been illustrated in this chapter, which are but a few of the numerous experiences of the kind, can only marvel at the fact that there are those who deny, or doubt or ridicule the psychosomatic approach to diseases of the respiratory organs.
CHAPTER 7: HEART AND CIRCULATION
The food we eat, the clothes we wear, the roof that shelters us and the very air we breathe are sources of pleasure or suffering, desire or rejection. The fundamental instinct of self-preservation makes man fight to possess these goods. Man grows plants; he breeds, raises and kills animals for food to preserve the race. Man fights man in- competition for the possession of the fertile parts of the earth, for the fuel and minerals beneath its surface. Man fights man for the control of water and power.
Man's relationship to matter is charged with emotions. In the continual battle for existence, our instincts and desires, in relation to our material intake and output, are constantly affected. The higher, more sublime desires of the soul are waylaid by the primitive urges of self-preservation and sexual satisfaction. In the process of remaining alive, food and air are transmitted to the points in the body where they are needed. The organs of circulation—the heart, blood and blood vessels, lymph and tissue fluids—are indefatigably on duty. Waste matter and substances which have become useless are carried away by the circulation and excreted. Circulation serves the internal transmission and exchange of material products between different parts within the person.
It is therefore self-evident that any disturbance in the intake or output of food and air and any disorder of the digestive or respiratory apparatus will affect this process of internal transmission. Any disturbance of this process may also induce emotional imbalance.
There is a sound relationship between psychic or mental strain and heart disease. Textbooks concur in the good effects of psychic reassurance upon persons with circulatory or heart disease. More than in other conditions, the physician's appearance at the bedside is conducive to the alleviation of the patient suffering from heart disease.
The baseball fan who suffered a heart attack as he was watching a game on television, the stock broker whose heart failed when the market took a sudden drop, the strong and healthy swimmer who became panic-stricken when caught in an undertow and died not from drowning, but because his heart went back on him, all point to the heart as one of the most sensitive organs to voice fear, anxiety and emotional reaction. The reader will remember the palpitations of his own heart in situations of excitement or distress.
Similar heart disturbances and reactions are quite prevalent when persons who are nearest and dearest to us become the helpless victims of uncontrolled evil forces, particularly when we can do nothing about it to help. This condition is known as "heartbreak" and the following experience is an example of the fact that:
Hearts Break For Loved Ones
Throughout his life Harry S. had never suffered a serious illness. For many years he had owned a small, tailor shop, which he operated efficiently and with an air of Old World courtesy that made of it a temporary refuge from the tense city life where his shabby place was located. Most of his customers had long since become old friends. He knew their trials and joys, their children and their children's children. Without ever voicing it in so many words, perhaps without being even aware of it, Mr. S.'s philosophy was simple: our lives are only lent to us for a little while. While we are here, let us help one another. The accumulation of money is less important.
Now at the age of sixty-three, he felt ill, weak, listless. He complained of pain in his chest and in his abdomen. Thorough physical examination revealed only normal changes compatible with his age. These findings did not explain his extreme weakness. There was no sign of heart damage or serious illness. Eventually, the patient was found prostrate in his bed. After emergency treatment he recovered, but similar attacks of circulatory breakdown recurred at irregular intervals. After his discharge from a hospital, where he had been treated for one of these incidents, Mr. S. consulted me for after-care and, if possible, preventive treatment. His physical history strongly suggested an emotional second history. Gradually his story unfolded:
He Had a Second History
Mr. S. had come to this country from Eastern Europe when he was about twenty years old. At first he worked in a factory. From his small earnings and with most frugal living, he managed to save enough money to send for his childhood sweetheart, whom he had left behind him. On her arrival in this country, they married, and he opened a small store which also served as living quarters. They worked hard but without complaint on an average of fourteen hours a day. They were happy in their new homeland. A year later their son was born, and two years after that a daughter. Their small savings were used for their relatives in Europe to bring them to this country and, once they were here, to help them gain a foothold.
Only, one favorite sister, who was married to a pharmacist and lived in a small town in Poland, had continually rejected Mr. S.'s offer. This refusal on the part of his favorite sister was a problem of economics. Because of the political conditions during that period between the First and Second World Wars, a transfer of family assets and belongings was impossible. She and her husband were in comfortable circumstances in Poland, but realized that by coming to this country, they would become a burden on her brother as poor immigrants.
A Letter About Brutal Murder
With the outbreak of the Second World War and the invasion of Poland, all news of his sister ceased. Mr, S. started to worry, as did many other people in similar situations. He blamed himself for not having insisted more strenuously that his sister and her family join him in America. His self-accusations and worries were aggravated by the receipt of a letter smuggled out of Poland by a distant relative, which told, in brutal detail, the fate of his sister and her family. It told of the unspeakable behavior of the invading German Army in gathering together the inhabitants, lighting a huge fire in the market place and then throwing the Jewish women and children alive into the flames. The men had been slaughtered soon afterwards, many of them buried alive.
This letter was just too much for Mr. S.'s heart. When his attempts to hide all the details of this letter from his wife proved futile, his physical and mental system could not take it and his collapse became complete. However, both Mr. and Mrs. S. were at last persuaded that in bravely facing reality together lay their only hope for a recovery. In sharing their grief, each gave comfort to the other, leaving less thought for futile self-reproach. Without other medication or treatment of any kind, Mr. S.'s heart attacks ceased.
About this time, another patient, Elsie H., came under my care. Mrs. H. was a German-American woman, nearing sixty years of age when she collapsed rather suddenly with a cardiac insufficiency, lowered blood pressure, rapid pulse and fainting spells.
Another Message of Despair
She, too, had received a message. Her brother, who had survived the Second World War and had managed to preserve his property, several hotels in Russian-occupied Germany, had been "invited to assume a highly influential position" behind the Ural Mountains. He was not heard from again. The hotels were expropriated and his wife and children were left destitute. No one could say what had happened to him, since no further news was available at that time.
These stories of Harry S. and Elsie H. have been selected because the psychic trauma in both cases can be sympathetically understood and felt by everyone. Fortunately, both were led towards satisfactory recovery.
Hypertension (high blood pressure) is not always a disease entity. Often it is a symptom like fever and may be associated with many organic illnesses such as valvular heart disease, arteriosclerosis, kidney disease and others. Even when high blood pressure is caused by organic illness, it may also be psychosomatically conditioned, in so far as the blood pressure is aggravated by psychic factors.
High blood pressure frequently stands as a symbolic expression of psychic tension. The latter is often the result of inhibited aggression and repressed hostility in persistent and over-controlled personalities. If the patient is conscious of the emotions and ideas which cause his attacks of hypertension, psychological guidance is often sufficient to lead him back to emotional equilibrium.
There are many patients who are unaware of the presence of a psychological motivation for their hypertension. These patients conceal their true motivation for the simple reason that they themselves do not know it. If brought face to face with it, they would refuse to recognize it because of an innate desire to conceal their most private emotional life from everyone.
There is an expression commonly used—not very elegant, perhaps, but very apropos—"Open confession is good for the soul, but bad for the reputation." Broken down into two clauses, heed to the first would assuredly profit those who, during illness, are tempted to conceal their motivation from the physician and the second need carry no import if they exercise good judgment in the selection of their confessor.
Unfortunately, in refusing to confide in their physician these patients choose a second course, a by-path. They go alongside the road to health, but not on it. They miss their destination by a margin of their own choosing. Like Mathilde G., they choose second best. In both medicine and marriage, this patient had failed because she had decided on:
Mathilde G., at the age of fifty, was outwardly calm, poised and self-possessed. Nevertheless, she maintained a blood pressure that would have alarmed most people. In the five years that she had been under treatment, her pressure had never been lower than 180/80 and more often was in the neighborhood of 240/100. No organic cause for her illness was ever found. While she was aware of her condition, she consulted her doctor once a month in a kind of routine schedule, listened to his advice, dutifully took her medicine and even consented to be hospitalized on several occasions; but to no avail.
I had been treating Mrs. G. for about three months with, I must confess, ungratifying results. There was no doubt in my mind that she was concealing her essential psychosomatic motivation. To all of my suggestions she turned a deaf ear. Sensing her reticence, I suggested the use of one of the so-called talking drugs; but this, too, she rejected.
Not long after, on a Sunday morning, I received an urgent call from her daughter. "Doctor, please come immediately. Something terrible has happened to my mother."
The Lady Found Dead
I hurried over and found Mrs. ,G. lying on the floor beside her bed. She was dead.
The next of kin were her daughter, whom I knew well and a husband whose existence she had never mentioned, having given me the impression that she was a widow. This husband, her second, reported, quite without emotion, that she had collapsed during the early part of the night. Yet now, seven hours later, the patient was still lying on the floor! I had been called, not by the husband, but by the daughter who lived two blocks away with her own family. It seems that on her way to the bakery, the daughter had stopped by to inquire whether her mother needed anything from the store. She learned that her mother had no further need of anything in this world. Stoically, the husband admitted that in these seven hours he had not attempted to lift his wife to her bed.
She Had Married the Wrong Man
Mathilde had never mentioned to anyone—neighbors, friends, even the doctors who treated her and, more latterly, myself—that her second marriage was under a shadow. Still less had she ever admitted that she had made a mistake in this marriage. Shocked and horrified, the daughter sensed the deep-rooted conflict which her mother had too skilfully hidden. It was this conflict, merged with her intense pride, that had gradually built up an irreversible tension increasing the blood pressure to such a degree and over so long a period that made the physical breakdown inevitable. The somatic toll followed m the wake of prolonged psychic and meatal strain.
Higher than normal blood pressure is often the somatic expression of mental and emotional strain which the patient tries to conceal from his environment. The blood pressure usually returns to normal when the patient learns that his efforts toward secrecy are futile, as in the following experience:
David L., though still a young man, had suffered from high blood pressure for many years. Unlike Mrs. Mathilde G., however, he lived in constant fear of a catastrophic breakdown. In his early forties, he was the successful and capable junior member of a well-known firm of attorneys. Paradoxically, he was aware of his hypertension, worried over the possibility of a "stroke" and had consulted several doctors. Yet, he did not take his condition really seriously.
Shortly before Mr. L. came to my office, he had represented a widow whose husband had suffered from hypertension and had collapsed at the wheel of his car while driving. A considerable number of scandalous activities in this husband's life were brought to light during probation of the will. The man, undoubtedly, had lived under a tremendous tension while keeping his right hand ignorant of his left hand's multifarious activities. The story of this client of Mr. L. does not concern us but must be mentioned because it obviously preoccupied his mind to a very large extent. Even during his first visit with me, Mr. L. referred many times to his lately departed client and, in fact, did most of the talking during the interview on this subject matter.
Be Protested Too Much
This was so noticeable that I was prompted to ask whether there might not be something unusual in David's own life. He demurred, quite jovially, "I have only one office, one wife, three children. My life is an open book." Did he protest too much? I wondered as I asked him the following questions:
Dr.: As an experienced lawyer, you must know that the motivations of human
behavior are not always obvious. In psychosomatic medicine we subject every
patient to a complete synoptic analysis. This includes the thorough
investigation of your physical, biological, psychic and spiritual being. Are you
Mr. L.: Certainly! That is why I came to you.
This interview and the many which followed showed that the patient was more than willing to reveal even the most intimate details of his instinctive and sexual feelings. He appeared to take pleasure in relating details commonly felt to be embarrassing. Because these "confessions" were offered too readily and because of my long experience with patients, I could not accept these admissions at face value.
The Fear of Death
Mr. L. assumed the role of an opposing lawyer trying a case and seemed to get a great satisfaction in reminding me, from time to time, that the psychosomatic approach was not producing results. With a quite condescending manner, he continued his treatment, but as the interviews continued, he began to reveal his subconscious fear of going the way of the late client.
This evident enjoyment in his resistance to my treatment was in conflict with his conscious striving for health. But because of this combination of resistance, desire and fear, his blood pressure continued to remain quite high. It was then that I began to diagram in the form of a "life chart" this patient's personal development. I set down graphically all important factors pertaining to his life—heredity, behavior, diseases, education, emotional changes, normal and unusual sexual experiences and social successes as well as his failures. The chart showed quite clearly all interrelated connections in his life history, emotionally and otherwise. Before Mr. L.'s "life chart" was brought up to date, it became apparent that there existed a gap of nearly two years, which seemed to have been obliterated from his memory. It was impossible to break through his resistance on this lapse of time. Yet he agreed with my suggestion that his wife might help to bridge the gap in his memory.
What His "Life Chart" Revealed
When she read the contents of her husband's "life chart," she asked with surprise: "Didn't you tell the doctor that those were the years when you were under criminal investigation, fearing every day that you might be disbarred?"
"Of course," he answered, "I forgot to tell him."
Mrs. L.: How could you forget that?
Mr. L.: You know very well that I don't like to talk about it.
Dr.: But you have done a great deal of other talking. Don't you realize that this episode is most probably known to your colleagues?
Mr. L.: Perhaps they know, but they don't discuss it, especially since I came out with a clean slate.
Dr.: If you came out clean, why are you afraid of it?
Mr. L.: You know how it is, doctor, something always sticks.
Dr.: But you have been cleared—or could it be that your conscience disagrees with the findings of the Court?
From then on, every detail of the moral conflict was discussed in the course of ensuing interviews. Not long after, the patient, not the doctor, was surprised to find his blood pressure returned to normal and a new sense of well-being filling him. He returned for periodic check-ups during the following two years, but there was never another elevation in Ms blood pressure.
In the life-situations of both Mathilde G. and David L., we find a third person playing an important role in the development of events. Yet the true cause of the internal tension had been created by the patients themselves. They were at least partly conscious of the fact that they were themselves responsible for their situations which they could not solve without assistance. From their false pride and hidden coa-flicts, they suffered thus:
"Like the owner of a foul disease, to keep it from divulging, let it feed
even on the pith of life".......
—Shakespeare, "Hamlet," Act 4, Scene 1.
In hypertensive disease, the organic and psychological developments follow a parallel course. It is therefore necessary that observation of clinical and organic symptoms runs parallel with the psychological observations throughout the entire course of the diagnostic and therapeutic procedures.
Coronary disease may develop in the course of hypertension. It may be a consequence of high blood pressure and arteriosclerosis. The sickly changes in the blood vessels may be caused by other primary pathology, diabetes, liver disease, abuse of alcohol and tobacco, venereal disease and many other conditions which eventually produce arteriosclerosis of the coronary vessels and coronary incidents. It is, however, a fact beyond doubt that emotional tension and the psychic constitution of the person play important parts in the outcome of coronary disease. The experienced psychosomatic physician can tell almost on sight that a person is predisposed to this disease or that a certain life-situation is especially dangerous to such a person. One such situation of hazardous implication is:
The Eternal Triangle
In the practice of medicine, as in other fields, the eternal triangle occasionally "rears its ugly head." From a medical standpoint, this is Peter M.'s problem, since he was my patient, as Paul W. (see Chapter 10, "Two Years of Panic") was also my patient. To the third party, Bianca, go the laurels for her contribution of drama and tragedy to the lives of both men. Both men loved her. Both were influenced by the almost unholy power of her personality, silencing moral murmurings and contritions, precipitating them onward to their failure in health.
It is strange how some persons can affect and alter the lives of those who touch them intimately. There are those who bring out the good in us and, by the same token, those who bring out the bad. Bianca was of the latter. No misdeed was ever proven against her. Yet Peter, her husband, looked to his death as a release. Paul, her lover, forsook wife and family, social prestige and peace of mind for two dreadful years.
He Was Sterile and Sensitive
This is the story of Peter, who lived with Bianca in childless marriage for twenty-six years. By diligence and hard work, he had painfully raised himself from the lowly position of messenger boy and porter to that of the owner of a large and flourishing business. At the age of twenty-four, he had married Bianca, a young Italian girl with no claim to beauty other than a buxom figure. He guarded closely his secret of an earlier venereal infection, the aftermath of a youthful indiscretion, which had left him sterile.
When the first years of marriage brought no children, Bianca became distant, unapproachable. Home and marriage became a farce. In despair, he suggested a separation, but she refused to relinquish the social prestige which she enjoyed as the wife of this promising businessman and remained adamant to his pleadings. In time, he accepted her relentless aloofness and frigid attitude. With the same perseverance to duty that marked his rise and success in business, he kept to his marriage. They lived together, placating the conventions for twenty-six years. However, she never forgave him for depriving her of motherhood and, lest he forget, grasped every opportunity to remind him.
Then suddenly, at the age of fifty, Peter suffered an acute coronary attack. His condition was critical and the doctor advised immediate hospitalization. Bianca had other ideas. "No," she said, "my husband stays home." Peter made no comment. He remained at home. His room was transformed into a hospital room with two nurses and a young doctor in constant attendance. He received expert care and a hospital routine was put into effect. In spite of all precautions, Peter suffered another attack one week later. It seemed that, exhausted by a life-long tension borne in silence, he wished to die. Three days later, he said, "I shall not leave this bed until I am finished. I mean—before I am better." Four days later, he succumbed to a third attack and passed on, we hope, to a peace he had not known on earth.
She Was Frigid and Cold
During Ms illness, the nurses and doctors were aghast at the coldness of their patient's wife. She kept constantly repeating a special phrase, "Peter and I have learned to respect our mutual independence. When Peter dies, it is his own affair." When she was summoned to his bedside near the end, there was not even a pretense of grief nor of pity. At the funeral service, friends and relatives were embarrassed at her behavior which would have been charming for the hostess of a party, but was sadly out of place for a bereaved wife. It is small wonder that neighbors and friends spread the rumor that Bianca had murdered her husband! In a matter of a few weeks, Paul became her lover and, though unaware of it, was walking to his own doom. But that, as Shakespeare said, is another story.
Patients who suffer coronary incidents have many characteristics in common. By temperament, they are serious and hard working, seeking no "short cuts" in business or even in pleasure. Their sense of responsibility and duty is keen; they are prone to marry and uphold their authority over their families, as well as over their business dealings. From their conflicts with authority and from the inevitable disappointments and disillusionments of life arise the tensions which ultimately determine their earthly fate at an early age.
The ubiquity of circulatory reactions is due to the fact that every organ is supplied by the circulation. No organ can be separated from the circulatory system. A special condition, anatomical or physiological, of the blood vessels in the duodenum, or those in the kidney or those supplying the heart itself may decide whether a psychosomatic reaction becomes apparent in the one or the other part.
Each of these patients has a psychology of his own. The motivation is sometimes repressed hostility. If every person who represses his hostility against his boss or neighbor were to become a hypertensive patient, high blood pressure would be the common fate of all. This observation proves once more that the inner causes of psychosomatic illness cannot be generalized.
Knowing how closely the vascular and nervous systems are mutually related, it could be argued that psychosomatic conditions of the circulatory organs—or of any organs—should never be given the names of isolated units of illness. It is a concession to traditional medical reasoning that our discussion is arranged according to special organs in relation to psychosomatic effects. It would be more logical to start always from the psychosomatic personality as a unit and to consider localized phenomena merely as signs and symptoms of the internal disturbance. Perhaps, in the distant future, patients will be truly respected as individual persons when their psychology is understood from within and cure is produced by the direct influence of the physician or of the remedy upon the central nucleus of the coordinating forces of life. By that time we may have reached that ideal stage of scientific development which Claude Bernard foresaw: "When all specialists in science and philosophy will speak the same language and understand one another."
CHAPTER 8: DIGESTION
Gastrointestinal Disease: It is ancient knowledge that emotions affect food intake and digestion. A hungry human being and a beast of prey most brutally take possession of anything edible and defend it with the most desperate determination. The instinct of self-preservation is the source of the strongest emotions of which we are capable.
The satisfaction of hunger as an act of self-preservation is linked with possessiveness and related emotional strivings such as greed, envy and jealousy. The restraint of these primitive urges is virtue. For thousands of years such restraint has been practiced under social pressure. We have almost forgotten the original instinct and consider the right to property, profit and competition as privileges of our society rather than as the ultimate result of tamed animal instincts.
The good and necessary instinct which God has given to all living creatures serves the preservation and protection of life. The equilibrium between instinct and social duty is disturbed in psychosomatic disease of the gastro-intestinal tract.
The organs which serve this most needed instinct are among the first to be developed in the human fetus. When the fetus in the womb is eleven weeks old (menstrual age), the peristalsis of its intestines can be observed. At twelve weeks M.A., the fetus reacts with deglutition. At sixteen weeks M.A., meconium and defecation occur. While living within the uterus, the fetus is brutally greedy. It extracts from its mother whatever food it needs without regard to her own requirements. Even against a very ill mother, the fetus demands its right to live at the price of the mother's death if necessary. This is nature's way.
The Greedy Infant
Some time after birth, the child will take possession of things within its reach, using its mouth as well as its hands.
Its most violent emotions are connected with hunger, eating and overeating. It learns early that emotions are contagious and induces its mother to satisfy its desires. A child knows or learns by experience that its refusal to eat or its overeating followed by vomiting incites emotion in the mother. Its own emotions respond mutually to those of the mother. When the motility of the stomach continues or increases, it affects the lower parts of the intestines and spasm and diarrhea may result. In this manner, the first psychosomatic gastro-intestinal disorder of the infantile person is established by the reciprocal or mutually excessive emotional currents which low back and forth between mother and child. Any other faulty emotional environment may have a similar effect.
In due course, greediness and overeating, cardio-spasms, gastric and intestinal spasms, vomiting and nervous diarrhea, spastic constipation may develop and become symptoms of disease. These symptoms may, in turn, become the causes of other morbid processes such as fermentation of the intestinal contents. Mechanical or chemical erosion of the inner covering of the intestine may lead further to duodenal or peptic ulcer, ulcerative colitis and other organic illness. In persons who, for any reason, have carried a lower resistance or an infantile immaturity of the gastro-intestinal tract from their fetal into their extra-uterine and adult life, the organs of the digestive tract are those most likely to be selected for the expression of psychosomatic disorder. The fact that gastric and intestinal diseases may have their primary origin in the psyche of the person is also familiar knowledge.
Your Brain Affects Your Stomach
We have accumulated a great amount of evidence to prove the concept that wrong thought produces psychosomatic disease. In addition to bedside experience, laboratory experiments have established the psychosomatic character of many functions of the autonomic nervous system, the interdependence of body organs with the sympathetic and para-sympathetic nervous system and with chemical processes occurring in the nerve endings. Enzymes, hormones and psychic forces modify, stimulate or paralyze the activities of the organs. The cortex of the brain, in some ways, affects the functions of the stomach, intestine and gall bladder. Melancholy (literally, "black bile"), does not only mean the slow, retarded flow of concentrated bile of dark color, but also the state of depression which is often associated with gall bladder trouble.
The motivations of persons who suffer psychosomatic illness can be very complex. It is not always one isolated organ which expresses the motivation. Just as the gestures of a speaker are not limited to motions of one finger, one hand or one arm but may involve the entire body, so psychosomatic reactions may include many organs at the same time or even the entire body of the person. It is generally understood that pregnancy, for example, is not a local change confined to the uterus of the mother, but alters her entire personality and affects many distant organs which have no direct relation to the function of procreation. The psychosomatic complexity of the following experience should be considered with a view to the unity of the person.
The history of Susan O. illustrates the symbolization of emotional urges in gastro-intestinal disease and also the role which body, psyche and soul may play in disorders of this kind. The details of her life-experience would fill a small volume if psychosomatic procedures and therapeutic techniques were to be recorded in detail. Therefore, this report is a highly condensed summary:
When, at the age of twenty-four, Susan had been married for over two years, she fell ill with severe abdominal colic. Her appendix was removed, she felt improved and gained considerable weight. One year later, another attack of colic occurred. Medicinal therapy, diet and physiotherapy remained without result. In another operation, adhesions were removed. The patient was again improved and a further increase of weight was noted. Again, one year later, a third attack of abdominal colic occurred. Another surgeon removed her gall bladder. After a third year of well-being, abdominal colic recurred. The surgeon opened her abdomen and, once again, adhesions were removed. A fourth year of well-being ensued. The patient felt fine, gained still more weight in comparative comfort. Then again abdominal colic set in. At this time the patient and her family doctor felt that surgery was exhausted and decided that a psychosomatic physician should be consulted.
No Relief After Four Operations
Susan was thirty years old when she came to see me. She was in great despair. Physical examination and laboratory tests indicated that the cause of this colic was a duodenal ulcer located in the intestinal environment of a violent mucous duodenitis. The duodenal tube discharged incredible masses of mucus. The patient was greatly overweight, discouraged and definitely depressed.
Symptomatic, dietary and medicinal treatment brought about some improvement of the duodenitis. Psychotherapy was then started. Her condition improved slowly and the symptoms eventually disappeared.
The fact should not be overlooked that the colics and repeated operations had occurred at regular intervals, allowing about three months, each time, for the operation and convalescence, followed by nine months of relative well-being and gain of weight. When I held up these time relations before the patient, she observed abruptly and with a sad smile: "If I had been pregnant each time, it would have been almost the same thing, gaining weight for nine months and then coming down with pain." Before she had finished the sentence she began to sob violently and broke into a pitiable spell of crying. Tears streaming down her cheeks, she was unable to continue the consultation.
If She Had Been Pregnant
In following interviews the patient uncovered the motivating event. When, some time after marriage, no pregnancy resulted, she began to fear that she might lose the love of her husband if she did not bear him a child. Both had come from families richly blessed with children. Her sisters and in-laws, also married, all had children; and she felt humiliated by her failure to live up to the expectations customarily associated with marriage.
In her feeling of defeat and guilt, she had misdirected her repressed emotions into somatic sensations. Rather than face the reality that she could not have a child, she chose psychomatic illness. The operations had been, to her, symbolic confinements with the suffering which delivery of a child would bring about. However, since each experience proved futile in so far as there was no baby to reward the suffering, they failed to solve her problem. She was left with a body weakened by four operations and a spirit frustrated by wrong thinking.
This patient needed the restoration of her intelligent judgment She needed insight into the reality of her individual life-situation. She had to be guided toward the realization that solutions are not reached from without, but from within the person. This re-education required much time, but as her physical condition improved, she was able to recognize the psychological motivations more clearly. In time she regained her health and, with the adoption of a baby, she returned to her position in her family circle.
Many organic disorders are complicated by superimposed psychic conditions which are, however, not essential, causal elements to the overall clinical picture. And there are also those psychiatric patients in whom gastro-intestinal symptoms are accidental or incidental occurrences of minor importance. Yet, there can be no doubt that the organs of the gastro-intestinal tract are endowed with a voice which expresses clearly the spiritual difficulties and psychic conflicts which arise either within the person or between the person and his environment.
It is difficult to overlook the fact that gastro-intestinal disease is the expression of the struggle between the instinct of self-preservation and the restraining and coordinating power of the soul.
The person who, throughout his life, races for happiness in the form of more money, may reach the point of insight into the futility of his endeavor. When the question is posed to him why he cares for money, he may realize the failure of his life's striving when it is too late. By then, his entire personality is conditioned for this kind of life. Any change of routine at that late hour would uproot him. This kind of patient races all his life on and on and on towards a goal which is not much different from the death of a hamster, as may be found in the following experience of a manufacturer of pharmaceutical products who placed:
Business Over All
Emile L. was the chairman of the board and owner of the majority of stock in two pharmaceutical firms, in a company which manufactured wall papers, and in a banking firm which controlled a large section of industry in a specified area. Emile was nearly fifty years old and suffered from an illness which frequently befalls business men and executives. A chronic gall bladder disease had, in time, produced a slightly gray, jaundiced appearance of his skin. There were definite signs of secondary liver damage. A disturbance of the sugar tolerance was not a sign of a typical diabetes, but rather a symptom of the complex disorder which was caused by emotional tension.
Emile did not realize the serious character of his condition. In his pharmaceutical firms he came in daily contact with physicians and frequently asked their advice. Yet, because he was so much wealthier than the best physicians of the city, he thought that superiority in wealth equalled superiority in knowledge and wisdom. He took their warnings lightly and disregarded their instructions.
His interest was completely absorbed by and concentrated upon his business activities. He was a bachelor, had no mistress, no social activities and no desire for either social or political prominence. He did not indulge in any excesses with regard to the proverbial wine, woman and song. His manner of living was nearer that of an ascetic recluse. He worked sixteen hours daily in the enterprises under his control. Emile had suppressed all of the distracting urges in order to conserve his energy for his sole ambition: to store wealth. There were no apparent psychological conflicts or complexes. His concentration upon his business caused, however, an enormous emotional and physical tension under which he lived and suffered constantly.
Stress and Strain Sickened Him
Such tension exercises a direct effect upon the involuntary parasympathetic nervous system and thereby disturbs the functioning of the gall bladder, the production of hormones in various glands and the metabolism of sugar and calcium in the blood. When conditions of this kind persist for any length of time, organic changes such as Emile's liver damage may result. If such tension continues still longer, the liver damage may become chronic and incurable. These abnormalities will eventually produce the appearance of the ever-busy, tense, concentrated and embittered, stockily built gentleman with the jaundiced skin. These symptoms of disease may form a pattern of the personality which is often mistaken for an inherited constitution.
The Choleric Gentleman
Very often, this kind of people show an appearance and behavior known as the "bilious" or "choleric" type. Ancient authorities, among them Hippocrates and Galen, the physicians of the Middle Ages and even modern physicians, have believed that this kind of pathological personality is constitutional. Modern psychosomatic research has revealed the truth that people such as Emile have developed their personalities in their own manner of living, which is of their own choosing, at their own free will and responsibility.
When Emile's indisposition began to impair his ability to work, he seemed to take more seriously the consultations with the physicians with whom he worked. But, like many overactive people, he refused to admit that nature cannot be forced to follow orders in the way that he expected his employees in his business to.
Emile was only a little shaken in his self-assurance when he made up his mind to come to me for treatment. In one consultation he complained that one of his competitors had effected a transaction which, in little more than a month, had yielded a profit of nearly a million dollars. Distraught, Emile lost his temper. "Why could I not have thought of this opportunity? It was so obvious, I cannot forgive myself for having missed it."
This was the point for me to step in and tell him, "Perhaps your physical condition, your gall bladder and liver affliction have weakened your alertness? Perhaps you should do something about it instead of overruling the advice of your doctor. Perhaps now that your disease hits your pocket-book, you may be willing to listen or you may wait for the next setback that is sure to come ..."
Our discussion continued:
What do you suggest?
Dr. A complete rest with dietary treatment in a sanitorium for not less than three months.
E. Impossible. That would kill me.
Dr. If you continue your own way, it will kill you even sooner.
E. Let's settle for one month.
Dr. Perhaps a Mediterranean cruise of three weeks?
E. No! That wouldn't interest me.
Dr. You could stay at home for three weeks.
E.: Of course, that would be impossible. . . . But I'll make it six weeks and go to South America and the United States.
Dr.: Yes, in order to check on your business representatives in those countries. This will be a business trip to im« prove your export profits. At the same time, you pretend that you are doing something for your health.
E. I promise that I shall take time out for sightseeing, entertainment and what you call rest.
Dr.You can bargain with your business associates and even with your doctor, but you cannot bargain with, nature. You may take my advice or leave it.
E. I promise that my trip to South America will not be all business and work. But you must understand that I cannot be idle.
Emile L. went to South America. He found business conditions in those countries so different from the ideas he wanted to impress upon his representatives that he decided to invite all his foreign, representatives for a conference in the home office.
When this meeting took place some time later, I learned by chance that Emile had spent every minute of his time in South America arguing with his representatives over issues of advertising, sales and promotion programs and methods. He had not even submitted to the custom of daily rest or siesta, which is indispensable in tropical countries to healthy Europeans unused to the climate.
This Instinct Killed Him
However, Emile was successful and satisfied with the considerable increases
in the export sales and profits which followed his trip and the conference. But
he survived the reorganization of his export business by only seven months.
Emile's fate is the tragedy of the man who subjects his spirit to the
dictatorship of one instinct.
There are other persons who have great difficulty making up their minds whether to follow the one or the other instinct, the satisfaction of material appetite or of sex. The person of this kind flees from decisions and resolutions, is always uncertain of himself and divided. "The native hue of resolution is sicklied o'er with the pale cast of thought." Restraint of the instinctive urges appears to him as defeat. In order to avoid it, he dares not persist in his pursuit of intelligent purpose and planning. All the time he expects a short cut on his way to success. All the time he sees only the surface of events and persons. Accordingly, he places:
Appearance Above Value
Felix U. was twenty-eight years old at the end of World War II. He had been pilot of a big combat plane. After his discharge from the U.S. Air Force, he became executive manager of a branch office of a commercial air travel company in South America with an annual salary of $15,000.
A good pilot is not always a good executive. Felix found it difficult to achieve commercial success and to maintain his authority. The strain of the tropical climate was added to his extraordinary efforts and produced considerable tension. The tension required further special effort and stress to compensate for moments of weakness. The vicious cycle which is often essential in psychosomatic disease was thus established. Felix held his position for a short time. When he returned to the United States, he felt weakened and suffered from frequent abdominal colics. A specialist diagnosed gastric ulcers as the cause of his complaints. After diet, medication and rest did not help, Felix was operated upon. The ulcers were removed, the convalescence was uneventful and the colics continued exactly as they had done before the operation.
No Medicine Helped
The patient returned to his family physician for medicinal treatment'. When there was no cure, he changed first the physician, then the climate, then again, the physician. He also took all the patent medicines that a midtown drug store can supply. Eventually, he happened to talk about his condition to one of those modern clergymen who specialize in pastoral psychology and who collaborate with psychiatrists and psychologists. This minister explained to Felix that his condition was partly organic and partly psychological and that, therefore, it would be best for him to consult a psychosomatic physician who is the specialist for just this kind of diseases.
When Felix came to my office, his history demonstrated the characteristic behavior-pattern of a patient who lives with a deep-rooted fear of defeat. For the first five years of his life, Felix had been the only child. Later, several brothers and sisters were born. He remained the pet child of his mother, who tried to keep him for herself and treated him not as a person in his own right, but rather like a pet cat or dog, belonging to her, acting for all purposes by no other motivations than her possessive love for Felix.
When he grew a little older and became more independent, she dressed him in ill-fitting clothing and gave him a peculiar haircut, which provoked the ridicule of other children and drove him back to his mother's apron strings. From this point on in his childhood, there resulted a feeling of inferiority, which he tried to overcompensate, later in life, by extraordinary grooming.
When he was twelve years old, he was rejected by a girl of the same age in a children's game. This experience left a deep impression and he remained shy for the rest of his life. He added guilt to his unhappiness when he took to masturbation. His feeling of guilt was intensified by unreasonable fear, as he had been told that masturbation rots the body and undermines the strength of the person. More guilt was added when, later, he developed a friendship with a married lady who, for many years, remained the only person in his life who gave him sympathy and understanding and, since she was older than he, some guidance. With her, he found all the love which he had never found in the home of his parents. Yet he realized that the situation was burdened with sin.
Too Much Love—Or Was it Sex?
The twofold guilt of masturbation and extra-marital relationship caused Felix to avoid everything that was not merely physical and material. He concentrated all his striving for accomplishment upon external success. He strove for sartorial perfection and physical fitness by athletic training and exercise. The purpose of his life became appearance—appearance for its own sake. He argued that his external appearance suggested good moral character, intelligence, superiority and executive capabilities. "I want to be an executive," he said, "in a respectable position and environment. I want to have a home and family. I need money to maintain this appearance."
He admitted that he was in need of a better education. To compensate he attended evening courses at college, but he had great difficulty in following the routine course of study. Instead of following a reasonable plan, he vacillated between extreme ambition and defeatism. Minor events of little importance distracted him easily from his aim.
About this time he began to give some thought toward marriage as a way out. He knew of a friend who had married and obtained a splendid job, with a substantial income in the business of his father-in-law. He knew that any marriage he might make would require more background and income than he had and that the long tedious hours of study irked him. So he entered upon a schedule of strenuous athletic exercises, even to the point of exhaustion, in order to forget sexual urges and to bask in the limelight of applause.
Later he turned from this routine and went back to college, undertaking a program that was far beyond his capabilities. This gave him no contentment or happiness because he missed his gymnastic activities and could not find the time to enjoy entertainment and a more active participation in social life.
All the time his urge to overcompensate for his inferiority tempted him into extraordinary expenses for clothing and appearance. A new car imposed obligations for installments and loans. He again gave up education and escaped into anything that would bring him additional income; he even worked as a lifeguard and longshoreman.
Love and Sex Must Be Fused
His animal vanity was in conflict with his better judgment; his interest in sex was in conflict with his religious conscience. He knew that he could not obtain forgiveness as long as he continued his sinful practices. Guilt and fear of his mother and father, of the effort required for education, the fear of coming to age without being married and well-to-do, the contradiction between his high ambitions and his unwillingness to spend the time and effort for accomplishment —all these conflicts had to be brought into the open. Eventually he became aware of them and could see and face them squarely. When he learned to discuss them as practical problems, they ceased to cause him further psychical tension and spastic intestinal disturbances. At this stage of treatment he was free of somatic complaints. But he had still to solve the problem before him—that of planning his future toward constructive living. This is a task which requires background, a balanced personality and guidance. If one of these factors is missing, the life of the person becomes haphazard and vacillating.
As long as Felix had been in the Air Force, his life had been planned for him by military authority. His position and uniform relieved him of his worries about grooming and appearance. If anything, they enhanced his personal pride. Whatever decisions he had to make were commonly subject to approval by his superiors. In most instances he merely carried out orders. Whether they were right or wrong, the responsibility did not rest with him. Thus, he was able to avoid the feeling of guilt.
In civilian life, however, he was faced not only with the necessity of making decisions, but also with the responsibility for their consequences. He required re-education to fit him for civilian life. Felix succeeded remarkably well. In less than one year's time, he became the manager of a department in one of the leading metallurgical firms.
When Parents Are Immature
This person had become a patient because neither his father, mother, nor himself had been sufficiently mature to be the head of a family. Every fool can have a child. But what do people do to become worthy of parenthood? Practically nothing. Some parents are behind in education, some lack cultural background, others spiritual maturity. Sometimes the mother, a relative or a teacher may successfully step into the father's place. Too often, the child grows up without competent guidance. Not infrequently, a pastoral counsellor or the physician may interfere to fill the gap. Such children of incompetent parents must not only be intelligent, but also persistent and diplomatic in their search for guidance and progress. Otherwise, they may be unable to face and meet the challenges of their environment and to establish a sound balance between body and mind.
The following experience illustrates a development of life and personality in which, eventually, not intelligence and reason, but:
The Colon Rules
Like all names in this book, this patient's name is not the original one. It is borrowed from a Moorish princess. According to Spanish tradition, Galliana's father, the King Gadalfe of Toledo, had built for her a palace so beautiful arid luxurious that its splendor became proverbial in Spain. Our Galliana was not a princess, but a girl born into a simple Irish-American family. She was a pretty girl. Her problem originated from her natural beauty. She was so proud of her appearance that she thought she was too good for any of her would-be wooers. Eventually, the boys began to stay away. Galliana accepted this situation and spent even more time, in fact practically all of her time, upon her outer appearance. She was diligent in dieting to keep her figure slim and fit. Her thoughts were concentrated upon the effect which every single action of hers had upon other people.
No Man Was Good Enough for Her
Our patient's disease began with dental disturbances, continued with stomach trouble and ended with colitis. On the one hand, Galliana desired to be loved and was willing to give love. On the other hand, she had denied herself the satisfaction for her longing because no one was good enough for her. The emotional tension was further increased by the subconscious presence of guilt, anxiety and frustration.
The disease of the teeth, which is organically destructive as the result of psychosomatic conflict, goes under the technical name of "Bruxism." Mental stimuli, restlessness and conflict with the social environment decrease the calcium content of the saliva. Pain, affecting all parts of the dental apparatus and mouth, peridontal disease, toothache and bad odor from the mouth are the results of the disturbed salivation and gastric excretion and are definitely known to be influenced by emotional thinking such as Galliana's.
Lost Teeth, Lost Health, Lost Happiness
Galliana began to lose tooth after tooth. When she was a little over twenty years of age, the condition of her teeth caused heartburn, hyperacidity and other digestive disturbances which made her life miserable. Patent medicines, as well as many doctors' prescriptions, were of little help. The condition became more and more aggravated. Diarrhea and constipation alternated for shorter or longer periods. The effect of suffering found its expression in Galliana's face. After this situation had lasted for several years, Galliana became defeatist in attitude, frustrated, pessimistic, distrustful of other persons. She felt rejected, as indeed she was—no longer because of her behavior, but because of her sickly appearance.
Her organic condition rapidly deteriorated and lately had been diagnosed as colitis. She went in and out the offices of numerous specialists and repeated again and again X-ray examinations of the gastro-intestinal tract, only to be told that she had a colitis for which no specific organic or infectious cause could be found. The condition did not yield to dietary experiments and medicinal applications. However, the psychosomatic approach was more successful than the traditional methods of treatment and brought improvement as soon as it was started. Symptom after symptom disappeared when Galliana learned to understand her motivations. If the complete readjustment of the personality and the prevention of recurrent attacks of colitis are to be accomplished, both patient and physician must be extremely persistent and must devote considerable time to the therapeutic effort. The functions involved are established very early in life, some of them as early as during the intra-uterine development of the fetus. Disorders of this kind are deep-rooted and more difficult to correct than other patterns of habit, which are acquired later in life, and are, therefore, more accessible to intelligent insight.
Self-Love Made Her Sick
A person like Galliana, who has spent a lifetime to satisfy her basic instincts of primitive self-love (narcissism), who has trained herself in the unconscious expression of emotions by intestinal symbolization, eventually arrives at a very peculiar state of mind. The infantile mind of such a person may consider every part of her body as the organ of expression. Some patients consider even the contents of their rectum as highly significant symbols. In connection with infantile understanding, the elimination of the intestinal contents may stand as a symbol of the birth act, or of a precious gift which may be released as an infantile form of giving or which may be withheld as an infantile expression of displeasure.
Diarrhea and constipation may result from abnormal subconscious conditions which are difficult to understand and therefore most often rejected by both the patient and the physician. The strong resistance against the psychoanalytical explanation of these personality disorders is to be expected.
Health Is Harmony
If it is correct to assume that maturity and psychosomatic health are conditions of equilibrium between the instincts and the rational soul, it is easy to see that psychosomatic disorders of the digestive organs are caused by disharmony within the person. As harmony is an accomplishment of maturity, the lack of maturity is due to the persistency or retention of early, infantile or juvenile elements which are out of place and incompatible with following developments.
The person who carries infantile concepts of pregnancy and birth into adult life will incline towards abdominal colics and surgery. The person who carries infantile concepts of digestive functions over into adolescence and beyond will suffer from diarrhea, constipation, and, ultimately, if no psychosomatic therapy is undertaken in time, will develop some of the non-infectious forms of colitis. What part of the digestive tract is mainly affected will depend upon the more or less complex psychological attitude and on the special organic weakness and the predisposing lower resistance of the individual patient's organs.
CHAPTER 9: OBESITY—LEANESS—METABOLISM
Obesity and leanness are the most obvious and the most common metabolic disorders. It is especially important to keep in mind the fact that (1) patients subject to these extremes in physical appearance have personalities that are divided; (2) that this division is not easily visualized; and (3) the patients themselves are not only unable, but also unwilling to comprehend it.
The problem of the treatment begins with the discovery of the underlying motivations. This is the point where the main difficulty is encountered. These patients have a peculiar manner of accepting all explanations given by their physician —they must change their ways of living, their diet and their individual outlook on life. While they consistently and with apparent cooperation profess to understand what they should do, they frustrate, at the same time, the purpose of the treatment by a kind of underground resistance of which they are sometimes partly, but most often completely unconscious.
Obesity is one of the most difficult psychosomatic conditions to overcome because it is, for many of those afflicted with it, a solution to a life-situation. Basic instincts and emotions have found an equilibrium which is not healthy, but which gives pleasure to the subconscious part of the individual who will defend his way of life with great persistency and resistance against therapeutic efforts. Subconscious and conscious insistence causes frustration of dietary measures and other restrictions. Hostility, always lurking in dark corners of the patient's mind, comes into the open when the doctor advises against temptations and deep-rooted habits. Dietary or medicinal treatment, or both, will succeed only if the psychological resistance is overcome by a strictly individual analysis, catharsis and reconstruction of the personality. Sometimes the result is accomplished with surprising speed and precision. Often, the solution is most difficult and requires much time.
They Love to Be Stout
Many fat people actually enjoy their obesity and will never consult or accept the advice of those who might deprive them of their precious weight and of their appearance, which they like. Most frequently, individual patients present very complex combinations of psychological and biological factors which cause their abnormal obesity or leanness.
Metabolic disorders of strictly somatic origin are sometimes contributory factors. When they do not explain the entire condition of the patient, the search for the ever-present psychosomatic motivation should not be abandoned before it has begun.
Treatment will only succeed when it is possible to trace the source of subconscious resistance, to expose it to the conscious and rational understanding of the patient and to obtain the patient's cooperation for a considerable period after he has accomplished the desired loss or gain in weight Enough time should be devoted to post-treatment in order to prevent relapse into the original deep-rooted habits of thought and actions which caused the condition.
Unfortunately, it is easier to advise the patient as to what he should and should not eat than it is to convince him of the need for frequent, regular consultations. The roots of overeating and self-starvation are deep-seated and can be eradicated only if both doctor and patient are persistent in their efforts. To illustrate: a drunkard does not give up drinking when you tell him that alcohol is injurious to his stomach and liver. In the same fashion that the habitual drinker cannot pass a tavern or bar without stopping in for a "quick one," the habitual eater cannot pass a restaurant, bake shop or his own kitchen refrigerator without stopping for a snack. The deep-rooted motivations seem to be irresistible. All of these persons need continuous guidance for long periods of time. As an illustration of a psychosomatic motivation causing obesity, I recall a certain patient whom I shall introduce to my readers as:
The Fat Cellist
This patient, thirty-three years old, of medium height, but so fat that he was unable to cross his legs when sitting on a chair, gave, in spite of the bulky, weighty mass which he carried into my office, the impression. of a boy rather than a man. He appeared unhappy and embarrassed. One glance was enough to establish the fact that he was overeating, and not too happy about it.
The patient's mother had died while he was still an infant. His father, an eminently successful musician, had, with characteristic indifference, hired a nursemaid to take over the care of the child. This woman, with neither home nor child of her own, took the boy to her ample bosom and literally kept him there long after the need for her care was gone. As the boy grew older, his awe for his father's musicianship grew in proportion to his own knowledge of music and his fear of his father's temperamental outbursts. The father did nothing to overcome the boy's fear of him, enjoying, if anything, his submissive attitude.
The Charming Lady Friend
Years later, as a young man and talented cellist, he displayed the same submissive attitude toward a lady friend. Fanny was an extremely charming woman, a cultured pianist and a successful entertainer, much in demand for her impressive presentations of somewhat risqué, but highly amusing French chansons. She was a tall, heavily built woman, sixteen years older than "Bum." (It was she who gave him this nickname.) She took him under her impressive wing and was seen with him, not only when professional duties threw them together, but also at many social events.
The appearance in public of the boyish-looking cellist, always in the company of the charming, but obviously much older companion, exposed "Bum" to much good-natured gossip. He remembered the occasional remark of a friend who had said, "In spite of the fact that you are so fat, you still have my sympathy." Another musician friend had once sung a little tune to him with the words, "My hubby is a skeleton, with just a little fat laid on."
Without being aware of his response to his somewhat embarrassing situation, he became very self-conscious in Fanny's presence. At parties, he found that he could avoid dancing with her as long as he was busy eating. Since eating is a source of pleasure in itself, the vicious cycle, so innocently begun, ended in "Bum's" tremendous growth to an impressive figure of 280 pounds. When he performed on the concert stage as a cellist, the mass of his thighs and hips was, of necessity, grotesquely exhibited in full view of the audience.
Eventually, Fanny was as much embarrassed by the Falstaff-like appearance of her young friend as he was by the awareness of an unbecoming situation. After all kinds of diets and patent remedies had been tried without result, Fanny placed her last hope on psychosomatic treatment and persuaded "Bum" to come to me.
His Impotency Caused by His Bulk
Like many obese persons, he denied that he indulged in excessive eating. His basal metabolism rate was normal. There were no significant findings of organic pathology. At that time (1926) our knowledge of the endocrine functions was less complete than it is today. A wider field was left open to speculation on the possible causes of the young man's affliction. "Bum's" obesity and depression were accompanied by a general inertia, which extended into the sphere of his social and personal relations. This inertia is commonly called impotence, but in so far as "Bum" was concerned, his impotency was not caused by organic deficiency, but rather by the general physical handicap of his bulk.
Under continued treatment, "Bum" lost eighty-five pounds within eight months' time. With the loss of weight, a sense of vigor and renewed vitality was acquired, almost without his being aware of it. Psychosomatic guidance furthered his understanding of the psychological motivation that had lain at the root of his condition, and he took sensible, decisive steps to remedy his life-situation. "Bum" severed his unbecoming relationship with Fanny with great tact, retaining her friendship but not her hold over him. He established a life of his own, unencumbered by either his father or his mistress. When I last saw him, he had kept to his normal weight of 185 pounds.
Mother Eats and Dies
More complex and not so easily understood is the fate of another patient, Julia F., who was a wealthy widow of Dutch extraction. She had lost some of her property, and her mind was preoccupied with this loss. In spite of the fact that she still owned very profitable investments in the movie industry, she believed that she was very poor and deserving of the sympathy of her family and everyone else. Her adult sons, active and successful businessmen and normally realistic in their outlook on life, did not give her that sympathy. They treated her respectfully and decently, but did not give in to her mistaken conception. This form of delusion is the central idea which caused her retreat into a childhood situation.
She Ate Herself to Death
Julia F. occupied a large apartment, the largest room being the dining room. In its center, there was a large dining table. Each morning, an opulent breakfast was served. After breakfast, the lady walked to another table near the window, where she sat in an easy chair and ate candies, nuts, figs, dates and various little delicacies until luncheon time. At noon, she walked back to the table in the middle of the room and consumed five courses of rich Dutch cooking for lunch. Then, the lady walked back to the table at the window and continued indulging in candies, nuts, figs, dates and petit fours, until it was time for afternoon coffee. At about three o'clock, the coffee and a large cake with heavy cream was served. Then followed again the candies, nuts, dates, figs and other delicacies until dinner time. At seven o'clock a large dinner of seven courses of rich Dutch dishes was served, after which the lady walked back to the table at the window and resumed her routine of eating candies, figs, nuts, dates and bananas until it was time to retire.
The day came when she fell into a coma, was taken to the hospital and died without regaining consciousness. The autopsy revealed fatty degeneration of all organs, especially the liver and kidneys, so far advanced that the original structure of the organs was hardly discernible. Julia had literally eaten herself to death.
One other person who ate himself to death was the late Senator Boise Penrose of Pennsylvania. His statue, facing the Capitol at Harrisburg, Pennsylvania, is a significant symbol.
Julia and many other persons like her are only slightly aware that they are psychosomatic patients. In this form of overeating, patients lose their normal, reasonably conditioned function of appetite. Instead, eating becomes the dominant means of self-satisfaction. It assumes a form of symbolic expression of personal importance and demands the attention of the family and the public.
Hunger, appetite and satiety are closely accompanied and linked by emotion. When infants and adults cannot satisfy their urge for pleasure by fondling and caressing, by friendly conversation or otherwise, they seek substitutes and usually find pleasure in eating. If this pleasure becomes a habit during infancy, it may be carried into adult life. When the social or family environment favors overeating, as in Western Europe in the beginning of this century, chubby infants are considered as expressions of good bourgeois standing.
When Children Are Too Stout
Obese children may easily become the object of their playfellows' ridicule. They feel ashamed, become shy, oversensitive and withdraw from contact with other children. The lack of playmates may become both the cause and the result of obesity. The same psychological chain may be the reason for inactivity which further increases overweight. Passivity and dependency are then followed by submissive resignation. The acceptance of dependency is inevitably followed by lack of social maturity, and a lack of normal sexual aggressiveness completes the chain.
To some people, eating and overeating is an indispensable factor of sociability. Others may add excessive drinking to this. In this state of mind, neurotic symptoms of anxiety, guilt and depression may occur as causal or associated phenomena. When dietary restrictions are not accepted and followed with sufficient care to become effective, thorough psychological examination is indicated. In these examinations, it is imperative to avoid generalizations since many forms of obesity are not primarily or exclusively produced by any single factor.
Many Causes of Obesity
I refrain from discussing rare forms of obesity such as are known under the name of Dercom's Disease (adipositas dolorosa), which is characterized by painful fat at ankles, wrists and abdomen, general weakness and muscle atrophy, endocrine disturbances and nervousness. Other rare forms of obesity are related to tumors of the pineal gland and associated with mental and physical precocity, followed later by the severe symptoms of the intra-cranial growth. Certain disturbances of the pituitary gland produce a feminine distribution of fat in men around the hips, breasts, waist and buttocks. This form of obesity may or may not be associated with abnormal sugar tolerance, premature sex development or dwarfism, small genitals or undescended testicles, scant hair in the axilla and public regions, a bright but sluggish and listless attitude. Another form of obesity is characterized by soft fat at the dorsum of the hands, ankles, breasts and back of the neck and is caused by a deficiency of the thyroid gland. All of these forms of obesity should be treated by physicians well versed in this branch of medicine. Patients with these conditions should avoid at all costs quack remedies and self-medication.
A constitutional form of stoutness is caused by a combination or concurrence of heredity and professional environment and is found in piano movers, butchers and people in similar occupations. Well-rounded athletes and arbitrarily manipulated figures of actors and fashion models become patients when they abuse their health by exaggerated, wrong and unnatural dieting.
Leanness, underweight and malnutrition appear to be the direct opposites of obesity and overweight. This is correct only with regard to the outward appearance of the person. Many organic conditions are the causative factors in leanness, underweight and malnutrition. The organic factors must be thoroughly examined in every individual patient before the psychosomatic concept of leanness can be understood in its full significance. Not always is the psychosomatic motivation so easily accessible as in the following experience:
Daughter Starves and Lives
One of Julia's daughters, Juliana F., in her early thirties, small and thin,
weighing less than eighty pounds, refused to eat and eventually found herself in
an advanced degree of nutritional deficiency.
Her mother, my patient reported in the preceding pages, who had refused treatment for herself, called me to prevent her daughter, as she said, "from committing suicide by self-starvation." Only with great difficulty was Juliana kept alive by careful nursing and much persuasion. After her mother's death, Juliana's resistance lessened and she agreed to take nearly normal amounts of food. She gained weight and strength just sufficient to live a solitary, friendless life in the small, stylishly furnished house of her own, which formed an incongruous background for her futile efforts to maintain an impressive appearance. At least her life had been saved.
Julia, the mother, in her psychotic delusion and manner of living had been unable to influence her sons, but her daughter was made of weaker stuff. She had submitted to her mother and came close to believing that they were very poor because her mother had said so. Watching the daily consumption of food, the continual procession of edibles to her mother's table, fostered in her the conviction that it was wrong for poor people to consume so much food. Mingled with this feeling of guilt was a not unnatural feeling of disgust and also a deep-seated resentment against this mother, whose belief in their poverty had prevented the daughter from leading a normal life, such as going to college and growing into adulthood with friends and acquaintances.
Her Self-Starvation Not Fatal
The girl retreated to her room, never daring to assert herself. There, she gave symbolic expression to the desires which her mother had suppressed. Her longing for companionship and pretty clothes appeared in primitive drawings and fashion designs. Her symbolic and negativistic reaction to her life manifested itself in the form of self-starvation. After her formative years had passed under these circumstances, tea more years of the same life were enough to establish an indelible life-pattern. Unhappily, her freedom from her mother's influence came too late.
The result was somewhat different with Julia's sons. They lived under the same roof with their mother and sister, but they were businessmen successful in the movie industry. They were not influenced by the conditions under which the mother and sister existed. They filled the house with lively companions and seemed to live a normal life. Perhaps, as productive and successful businessmen, they were more realistic in their view of life and developed a protection against their own emotions and delusions.
But businessmen, in general, axe like other people. They, too, have their individual problems under specific circumstances. No matter how devoted a man may be to his business or profession, he spends only part of his time working at it. He also belongs to his family and to his friends, whether they are directly related to his business or not. He is bound to react in his own individual way when meeting the challenges of his specific environment.
You Cannot Bargain With Nature
When businessmen become patients, they cannot very well help but carry some of their specific psychology into the doctor's office. They bargain with nature before they learn that this is impossible. They try to change conditions to suit their own purposes. Some try to persuade their doctors to agree that their way of emotional thinking is the right way. Many go from one doctor to another, hoping to find a doctor who will agree with them. These men do not obtain any cure or improvement unless they relinquish their resistance. Every person in business, in the professions and in every field of human endeavor needs to follow a purpose and plan in order to succeed in health as in business. Purpose and planning must be the result of clear and realistic thinking. Emotional thinking without a clear vision of reality is not only characteristic of the psychosomatic patient, but also of:
The Unsuccessful Businessman
Oscar B. earned very little selling wooden coffins. His income was less than that of his wife, Leonora, who was a librarian. Their economic security was fortified by the considerable property which Leonora had inherited from her parents. Their family life was harmonious. As time passed, Oscar assumed quite some importance in the home in his role as chef. On Sunday, holidays and special occasions, he was in his glory supervising the preparation of roasts and chicken dinners with all the trimmings. This seemed to be his hobby and he pursued it with great pleasure— and great gain in weight. Leonora, on the other hand, carried her extreme leanness rather proudly and with emphasis. She was a vegetarian and preferred a doctor who would accept, as her unchangeable constitutional condition, the fact that she was frail and sickly and in need of special diets. While Oscar served the dinner to the guests and himself, she picked from her barren plate, with demonstrative reluctance, a few carrots and string beans (which had been mincing bites. She advocated austerity in the midst of abundance! This situation lasted for many years.
One day, Oscar, never seriously ill before, felt unwell. A neighboring doctor was called. He examined Oscar and found him perfectly well and judged that his complaints were due to a minor indisposition. In leaving, the doctor gave Leonora the customary assurances. As they stood in the doorway of the apartment, they heard a sound from the bedroom where Oscar had remained—the dull, somewhat muffled sound of a slumping body. Turning back, they found Oscar dead.
A dignified funeral was followed by a dignified period of mourning. Before a year had passed, Leonora began to change. First she changed doctors and then, of course, on the advice of the new doctor, she changed her diet. The vegetarian diet was a thing of the past. Now she ate reasonably well-balanced meals and soon ceased to consult any doctor. She did not even mention her suffering and began to look like a normal person.
The immediate cause of Oscar's death had been an acute coronary incident, easily explained by his overeating, obesity and the consequent arteriosclerosis. His emotional second history was never mentioned. He had given it to me on one occasion, a long time previously:
Oscar Played Chef and Succumbed
He was born in a small, mid-western community. His mother had died when he was very young. His father was manager of a logging camp. There was not enough money to send Oscar to college and moreover, the widowed father did not want to be left alone. Oscar went into his father's business and, at the latter's death, succeeded him in the position of manager of the camp, eventually supervising more than one hundred men. Times changed, the camp closed down and Oscar went to the big city. Since all he knew was lumber, he considered himself lucky when one of his former customers offered him a job as salesman, selling wooden coffins. He knew lumber, but he was not a salesman and was never successful in his job. At home he felt inferior because he earned less than his wife. He suffered tragically from his conflicting feelings of resentment against his father, who had kept him back, and his feeling of shame in the face of his wife's superior education and earning capacity. His awareness of his emotional brooding was all the more painful, since he could not discuss it with anyone. Reality had to be ignored and emotions repressed. The only time he felt important was when he "played chef." Since he was an excellent cook and enjoyed the fruits of his labors, he chose this as his outlet. Unfortunately, it was not the correct solution, though it served him for many years.
Conflicts of this kind are frequently found in patients suffering from coronary disease. The effect of this psychological motivation is further increased by a development which starts with overeating, sometimes leads to excessive drinking as well, then to obesity and circulatory disturbances, eventually to coronary death.
Obesity and leanness are only two of the many most obvious metabolic disorders to which man is subject. Among the complete list, there are a number which are not at all familiar to the general public. However, there is another troublesome disorder about which nearly every one has heard something. This disease is commonly called diabetes. This disease is not caused by psychosomatic disturbance but is decidedly influenced by it and, in turn, diabetes influences the mind of the patient. It is also known that hereditary, endocrine and psychic factors contribute to or concur in this disease as well as in manifold other metabolic disorders. Anxiety, tension and depression are the emotional states which are found in diabetes, but depression often appears to be a reaction to the illness, rather than its cause.
We have no conclusive evidence that these metabolic disorders are strictly caused by psychological conflicts, but we do have evidence that, at times, certain emotions and metabolic disorders are strongly and mutually influenced.
Emotions may influence the blood sugar level to become higher or lower than normal. Slow activity of the brain waves may be recorded as a psychosomatic parallelism with low blood sugar. The fact that low blood sugar levels are accompanied by increased nervous irritability does not ascertain the causal relation between the two symptoms. Psychoneurotic instability is so regularly found in such patients that integrated organic and psychological treatment is to be preferred. There are also many metabolic changes Which occur as immediate effects of emotional disturbances. Occasional attacks of fever, fainting, dizziness, vertigo, chill, tremor, collapse or shock may be caused by sudden emotional upset. Sudden transitory changes occur in biochemical disturbances, especially in the chemistry of blood, gastric, intestinal and other excretions.
The relation between intake and output of water is greatly influenced by emotion. Hypnotic suggestion may alter the normal curve of urine excretion.
Hypnotic suggestion, indicating to the subject in hypnosis that the water he drinks is strong coffee, may result not only in frequent urination, but may also produce urine which has the same concentration and composition as urine eliminated after the real intake of real coffee without the hypnotic suggestion.
This is another example of experimental evidence for the effect of the psyche upon somatic functions. Most careful attention to the integrated psychosomatic treatment of metabolic disturbances is, therefore, justified.
CHAPTER 10: CANCER AND INTROSPECTION
The brain is a physical organ of the psyche and functions as an exchange center in which incoming messages from the organs and the senses are connected with outgoing orders traveling to the peripheral organs. The nerves which carry the messages are connected by association fibres in the cerebral cortex and in the centers of the mid-brain. These messages are silently transmitted in form of nervous energies, which we know only from their effects. These effects are real, beyond doubt. We are therefore entitled to call them messages without words, the voice of the organs.
The Voice of the Organs
In this sense, the voice of the organs, as a phenomenon, is open to scientific observation and research. It is of greatest importance in psychosomatic practice. It should also be noted that the voice of the organs speaks in different ways.
Psychophysiognomics is one field in which both the artist and the physician profit from observations which are not yet scientifically organized, but are nevertheless entirely realistic. All physicians know the Hippocratic face as the expression of impending death; the abdominal face which is seen in severe peritonitis; the choleric face with sunken cheeks and pointed nose of the patient who suffers from cholera; the leontine face of the leprous person; the sphinx-like face, which looks like a mask, with thick lips and half-open mouth incapable of other expression, and which develops in certain diseases of the muscular system; the ovarial face seen in diseases of the ovaries which shows the characteristic downward tendency of the forefront, nostrils and lips. These examples of the physiognomic expression of disease have become part of the classical literature in medicine.
Homoeopathic diagnosis considers the subjective symptoms as the basic expression of the organic suffering of the body organs, whereas scientific medicine respects the voice of the organs by the great care with which all local and general expressions of subjective and objective symptoms and signs are observed and followed up. In scientific medicine, the voice of the organs is a highly concrete and tangible mechanism.
Messages to the Mind
Not only well-defined and localized pain, but hunger, satiety, fatigue and overstimulation are sensations which may express the awareness of disease, depending upon their intensity and duration. If hunger persists after a meal, this sensation represents a message to the brain that something is wrong somewhere hi the digestive or metabolic system. Attacks of dizziness are often messages to the conscious mind indicating a disturbance in some distant organ, long before clinical methods of investigation and testing can locate the place of origin. Dizziness may mean anything between a temporary disturbance somewhere in the circulatory, digestive or other organs, as well as the beginning of cancerous growth in the pancreas gland or in the brain, which may be diagnosed only years later.
Change in the chemical composition of the body fluids may lead to intra-cranial pressure and headache. The headache may be felt long before it is possible to measure the organic changes or to determine its cause by clinical methods. Other changes in the composition of body fluids may not be discernible to the individual himself, but may be observed by other persons as a change hi the texture or color of the skin. It often happens that long before the individual feels a change, the outsider observes that the person looks fatigued, prematurely old, or otherwise different from normal.
Awareness May Be Subconscious
Subconscious awareness of illness: The organs express their well being or disorder in many ways of appearance and sensation. Minute changes of organic conditions are, indeed, registered by the subconscious or conscious mind. Whilst the psychophysiognomic expressions and common symptoms appear as a rather loud voice of the organs, audible to everyone who has ears to hear, there seems to exist another voice of the organs, which is of a much greater subtlety, so fine and delicate as to elude explanation or analysis. This particular voice of the organs seems to exist in some persons and to be absent in others. Perhaps it is present in every person, but education or social interests may lead the person to repress it.
In the absence of a definite pain or sensation, a patient may feel an inner unrest, which is often described as "nervousness." The patient is unable to describe the feeling iti detail. Even highly educated persons and physicians well-trained to describe symptoms are unable to specify their sensations of impending illness in a manner that can be understood by the outside person. Disturbances due to minute alterations of the hormonal and emotional system o* many phenomena of advancing old age cannot be objectively diagnosed by any means, but they distinctly affect the subconscious. It may, at times, affect the conscious behavior.
It depends upon the experience, insight into nature and professional astuteness on the part of the physician how much or how little use the voice of the organs may prove to be in his diagnosis and treatment of individual patients. These phenomena take place at the border between the subconscious and conscious sphere and are subject to all the mechanisms of subconscious and neurotic behavior. Sometimes the voice of the organs is suppressed; in other conditions it may become excessively loud in response to the smallest stimuli. We may draw the conclusion, however, that the voice of the organs is a highly complex function.
Some may consider the voice of the organs as the summary expression of all the combined subjective and subconscious, as well as conscious sensations of the patient. As this is a realistic concept, I have always felt obligated to observe and study this phenomenon in individual patients and to consider it as an essential element of the inner process in psychosomatic patients.
Listen to the Patient
The least we can say is that we have no right to ignore the sensations of the patient. In the beginning, it is often doubtful whether a patient's belief that he has cancer, or is much more than fear supported by superstition, or superstition supported by fear. After the events have taken place and the outcome is known and when the causal connections can be evaluated, only then is it possible to form an opinion as to whether the premonition of the patient was objectively correct. Even then, a sceptic interpreter of events may still prefer to consider coincidence as one of the factors in question. It is with these thoughts in mind that I present the following experiences of Caroline G. and Paul W. I ask the reader to form his final opinion after he has carefully weighed the evidence of objective, scientifically established information against the more fluid workings of the patient's thoughts and emotions. Therefore, the reader should not forget that thoughts and emotions rank as factual findings in psychosomatic medicine.
Last Year of Happiness
Caroline G. was a lady of about fifty years of age, who lived with two of her adult daughters. She came to my office at irregular intervals seeking reassurance for "worries." She called herself the "worrying type." While her husband and one of her daughters had been living abroad in Eastern Europe, where they were exposed to serious political risks, she symbolized her tears of fear for them in a post-nasal drip, which stopped almost on the day when husband and daughter returned home. A few weeks later, Caroline came to my office trembling with excitement and fear of something she did not reveal at once. Physically she had not changed and there were no organic complaints. She had no pains, no definite symptoms of any kind. Eventually, in the course of the extended interview, she volunteered the remark, "This is the happiest time of my life. My entire family is now safely at home after a time of terrible uncertainty . .."
Dr.: Then why are you excited and worried?
C: Because I have known all the time that I have a cancer. I know it for certain! Do you think, Doctor, that I will have one more year to live in happiness?
Dr.: You should have a complete physical examination to find out. It would be a good plan for you to go to the hospital.
C: Will you find out, in the hospital, whether I have a cancer? Dr.: I shall have you examined by the most competent specialists.
Later the result of this examination clearly showed that there was a cancer of the stomach and surgery was indicated. The patient was convinced that she would not survive and strictly refused to consent to an operation. She lived for exactly "one year of happiness."
Fear and Anxiety
At this point a few words about fear may be in order, because fear and anxiety are often unjustly blamed as the cause of many neurotic and psychotic disorders. But fear is not the cause of psychosomatic illness under any circumstances. It would be equally correct to say that to be poor is the cause of poverty—or, to be rich is the result of accumulating money, to limp is the result of dragging the leg, that death results when the will to live subsides, that neurosis occurs, because the peace of mind is absent, or, the moron suffers from lack of intelligence.
Such statements have no place in scientific medicine. Fear or anxiety can not be explained in blanket statements. It is not possible to relate the surface symptoms of fear or anxiety to the experience of the fetus during the intra-uterine life or to the shock the baby suffers, when he is expelled from his mother's womb. Nor is the anxiety of suffocation which the fetus or infant may have once upon a time experienced during the birth process the origin of neurosis. The sensation of anxiety which girls or boys may feel, when they go through their first sexual experience or adventure, is not sufficient to explain anxiety as a cause of psychoneurosis. If this were so, we should all be psychoneurotics, because we have all gone through these experiences. For these reasons, I shall not be satisfied to state that a patient suffers from a fear or anxiety neurosis. Anxiety and fear are mere symptoms; so it is always necessary to uncover the part they play in the chain of motivations.
Fear is caused by threats which originate in the patient's environment. Anxiety originates within the personality of the patient. Both must be traced, step by step, to their origin in every individual life. Even when the obvious situation is charged with sex problems and related tensions, the essential psychosomatic chain of causes and effects may be found in conflicts and solutions of quite different problems, as in the following experience which involved:
Two Years of Panic
Paul W., in his mid-forties, was a very busy man. He was also a very confused man. For the twenty years after I became acquainted with his story, I found ample reason to meditate about the problem of patients' introspection. My report should speak for itself.
In business, Mr. W. was uncommonly successful, and deservedly so; for he possessed an amazing acumen coupled with an energy and diligence rarely encountered. He took quiet pride in his success and enjoyed his work. His office was, to him, another world far removed from his personal life. He was married, had a sweet wife and three fine children. Their home was a charming estate in an exclusive suburban community, where Mr. W. Was treasurer of the country club and prominent in local activities.
Had She Killed Her Husband?
It was only in later interviews that I gathered that about three years before Mr. W. consulted me, considerable furor had been created in his neighborhood when the lady who occupied a nearby estate became widowed. Tongues wagged. Suspicions were voiced in not-so-guarded whispers that she might have killed her husband. Police investigation, however, found no evidence of foul play. The lady was left unmolested with her grief. During the unpleasantness, her erstwhile friends keeping discreet distance, Mr. W. thought it fitting and proper that he should befriend her. Friendship sowed the seed of a deeper emotion, bore the fruit of intimacy and provided rare fare for the local gossips. His wife declared an ultimatum of "one or the other—but not both." This was unwise because Mr. W. eventually chose "the other."
In overthrowing social standards, he shouldered the burden of being ostracized by many of his friends and neighbors. Yet he still loved his wife and children and, not long after, would have been happy to obtain a reconciliation; but gossip had created a barrier he could not hurdle. Prior to this, he had possessed an elastic energy and wit. Now, he was tense, keyed-up, finding his only outlet in his business, where he worked long hours at his desk.
His Only Symptom
At about this time, his eighty-two-year-old father died from a slow-growing type of cancer frequently found in the aged. Shortly after that Mr. W. consulted me. He feared that he, too, had cancer. His only symptom was fear. The negative results of all tests and examinations allayed his fears for a brief period, only to have them return, magnified a hundredfold. Repeated examinations by other doctors had similar results.
Meanwhile, in his sporadic visits to my office, I had succeeded in piecing together his second, emotional history. On the day when he told me that he had become impotent, I started with more aggressive methods of treatment. I told him bluntly that he was in need of a sincere review of his life-situation in order to regain his peace of mind by a solid readjustment.
After this interview, I did not see Mr. W. until a year later, when he consulted me again. His fear of cancer still persisted. At this time, there were some objective findings. I suggested that he see a surgeon. When the latter insisted upon an exploratory laparotomy, he was operated upon. A cancerous growth of the stomach was found and the patient died on the operating table.
In reviewing this experience, one cannot overlook the terrific tension which grew out of the life-situation and continued over a period of two years. During this time, the patient exerted enormous effort to overcome this tension in order to keep his mind free for his business. The result was complete exhaustion, in which sexual impotence was only one of the symptoms.
Inside this patient, his rational mind argued against his conscience and strove to ignore the deep-rooted knowledge of his natural obligations. It is in accordance with accepted scientific concepts that a prolonged emotional tension of this kind may produce ulcers of the stomach or duodenum. Statistics show that about five out of every hundred stomach ulcers turn into cancer. It is also a fact that ulcers and even cancers of the stomach do not always show in X-rays.
Referring back to the remarks about fear, which preceded this report of "Two Years of Panic," it may be helpful to remember that fear is psychosomatically related to many bodily changes. Fear is accompanied by pallor, flushing of the skin, widening of the pupils of the eyes or muscular rigidity.
At times, even the hair "stands on end." The picture of a terrified person in a state of acute fear is commonly known and is quite well-illustrated in the case of a person being literally "rooted to the spot" upon suddenly coming into contact with a poisonous snake. This is a bodily expression of fear.
Many Chronic Reactions
Recurrent fears or anxieties may also be accompanied by other symptoms which are
more difficult to observe and which require medical care. Circulatory
disturbances of the rhythm of the heart, too much or too little blood sugar, the
sudden increase or fall of blood pressure during periods of anxiety may persist
and produce chronic reactions. Many such psychosomatic phenomena have been
Organic changes may also result from chronic fear. A great number of effects have been observed in animal experiments. Therefore, the serious scientific men who are familiar with this recent research are not hesitant to accept these psychosomatic relations between body and soul.
The psychosomatic aspects of benign and malignant tumors are being studied extensively today. We do not claim that emotion causes cancer, but we know as a fact that patients with genito-urinary cancer or gastro-intestinal cancer have, as groups, certain resemblances in common. Fear of cancer often precedes the diagnosis that cancer is present Often these developments are highly dramatic because decisions on the life or death of the patient may be made at the right moment in the wrong direction or only when it is too late.
In many persons, great emotional tensions from various causes produce commonly known symptoms of nervousness, ranging between normalcy and illness. In certain persons, this tension turns suddenly into fear of cancer which is not supported by any specific sign or symptom. And yet, the organic examination undertaken for no other reason than the seemingly unsubstantiated fear of the patient reveals the presence of advanced malignancy in some organ, where, according to our experience, the same condition would have caused symptoms, dysfunctions or pain in other persons.
They Both Knew They Had Cancer
Cancer or malignant growths are not caused by psychological mechanisms. It is common knowledge that the beginnings of cancer are very insidious. Many people live in fear of cancer without having the dreaded disease. It is remarkable in the histories of Carolyn and Paul just related, that they did not simply fear cancer; they insisted that they "knew" they had it before even subjective symptoms or complaints directed the attention to a specific organ. They persisted all the time that they were right. The fact remains that the voice of their organs had clearly spoken to their own consciousness.
The Voice of the Organs
These are some of the psychosomatic aspects of the problem of the voice of the organs:
(1) The fear of existing illness may repress into the subconscious sphere the physical sensations and symptoms ordinarily associated with the conditions. This is a familiar neurotic escape-mechanism and is not a specific cancer problem.
(2) The fear of illness may possibly produce real disease and even malignancy through emotional psychosomatic mechanisms, similar to those in which burns, skin rashes and other organic symptoms are produced by hypnotic suggestion. Despite the fact that we know many cases of psycho-genie production of organic changes, we have no scientific evidence that cancer is produced in this way.
(3) Intensive emotion associated with fear of illness could cause the disappearance of the condition. Yet, as no explanation for these phenomena exists, doctors are inclined to ignore them with the same condescending tolerance that they apply to reports of religious "miracle cures."
(4) We may be just as correct if we assume that there exists a voice of the organs, a natural way by which the consciousness of the person is alerted to minute changes anywhere in the body and is stimulated to transform emotional thinking into bodily sensations.