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Non-state educational institution
Higher professional education
"Moscow Institute of Physical Culture and Sports"
Course work
in the discipline: “General Psychology”
on the topic: “Franz Alexander. Psychosomatic medicine"
Introduction
The name of Franz Alexander, an American psychoanalyst of Hungarian origin, is well known throughout the world. He is recognized as one of the founders of psychosomatic medicine (psychosomatics). However, until now, none of Alexander’s works, with the exception of a book on the history of medicine written together with Shelton Selesnik, have been published in Russian. This is explained by the psychoanalytic foundation of his approach to the analysis of the causes of diseases and their treatment, which in Soviet times seemed especially unacceptable in psychosomatics - a discipline directly related to the ideologically dangerous problem of the connection between soul and body. Only now does the Russian-speaking reader get the opportunity to appreciate the strict logic and depth of ideas of this classic manual.
Alexander, Franz Gabriel. short biography
Alexander, Franz Gabriel January 22, 1891 (Bucharest) - March 8, 1964 (Palm Springs, USA). Franz G. Alexander's father was a professor of philosophy. All three of Franz's sisters were older than him. After completing his medical studies in Göttingen, Alexander worked at the Institute of Hygiene in Budapest in 1913; in 1914 he was called up for military medical service, finally working in a bacteriological field hospital treating malaria. Then Alexander works at the psychiatric clinic of the University of Budapest. Alexander begins to become increasingly attracted to Freud's views. In 1919 he went to Berlin, becoming the first student at the Berlin Psychoanalytic Institute. Alexander receives training analysis from Hanns Sachs. At first, Alexander became an assistant at the institute, and from 1921, a member.
The decision to become a psychoanalyst was not easy for Alexander, because he was very attached to his father, and while studying in Göttingen he met Husserl and Heidegger. The time spent in Berlin was very productive for Alexander. The following works were published: “Metapsychological Way of Vision” (1921), “Castration Complex and Character; Study of Transient Symptoms”, for the latter Alexander was the first to receive the prize established by Freud. In 1926, Alexander's first book was published, compiled from his lectures at the Berlin Psychoanalytic Institute: "Psychoanalysis of the Whole Personality. Nine Lectures on the Application of Freud's Theory of the Self to the Doctrine of Neuroses." Alexander's interest then turned to the application of psychoanalysis to criminology. In 1929, together with Hugo Staub, he published the work “The Criminal and His Judge.” The book's subtitle is provocative: "A Psychoanalytic Approach to the World of Criminal Law."
While still working in Berlin, Alexander became very interested in the therapeutic applications of psychoanalysis. At the Salzburg Congress (1924), Alexander made a report “Metapsychological image of the healing process.” Despite the medical-therapeutic position presented in it, in the 1927 discussions about amateur analysis, he rather shared the traditional approach.
In 1929, Alexander, at the invitation of the University of Chicago, moved to the United States, becoming a professor of psychoanalysis at the Faculty of Medicine. But the faculty doctors opposed him. Before moving to Boston, Alexander managed to create the Chicago Psychoanalytic Society. In Boston, Alexander publishes the book The Roots of Crime, and also becomes director of the newly created Institute of Psychoanalysis, independent of the Chicago Psychoanalytic Society. Great support was provided by the Rockefeller Foundation. For 24 years, Alexander was director of the institute, focusing primarily on psychosomatic research.
Alexander's goal was to create short-term therapy to shorten the time of psychoanalytic treatment. In 1949, Alexander's work Psychoanalytic Therapy appeared, in which Alexander tried to introduce the principle of flexibility, corrective emotional experience and “planning” of psychotherapy into psychoanalytic therapy. Alexander met with powerful rejection from American psychoanalysts and, disappointed that most of the members of his institute did not want to give up membership in the American Psychoanalytic Association, left Chicago to create and head the psychiatric department in Los Angeles at Mt. Sinai-Hospital.
Shortly before Alexander's death, the Franz Alexander Chair in Psychophysiology and Psychosomatic Medicine was created at the University of Southern California. The first head of the department was Alexander himself. The last book Alexander wrote further demonstrated his intellectual breadth; although many psychoanalysts believed that he expanded the boundaries of psychoanalysis too much, that his psychoanalysis moved too far into illness-centered psychotherapy. Yet it is impossible to deny Alexander's enormous influence over more than thirty years on American psychiatry and psychoanalysis. Alexander is one of the most significant figures in American psychoanalysis. Alexander's tendency to include psychoanalysis in the university and his preference for the medical aspect of psychoanalysis fit particularly well into the American psychoanalytic tradition.
"Psychosomatic Medicine" by Alexander Franz
Franz Alexander's "Psychosomatic Medicine" bears the imprint of the personality of its author - a professional in both psychoanalysis and medicine. In 1919, having already received his medical education, he became one of the first students at the Berlin Psychoanalytic Institute. His first book, Psychoanalyse der Gesamtpersoenlichkeit (1927), which developed the theory of the superego, was praised by Freud. In 1932, he helped found the Chicago Psychoanalytic Institute and became its first director. A charismatic leader, he attracted many European psychoanalysts to Chicago, including Karen Horney, who was appointed assistant director of the Institute. Sharing most of Freud's positions, Alexander, however, was critical of the theory of libido and showed great independence in developing his own concepts, and also supported the unorthodox ideas of other psychoanalysts. In general, his position is characterized as intermediate between orthodox Freudianism and neo-Freudianism. In the history of psychoanalysis, Alexander stands out for his special respect for the scientific approach and precise methods, and that is why the Chicago Psychoanalytic Institute, which he continuously directed until 1956, was the center of numerous scientific studies on the role of emotional disorders in a variety of diseases. Although the psychosomatic direction began to take shape in medicine long before Alexander, it was his work that played a decisive role in recognizing emotional stress as a significant factor in the emergence and development of somatic diseases.
The formation of psychosomatics in the 30s of the twentieth century as an independent scientific discipline was not a simple consequence of the invasion of psychoanalysis into somatic medicine in the process of expanding its sphere of influence, just as it penetrated, for example, into cultural studies. The emergence of psychosomatic medicine was predetermined, firstly, by the growing dissatisfaction with the mechanistic approach, considering a person as a simple sum of cells and organs, and secondly, by the convergence of two concepts that have existed throughout the history of medicine - holistic and psychogenic. Alexander's book summarized the experience of the rapid development of psychosomatics in the first half of the twentieth century, and the most interesting thing about it, undoubtedly, is the concentrated presentation of the methodology of a new approach to understanding and treating diseases.
The basis of this methodology, which runs throughout the book, is the equal and “coordinated use of somatic, that is, physiological, anatomical, pharmacological, surgical and dietary, methods and concepts on the one hand, and psychological methods and concepts on the other,” in which Alexander sees the essence of the psychosomatic approach. If now the area of competence of psychosomatic medicine is most often limited to the influence of psychological factors on the occurrence and development of non-mental diseases, that is, the line coming from the psychogenic concept, then Alexander was a proponent of a broader approach coming from the holistic concept. According to this approach, the mental and somatic in a person are inextricably linked with each other, and understanding the causes of diseases is impossible without a joint analysis of these two levels. Although the holistic approach is not currently rejected outright, it often escapes the attention of both researchers and clinicians - probably due to the difficulty of following its methodology, which requires not only a good knowledge of both the psyche and somatics, but also an understanding of them interconnected functioning. The latter is difficult to formalize, necessary in scientific research and clinical practice, and easily escapes the scope of scientific analysis, especially in the context of the ongoing differentiation and specialization of branches of medicine. In this regard, the significance of Alexander's book, in which holistic psychosomatic methodology is not only formulated and substantiated, but also illustrated with numerous examples of its specific application, has perhaps only increased in our days.
Alexander's predecessors and contemporaries described many different kinds of correlations between the emotional sphere and somatic pathology. The most deeply developed theory in this area was Flanders Dunbar's theory of specific personality types. This researcher showed that the psychological portrait ("personal profile"), for example, of patients suffering from coronary heart disease and patients prone to frequent fractures and other injuries, is fundamentally different. However, as in any other field of scientific knowledge, statistical correlation provides only initial material for studying the mechanisms of the phenomenon. Alexander, who has great respect for Dunbar and often cites her work, draws the reader's attention to the fact that the correlation between character and susceptibility to disease does not necessarily reveal the real chain of causation. In particular, between character and predisposition to a certain disease there may be an intermediate link - a specific lifestyle to which people with a certain character are prone: for example, if for some reason they are inclined to professions with a high level of responsibility, the direct cause of the disease may be occupational stress, and not the character traits themselves. Moreover, psychoanalytic research can reveal the same emotional conflict under the guise of apparently completely different personality types, and it is this conflict, from Alexander’s point of view, that will determine the disease to which the individual is most prone: for example, “the characteristic emotional pattern of an asthmatic can be identified in individuals with completely opposite personality types, who protect themselves from the fear of separation using various emotional mechanisms." Thus, thanks to his reliance on the psychoanalytic method, Alexander does not stop at discussing statistical correlations between external indicators of mental and somatic functioning, which have very limited value in relation to the main task - treating the patient, and goes much further, trying - although not always successfully - to identify deep-seated mechanisms of pathology.
The theoretical foundation of this manual is mainly the theory of psychosomatic specificity, or specific conflicts - the most famous concept of Alexander. According to it, the type of somatic illness is determined by the type of unconscious emotional conflict. Alexander proceeds from the fact that “each emotional situation corresponds to a specific syndrome of physical changes, psychosomatic reactions, such as laughter, crying, blushing, changes in heart rate, breathing, etc.”, and, moreover, “emotional effects can stimulate or suppress the functioning of any organ." Psychoanalytic research reveals unconscious emotional tension that persists for a long time in many people. It can be assumed that in such cases, changes in the functioning of physiological systems will persist for a long time, leading to disruption of their normal functioning and ultimately provoking the development of the disease. Moreover, since various physiological changes are observed in different mental states, the result of various long-lasting unconscious emotional states will be different pathological processes: high blood pressure - a consequence of suppressed anger, dysfunction of the gastrointestinal tract - a consequence of frustration of dependent tendencies, etc. Striving to be an objective researcher, Alexander recognized that the key provisions of his theory required additional verification and justification. Unfortunately, the theory of specific conflicts has not received clear experimental confirmation, including in numerous studies of the institute headed by Alexander specifically dedicated to this. However, it was not refuted. It continues to be considered one of the leading psychosomatic theories.
A feature of Alexander's approach was the emphasis on unconscious emotional tension, which, from a psychoanalytic point of view, is more pathogenic because it cannot find a way out in conscious actions. In this way, his approach differs from non-psychoanalytic ones, including those that prevailed in Soviet, and even those that prevail in modern Russian medicine, in which the influence of only conscious mental processes that are accessible to direct observation and description is analyzed. On another level, the opposite of Alexander's approach is a non-specific concept. According to it, the emergence and development of pathology is caused by prolonged conditions of stress, however, the specific form of pathological changes does not depend on the type of stress, but on which organs or systems in a given individual are more vulnerable. Criticizing the specific concept, supporters of the nonspecific concept especially emphasize the lack of complete correlation between the specifics of a psychosomatic disease and the personality of the patient. Apparently, there is no antagonism between all these concepts: some cases may be more consistent with one of them, others - with another. As noted above, the incomplete correspondence between the disease and the external characteristics of the personality is easily explained if unconscious conflicts are taken into account, as Alexander proposed. However, he by no means made a fetish out of psychic influences, recognizing the large role of somatic factors. In particular, he noted that typical emotional constellations characteristic of a certain somatic disease (for example, ulcers) can also be found in a person who does not develop this disease, from which he concluded that the presence or absence of a disease depends not only on emotional , but also from somatic factors that have not yet been sufficiently identified. He turned out to be right - in recent decades, the important role of genetic factors independent of the psyche in determining the individual vulnerability of physiological systems has been convincingly demonstrated.
Most of the space in the book is devoted to the application of the psychosomatic approach and the theory of specific conflicts to specific diseases. Although Alexander, based on a holistic approach, was against identifying a separate group of psychosomatic disorders (in any somatic disease one can find both somatic and mental factors!), the range of diseases he considered almost exactly coincides with what is now generally classified in this group. solid clinical material, including his own observations, data obtained by employees of the Chicago Psychoanalytic Institute, and numerous data from other researchers, he builds a well-thought-out scheme of psychosomatic genesis for each disease. The given case histories perfectly illustrate the ways of using the psychoanalytic method to identify underlying disorders of hidden emotional conflicts and treat these conflicts, and ultimately the disease as a whole.
Excessive optimism and confidence in his approach seemed to have let Alexander down - he often, without sufficient grounds, considered the mechanisms of diseases to be quite well understood, which in fact have been little clarified to this day. Because of this, the chapters devoted to specific diseases look, despite the constant reliance on clinical material, somewhat lightweight and are less convincing than the theoretical part. Thus, the connection between psychogenic constipation and anal-sadistic tendencies, although it will not raise doubts among many psychoanalytically oriented specialists, is unlikely to seem fully proven to others. Alexander's widely known hypothesis about the role of repressed anger in the formation of chronically high blood pressure is generally very convincing, but even it does not have unambiguous experimental confirmation, and many questions related to it are still not clarified. The situation is no better with other psychosomatic hypotheses: although clinical data in favor of one or another of them are periodically reported, it is still too early to draw definitive conclusions. Finally, the effectiveness of psychoanalytic treatment of psychosomatic disorders has apparently been exaggerated: according to modern experts, many psychosomatic patients are simply unable to adequately express their emotions, and therefore classical psychoanalytic techniques often do not improve their condition.
At the same time, we should not lose sight of the fact that these flaws in Alexander’s book are a consequence of the extreme complexity and poor development of the subject. And the understanding of this subject over the past half century, alas, has advanced very little. One reason for this is that most research in the field of psychosomatics unreasonably ignores the methodological principles developed by Alexander. This is manifested either in focusing on only one side, somatic or mental, or in limiting the analysis to the calculation of correlations of somatic and psychological indicators, on the basis of which only the most superficial conclusions about causal relationships are made. Conducting large-scale “correlation” studies is now a task accessible to a wide range of specialists: having data from clinical examinations of patients, you only need to supplement them with “psychology” - connect the psychological “profiles” of the individual, drawn by one of the psychometric tests, and then calculate how they are related to each other with a friend. There are now a great variety of psychometric tests, as well as methods of statistical analysis, and both are easily implemented in computer programs; As a result, the productivity of the researcher, in comparison with the times of Alexander, increases monstrously. However, if the descriptions of the mechanisms of psychosomatic pathology proposed by Alexander were often too speculative, then correlation studies, capturing only individual strokes in the complex picture of psychosomatic interactions, often do not clarify anything at all. The result is extremely little progress in understanding the psychosomatic nature of diseases.
It should be noted that Alexander was clearly wishful thinking, believing that the “laboratory era of medicine,” which was characterized by reducing the goal of medical research to identifying “more and more details of basic physiological and pathological processes,” had already ended. On the contrary, the “tendency he noted to squeeze more and more diseases into the etiological scheme of infection, where the connection between the pathogenic cause and the pathological effect seems comparatively simple,” does not seem to be going to weaken at all: more and more new hypotheses that this or that other disease - stomach ulcer, cancer, etc. - caused by some pathogenic microorganism, the scientific and other public meets with genuine interest. One of the reasons for the continued flourishing of the “laboratory approach” is due to the fact that the understanding of human physiology has increased not only quantitatively, but also qualitatively over the past half century. The discovery of many details of physiological mechanisms at the cellular and molecular level served as the basis for new advances in pharmacology, and the huge profits of pharmaceutical concerns, in turn, became a powerful factor supporting physiological research; a vicious circle has developed. This powerful system, which develops according to the principle of positive feedback, largely determines the modern face of “laboratory” medicine.
It is curious that the role of physiological mechanisms has begun to be recognized as leading even in the etiology and pathogenesis of mental illnesses. This was led to enormous progress in uncovering the mechanisms of information transfer between brain cells and associated successes in the pharmacological correction of mental disorders. The need for a broader, systemic understanding of the disease is not denied; on the contrary, sometimes it is even elevated to dogma, but the real orientation of research, medical education, and the organization of medicine contributes very little to this. As a result, many researchers and doctors are actually guided by the principle of reductionism - reducing phenomena of a higher order to lower ones. Instead of considering a healthy and sick organism as a psychosomatic unity, in which both cellular mechanisms and interpersonal relationships in which the individual is included are important - an approach substantiated and developed in detail by Alexander - narrow specialists try to resolve all issues without going beyond their favorite physiological level. At the same time, under the banner of a holistic approach, completely amateurish ideas are most often put forward, ridiculous in theory and ineffective in practice, which have nothing in common with the truly scientific approach of the author of this book. Thus, the advent of the psychosomatic era, contrary to Alexander's expectations, is still delayed.
The reader not connected with medicine and physiology must be warned that many of the “somatic” details of the hypothetical mechanisms of pathogenesis proposed by Alexander are undoubtedly outdated to one degree or another. Even such a seemingly simple phenomenon as ulcer formation is understood today completely differently than in the time of Alexander, and instead of one disease, about three dozen types of peptic ulcers are now distinguished, differing in the physiological mechanisms of the occurrence and development of the pathological process. A lot has become known about the hormonal regulation of physiological processes, about immune processes (which play, in particular, an important role in arthritis), and progress in understanding the mechanisms of heredity is absolutely colossal - it is worth at least remembering that the carrier of the genetic code was established after the appearance of this books! However, the most valuable thing in the book is not the descriptions of the hypothetical mechanisms of specific diseases, although they contain many subtle observations and completely indisputable conclusions, but the methodology behind them for penetrating into the psychosomatic nature of diseases.
Psychosomatics in the modern understanding
Psychosomatics is one of the branches of clinical psychology. Uses a synthesis of ancient traditions in the treatment of physical and mental illnesses and modern scientific ideas in the field of medicine and psychology.
In the modern understanding, psychosomatic medicine is considered as a method of treatment and the science of the relationship between mental and somatic processes that closely connect a person with the environment.
The fact that in certain somatic diseases, for example, bronchial asthma, a more or less clear connection is found between external and internal conflicts and the appearance of symptoms of the disease, has led to their definition as psychosomatic.
Psychosomatics arose in the historical and medical aspect as the antithesis of a one-sided organocentric perception of the disease, which separates a person from the world around him. Psychosomatics assumes that a sick person should be considered as a living and acting being, with all his inter-human relationships and interactions with the world, with its cultural norms and values.
In modern psychosomatics, a distinction is made between predisposition, resolving and delaying factors for the development of the disease. Predisposition is an innate, and under certain conditions, acquired readiness, which results in the form of a possible organic or neurotic disease. The impetus for the development of such a disease is difficult life situations. If neurotic or somatic diseases manifest themselves, they develop according to their own laws, which, however, are closely related to environmental factors (the importance of disease-promoting factors, for example, in chronic diseases, has become known only recently). Statement of the presence of a psychosomatic illness does not lead to denial of the main diagnosis. If today we talk about a psychosomatic biopsychosocial disease, then this only indicates a connection: predisposition - personality - situation.
medicine psychosomatic Alexander
Psychosomatic disorders
Psychosomatic disorders can be divided into the following large groups:
1. Conversion symptoms.
The neurotic conflict receives a secondary somatic response and processing. The symptom is symbolic in nature; the demonstration of symptoms can be understood as an attempt to resolve the conflict. Conversion manifestations mostly affect voluntary motor skills and sensory organs. Examples are hysterical paralysis, paresthesia, psychogenic blindness and deafness, vomiting, and pain phenomena.
2.Functional syndromes.
This group contains the predominant part of “problem patients” who come to the appointment with a motley picture of often vague complaints that may affect the cardiovascular system, gastrointestinal tract, musculoskeletal system, respiratory organs or genitourinary system. The doctor's helplessness regarding these symptoms is reflected, among other things, in the variety of concepts that refer to these complaints. We are talking about functional disorders of individual organs or organ systems; as a rule, any tissue changes are not detected. Unlike conversion symptoms, a single symptom has no specific meaning, being a nonspecific consequence of a violation of bodily function. Alexander described these bodily manifestations as accompanying signs of affect without the nature of expression and designated them organ neuroses.
3. Psychosomatic diseases in a narrower sense (psychosomatosis).
They are based on a primary bodily reaction to a conflict experience, associated with morphologically established changes and pathological disorders in organs. The corresponding predisposition may influence the choice of organ. Historically, this group includes classic pictures of psychosomatic diseases:
Bronchial asthma
Ulcerative colitis
Essential hypertension
Neurodermatitis
Rheumatoid arthritis
Duodenal ulcer.
Conditions for the development of disease in psychosomatic diseases.
In modern psychosomatic pathogenesis, multifactoriality is recognized in the explanation of psychosomatic diseases. Somatic and mental, the influence of predisposition and environment, the actual state of the environment and its subjective processing, physiological, mental and social influences in their totality and in addition to each other - all this matters as a variety of effects on the body, described as factors that interact between themselves.
For psychogenic diseases, i.e. neuroses, and somatic functional disorders of a neurotic nature, H. Schepank, in a large review devoted to the results of a long-term study of heredity and environment, assessed the importance of variance components. Heredity factors come first (30%). Then comes early development (25%), and finally, if you combine all three subsequent factors (childhood - 15%, life events - 15%, social influences - 10%, others - 5%), then in 40% of cases it matters interaction with the environment in later life.
In most somatic diseases, hereditary factors play an important role. For most psychosomatic complaints and symptom complexes, one has to look for a formative influence (“why here?”), i.e. an organ with a hereditarily determined predisposition (disposition). Whether the disposition will manifest itself, whether it will turn into manifestations of the disease (“why now?”) depends on the further course of life, the difficulties and relief that the person experiences. And whether the disease caused by the disposition will again go into a latent form depends on further living conditions, on the success of treatment and, no less often, on social support from others.
An illustrative example is a kind of natural experiment with the birth of twins, which, with modern research methods, allows one to find answers to questions about the interdependence of predisposition and environmental influences.
Neuroses and psychosomatic diseases.
If, along with hereditary factors, we describe as pathogenic a certain organ-specific readiness of the patient’s response to homogeneous environmental influences (for example, to the early loss of an attachment figure), then a number of questions arise. In particular, why does this lead to a psychosomatic disease in one case, and to a neurotic disease in another?
Epidemiological data indicate a higher frequency of psychosomatic disorders in lower social strata.
In conversations with psychosomatic patients, the psychotherapist often encounters severe resistance to attempts to carefully clarify the history of life and illness. This is due to several reasons. The leading role of somatic causes is not only more acceptable for the patient, but is also deeply rooted in the public consciousness under the influence of medical attitudes. Mental illness brings a sense of responsibility to oneself, sometimes stigmatization, somatic illness - on the contrary, a feeling of relief. Many patients experience this feeling when they learn about the organic nature of their disease, although this often means a more severe prognosis. Targeted assistance is expected to be provided by the doctor, and the patient’s own experiences and behavior are not taken into account.
One can imagine a psychosomatic illness as a genetically different form of overcoming a mental conflict, which from early childhood replaces another, possibly verbal, overcoming the conflict. We can talk about the “emotional illiteracy” of psychosomatic patients, their emotional lack of education. A psychosomatic patient speaks and operates in “bodily” formulations, expressing himself in the language of organ psychosomatic symptom formation.
The question of whether there is a specific family type of environmental influence that predisposes to certain psychosomatic diseases or to psychosomatic rather than neurotic ones can only be answered in future research. The methodological solution to this issue encounters great difficulties.
With bronchial asthma, empirical studies always describe an overly caring mother, in the same way, an increase in the incidence of obesity is associated not only in adults, but also in children with belonging to a certain segment of the population or ethnic group, including parents and more distant relatives in a given family.
Frequency of psychosomatic complaints and diseases
If we regarded all people with somatic complaints without an organic basis, which are most likely due to mental or social conflicts, as psychosomatic patients, this would lead to too many psychosomatic cases. Typically, somatic complaints of this kind are defined as autonomic disorders (autonomic dystonia, psycho-vegetative syndrome, autonomic lability, functional disorders, etc.).
In any case, whether the person considers himself sick is of great importance. Karl Jaspers notes in this regard that what might generally be considered a disease depends less on the opinion of the doctor than on the judgment of the patient and on the prevailing opinion in a given cultural environment. Disease, according to Jaspers, is a social concept, not a scientific one. This means that there is no generally accepted concept and clear delineation of the disease that can be given completely objectively.
The same case of psychosomatic illness may be assessed differently in a research center, by a general practitioner and in an epidemiological study. How strongly these data depend not only on the structure and location of the clinic, but also on the definition of “psychosomatic” and the diagnostic technique is shown by the spread of data in 11 studies in Germany from 5.1 to 66.8%. Such data on the percentage of psychosomatic patients among all people who consult a doctor are obtained as a result of various research methods.
As for the disease state, there was no correlation between the presence of severe symptoms of the disease and the tendency to consider oneself as sick.
There is no specifically “psychosomatic” treatment. The psychosomatic approach to treatment involves taking into account, along with biological, psychological and social factors. A doctor who adheres to this approach tries, during a medical examination, to obtain information about the patient’s current and past life, his personality traits, feelings, attitudes, relationships with other people, which requires knowledge not only of biological, but also of psychological and social sciences. A holistic therapeutic approach is to see the patient as a sick person, and not just a particular disease. In some cases, along with biomedical treatment, it is advisable to turn to specialists in psychotherapy, biofeedback and other similar techniques. Typically, however, some variation of such techniques is used by the attending physician as part of a holistic psychosomatic approach.
Conclusion
Most people are self-conscious about their physical appearance and have little knowledge of how their body functions and how its functioning relates to their personality. In Western culture, it is generally common to avoid physical contact. Body psychotherapy includes a physical dimension in the group experience and is a counterbalance to approaches that emphasize the first half of the mind-body formula. Therefore, body therapy techniques are used as an auxiliary in treatment focused on verbal interaction between the therapist and the patient.
Reich therapy, bioenergetic psychotherapy, Rolfing, primal therapy and other variations of body therapy methods are powerful psychotherapeutic tools that are used to bring about emotional release and radical changes in the human body, his feelings and personality as a whole.
The effectiveness of these methods and the possibility of their abuse are the reasons why a lot of speculation and controversy arises around the psychocorrectional groups where they are practiced. However, the tasks of these groups are not so different from those faced by groups that use other psychotherapeutic approaches, for example, Gestalt groups, in which feelings are comprehended through awareness of them.
Body-based psychotherapy is suitable for most participants. The exception is uncommunicative people who may seek body-based psychotherapy to avoid the need to improve their traditional communication skills. Another exception is individuals with a pathological need for physical contact and even inflicting pain on other people.
One of the controversial issues related to bodily psychotherapy is the issue of catharsis. Most adherents of this method believe that until emotions are discharged, they accumulate somewhere in the body. Thus, it seems that emotions are a kind of substance, a kind of genie in a bottle, which effectively emerges from it as soon as the right conditions arise. However, it is more likely that memories, rather than emotions, are stored in the nervous system, and when they emerge, they cause feelings corresponding to them. In this case, catharsis is associated not with energetic release, but with the reproduction of what is stored in memory, with the emergence of emotions that correspond to these memories, and with physiological reactions to these emotions.
When emotions are expressed in physical actions, this is, of course, accompanied by some reduction in tension in the body. But what’s more important is that experiencing deeply buried emotions helps you overcome the habit of avoiding them. This process expands a person's emotional repertoire and teaches that control over feelings can be weakened without any dire consequences. The subsequent integration of all the experiences gained helps to achieve a new level of self-understanding.
In conclusion, it remains to express the hope that a wide range of specialists and simply curious readers will be able to greatly benefit from the works of Alexander Franz. All of them will be able to get acquainted in the author's presentation with Alexander's famous hypothesis about the psychogenesis of organic diseases, which is recognized as the most deeply developed of all ever put forward. It may be of particular interest to domestic doctors specializing in the field of psychosomatic medicine, since the possible meaning of the unconscious revealed by the author mental conflicts in the etiology of somatic disorders - this is exactly what, for ideological reasons, was tabooed in the Soviet school of psychosomatics. Both doctors and psychologists and psychoanalysts will be able to get acquainted with many subtle observations from clinical experience. For all of them, it will undoubtedly be interesting to know how exactly one of its founders understood the goals and essence of psychosomatic medicine. And, of course, a brilliant anti-reductionist analysis of the interaction between soul and body, insightfully and logically carried out by an excellent practitioner, is a real find not only for professional philosophers and methodologists.
Bibliography
S.L. Shishkin. Preface to the Russian edition of the book: F. Alexander. Psychosomatic medicine. - M.: Gerrus, 2000.
“The History of Psychology in Persons,” ed. Karpenko L.A., M. 2005.
Karvasarsky B.D. “Psychotherapeutic Encyclopedia” St. Petersburg: ZAO Publishing House “Peter”, 2002.
Kulakov S.A. Basics of psychosomatics. - St. Petersburg, 2003.
Materials from the site www.psychol-ok.ru
Materials from the site www.koob.ru
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Psychosomatics- a branch of psychology that studies the relationship between mental experiences and bodily reactions of the body. The disease brings us one or another symbolic message - we just need to learn to understand the language in which it speaks to us through its symptoms.
Psychosomatic diseases are diseases the causes of which are more the mental processes of the patient than any direct physiological causes. If medical examination cannot detect a physical or organic cause of the disease, the disease is classified as psychosomatic.
Psychosomatic approach begins when the patient ceases to be only a carrier of a diseased organ and is considered holistically. Then the psychosomatic direction can also be considered as an opportunity for “healing”. The main goal is to find connections in time between the onset of somatic manifestations and reliable life situations.
All methods and methods of work are aimed at unfolding the energy, sensations and experiences that are blocked in the symptom. i.e. directly in the client’s body. To study ways of interacting with the outside world through illness. Search and formation of new, healthy manifestations through awareness, sensation, feelings, search for an object and action.
Psychosomatics helps:
- find the root of the problem of psychosomatic disorder;
- hear and understand your own body signals;
- learn to express suppressed emotions and feelings;
- speak openly about your needs;
- build relationships with others in a healthy way without using symptoms.
- understand the causes of illnesses of your loved ones;
- understand why the disease is beneficial for you;
- learn to independently cope with the symptoms of the disease;
- resolve intractable life situations without getting sick.
- learn to speak and hear people close to you;
- help your children build healthy relationships and be healthy;
- live a more fulfilling and creative life.
From the history of psychosomatics:
Psychosomatics - “Psychosomatic” translated from Greek means “psycho” - soul and “soma, somatos” - body. The close relationship between the mental and the somatic has been noticed and studied for several centuries, since the times of Hippocrates and Aristotle. This term was introduced into medicine in 1818 by the German psychiatrist Johann Heinroth, who was the first to say that a negative emotion that remains in memory or is regularly repeated in a person’s life poisons his soul and undermines his physical health. With the works of S. Freud in the late 19th and early 20th centuries, a systematic study of the mutual influence of the psyche and body in the picture of the disease begins. He is known to have argued that memories repressed as a result of psychic trauma and the psychic energy associated with them can, through conversion, manifest themselves in somatic symptoms. Freud also pointed out that "somatic readiness" is an important influence - a physical factor that is important for the "choice of organ"
The term “psychosomatic” finally took root in medicine thanks to the Viennese psychoanalysts (Deutsch 1953), and from that time on, psychosomatic medicine was designated as “applied psychoanalysis in medicine.” A huge contribution to the study and development of psychosomatics was made by Deutsch, Flanders Dunbar, Franz Alexander, Adler, Sondi...
Franz Alexander (01/22/1891 - 03/08/1964) Hungarian-American psychoanalyst. One of the creators of psychosomatic medicine, founder and leader of the “Chicago School” of psychoanalysis. Professor of Clinical Psychiatry at the University of Southern California (1957). Winner of the Sigmund Freud Prize (1921) of the International Psychoanalytic Association and other scientific awards and honors. President of the American Psychological Association (1938). Editor-in-Chief of the Journal of Psychosomatic Medicine (1939). President of the American Society for Research in Psychosomatic Problems (1947). Author of more than 120 articles. “Psychoanalysis of the Whole Personality,” 1927; “Psychoanalytic Therapy,” 1946, co-author. with T. French; “Fundamentals of Psychoanalysis”, 1948; "Psychosomatic medicine. Its principles and application", 1950; "Dynamic Psychiatry", 1952, co-author. with G. Ross; “History of Psychiatry”, 1966, co-author. with Sh. Selesnik. In the Russian translation “Man and his soul: knowledge and healing from antiquity to the present day”, 1995, etc.
Franz Alexander graduated from the Faculty of Medicine of the University of Budapest (1913). He studied a wide range of various psychological problems, including the negative consequences of raising children in excessive severity or pampering. Studied and typified emotional conflicts. During the First World War, Alexander was a military doctor (1914 - 1918). After the war, he took up psychotherapy and psychoanalysis and worked as an assistant at the Neuropsychiatric Clinic of the University of Budapest (1919 - 1920). Alexander worked and taught at the Berlin Psychoanalytic Institute (1924 - 1925), where he practiced short courses of psychoanalytic therapy along with standard ones.
Alexander formulated the principle and created a model of “corrective emotional experience,” according to which a psychoanalyst can consciously and actively regulate his own emotional reactions and direct his influence on the patient in order to counter his unproductive attitudes.
Franz Alexander interpreted obsessive-compulsive neurosis, conversion hysteria, and manic-depressive psychosis as various forms of disruption of the interaction between the repressive functions of the ego and repressed drives.
Alexander differentiated the concepts of “guilt” and “shame” according to their emotional content and functional results. In 1930, he was invited to lecture at the University of Chicago, where he became the first professor of psychoanalysis. Soon he moved to the USA and in 1932 he organized and headed the Chicago Institute of Psychoanalysis, which he directed until 1956.
Franz Alexander founded the first psychosomatically oriented psychoanalytic laboratory, where, together with his colleagues, he studied and described conflict models of illnesses manifested in various personality types, studied social disorganization and a number of criminological problems. In the late 40s - early 50s. Alexander developed and systematized the ideas of psychosomatics. He became one of the founders of psychosomatic medicine. He developed a functional theory of personality, within the boundaries of which he established four main personality functions:
- perception of subjective needs (internal perception);
- perception of information from the surrounding world (external perception or “sense of reality”);
- integration of external and internal perceptions (entailing planning actions to satisfy subjective needs);
- control of voluntary motor behavior (executive function “I”).
Alexander completed a series of works on the emotional causes of hypertension and stomach ulcers, which are considered classics of psychosomatics and psychosomatic medicine. From 1956, for a number of years, he was director of the Psychiatric and Psychosomatic Research Institute in Los Angeles. He was considered the leading psychoanalyst in the United States.
“The term “psychosomatics” should be used only to illustrate a methodological approach in research and therapy, which means the simultaneous and coordinated use of somatic - that is, physiological, anatomical, pharmacological, surgical and dietary - methods and concepts, on the one hand, and psychological methods and concepts - on the other. The emphasis here is on the expression "consistent use", showing that two methods are used in the conceptual framework of causal sequences." Alexander Psychosomatic medicine.
Therapists about psychosomatics:
As a former medical professional, I want to help clients stay out of the hospital. Learn to listen to your body's signals and not put off your symptoms until later.
Personally, understanding my body's reactions helps me stop symptoms from developing.
There are good results in working with panic attacks, migraines, pain of various localizations, and gynecological problems.
For me, psychosomatics is the likelihood of meeting with the inner world of a person, with his hidden resources, with his ways of interaction, with his secret desires to be seen, heard, recognized. Meetings with his impossibility, with his desire to change his life and his world, to become healthier!
BBK 88.4 A46
Franz ALEXANDER PSYCHOSOMATIC MEDICINE IT "S PRINCIPLES AND APPLICATIONS
Translation from English S. Mogilevsky Artist's serial design D. Sazonova The series was founded in 2001
Alexander F. ",
A 46 Psychosomatic medicine. Principles and practical application. /Trans. from English S. Mogilevsky. - M.:
Publishing house EKSMO-Press, 2002. - 352 p. (Series “Psychology Without Borders”).
ISBN 5-04-009099-4
Franz Alexander (1891-1964) - one of the leading American psychoanalysts of his time. In the late 40s - early 50s. he developed and systematized the ideas of psychosomatics. Thanks to his work on the emotional causes of hypertension and stomach ulcers, he became one of the founders of psychosomatic medicine.
In his main book, he summarizes the results of seventeen years of work devoted to the study of the influence of psychological factors on body functions, on the occurrence, course and outcome of somatic diseases.
Based on data from psychiatry, medicine, Gestalt psychology, psychoanalysis, the author talks about the relationship between emotions and diseases of the cardiovascular system, digestive system, metabolic disorders, sexual disorders, etc., revealing his understanding of the body as an integrated system.
For psychiatrists, psychologists, doctors, students of all these specialties.
© ZAO Publishing House EKSMO-Press. Translation, design, 2002
ISBN 5-04-009099-4
To my colleagues at the Chicago Institute of Psychoanalysis
PREFACE
This book, which is based on an earlier publication "Medical value of psychoanalysis" has two goals. It attempts to describe the basic concepts on which the psychosomatic approach to medicine is based and to present existing knowledge regarding the influence of psychological factors on body functions and their disorders. The book does not provide a comprehensive review of the many anecdotal observations published in the medical literature concerning the influence of emotions on illness; it presents only the results of systematic studies.
The author is convinced that progress in this area requires the adoption of a basic postulate: psychological factors influencing physiological processes should be subjected to the same detailed and thorough study as is customary in the study of physiological processes. Referring to emotions in terms such as anxiety, tension, emotional instability is outdated. The actual psychological content of emotion should be studied by the most advanced methods of dynamic psychology and have a correlation with somatic reactions. Only those studies that adhered to this methodological principle were included in this book.
ALEXANDER FRANTZ
Another postulate characterizing this work is that psychological processes are fundamentally no different from other processes taking place in the body. At the same time, they are physiological processes and differ from other bodily processes only in that they are perceived subjectively and can be conveyed verbally to others. They can therefore be studied by psychological methods. Every bodily process is directly or indirectly influenced by psychological stimuli, since the body as a whole is a unit, all parts of which are interconnected. The psychosomatic approach can therefore be applied to any phenomenon occurring in a living organism. This versatility of application explains the claims of a coming psychosomatic era in medicine. There can now be no doubt that the psychosomatic point of view offers a new approach to understanding the organism as an integrated mechanism. The therapeutic potential of the new approach has been established for many chronic diseases, and this gives hope for its further application in the future. "
Chicago, December 1949.
GRATITUDE
The psychosomatic approach is a multidisciplinary method in which psychiatrists collaborate with experts in various fields of medicine. This book is the result of my seventeen years of collaboration with colleagues at the Chicago Institute of Psychoanalysis and other medical specialists.
I would like to thank Dr. I. Arthur Mirsky for his assistance in evaluating some of the physiological data, particularly in the chapters on hormonal mechanisms, anorexia nervosa, hypertension, thyrotoxicosis, and diabetes mellitus, and for preparing the illustrations and Miss Helen Ross, Drs Thomas Szasz and Dr George Ham, who read the manuscript and made valuable comments. The chapter on thyrotoxicosis is based on research work I conducted in collaboration with Dr. George Ham and Dr. Hugh Carmichael, the results of which will be published in « JournalofPsychosomaticMedicine».
Some of the book's chapters are based on previously published articles. I would like to thank Dr. Carl A. L. Binger and Dr. Paul B. Hoeber for permission to reprint in this book portions of articles previously published in « PsychosomaticMedicine» (F. Alexander: “Psychological Aspects of Medi ALEXANDER FRANTZ
cine", "Emotional Factors in Essential Hypertension", "Psychoanalytic Study of a Case of Essential Hypertension", "Treatment of a Case of Peptic Ulcer and Personality Disorder"; F. Alexander & S.A. Portis: “A Psychosomatic Study of Hypoglycaemic Fatigue”), Dr. Sidney Portis for permission to partially reprint my chapter published in «
DiseasesoftheDigestiveSystem»,
National Security Council of Chicago for permission to reprint my article published in «
CurrentTopicsmHomeSafety»,
and Drs. Lago Galdston and Henry H. Wig-gins for permission to reprint portions of my article “Present Trends in Psychiatry and Future Outlook”, published in «
ModernAttitudesinPsychiatry»,
Columbia University Press, which served as the basis for parts of the introduction and the first five chapters.
Part 1 GENERAL PRINCIPLES
CHAPTER 1
INTRODUCTION
And again, the focus of medical attention is on the patient - a living person with his troubles, fears, hopes and disappointments, who represents an indivisible whole, and not just a set of organs - liver, stomach, etc. Over the past two decades, the main attention has been paid to the causal role of emotional factors in the occurrence of the disease. Many doctors began to use psychological approaches in their practice. Some serious conservative clinicians believe that this trend threatens the hard-won foundations of medicine. Authoritative voices are heard claiming that this new “psychologism” is incompatible with medicine as a natural science. They would like medical psychology to be reduced to the tact and intuition of the doctor in caring for the patient, which has nothing to do with the Scientific method based on physics, chemistry, anatomy and physiology.
Nevertheless, from a historical perspective, such interest in psychology is nothing more than a revival of previous, pre-scientific views in an updated scientific form. The priest and the doctor did not always share the care of a person’s physical and mental health. There were times when care for the sick was concentrated in the same hands. Whatever explains the healing power of a doctor, an evangelist, or holy water, le11
The therapeutic effect of their intervention was very significant, often even more noticeable than that of many modern drugs, the chemical analysis of which we can carry out and the pharmacological action of which we can evaluate with a high degree of accuracy. The psychological component of medicine was preserved exclusively in a rudimentary form (in the process of the relationship between the doctor and the patient, carefully separated from the theoretical foundations of medicine) - mainly as a convincing and comforting influence of the doctor on the patient.
Modern scientific medical psychology is nothing more than an attempt to put the art of healing, the psychological impact of the doctor on the patient, on a scientific basis, making it an integral part of therapy. Apparently, the therapeutic success of the physician (doctor or priest, as well as the modern medical practitioner) in modern practice is largely due to the existence of some kind of emotional connection between the doctor and the patient. However, this psychological function of the physician has been largely ignored in the last century - a period when medicine became a true natural science, based on the application of physical and chemical principles to the living organism. This is the fundamental philosophical tenet of modern medicine: the body and its functions can be understood in terms of physical chemistry in the sense that living organisms are physicochemical machines, and the ideal of the physician is to become the engineer of the human body. Therefore, recognition of the existence of psychological mechanisms and psychological
This approach to the problems of life and illness could be perceived as a return to the ignorance of those dark times when illness was considered the work of an evil spirit and treatment was an exorcism from the sick body. It was considered natural that new medicine, based on laboratory experiments, should carefully protect its newly acquired scientific aura from such outdated mystical concepts as psychological ones. Medicine, that nouveau riche among the natural sciences, has in many respects adopted the attitude typical of the nouveau riche who wishes to forget his humble origins and becomes more intolerant and conservative than a true aristocrat. Medicine is becoming intolerant of everything that resembles its spiritual and mystical past, while at the same time its older sister, physics, the aristocrat of the natural sciences, has undergone a much more thorough revision of fundamental concepts, affecting the very core of science - the validity of the concept of determinism.
These remarks are not intended to diminish the significance of the achievements of the laboratory period in medicine - the most brilliant stage in its history. The orientation of medicine towards the physicochemical approach, which was characterized by a scrupulous analysis of the smallest aspects of the subject of study, became the reason for significant progress in medicine, examples of which are modern bacteriology, surgery and pharmacology. One of the paradoxes of historical development is that the more significant the scientific merits of a method or principle, the more it hinders the subsequent development of science. Due to the inertia of human thinking, ideas and methods whose value has been proven in the past do not remain in science for long, even if their benefits obviously turn out to be harmful. In the history of the exact sciences, for example physics, one can find many similar examples. Einstein argued that Aristotle's ideas regarding motion stalled the development of mechanics for two thousand years (76). Progress in any field requires reorientation and the introduction of new principles. Although these new principles may not contradict the old ones, they are nevertheless often rejected or accepted only after a long struggle.
A scientist in this regard has no less prejudices than any layman. The same physicochemical orientation to which medicine owes its outstanding achievements becomes, due to its one-sidedness, an obstacle to further development. The laboratory era in medicine was characterized by its analytical attitude. This period was characterized by a specific interest in particulars, in understanding particular processes. The advent of more precise methods of observation, in particular the microscope, opened up a new microcosm, creating the possibility of unprecedented penetration into the smallest parts of the body. In the process of studying the causes of diseases, the localization of pathological processes became a fundamental goal. In ancient medicine, the humoral theory prevailed, which stated that body fluids were carriers of diseases. The gradual development of dissection techniques during the Renaissance made it possible to accurately examine the organs of the human body, and this led to the emergence of more realistic,
but at the same time also more localizationist etiological concepts. Morgani in the middle of the 18th century argued that the sources of various diseases are located in certain organs, for example, in the heart, kidneys, liver, etc. With the advent of the microscope, the location of the disease became even more defined: the cell became the location of the disease. The main merit here belongs to Virchow, who argued that there are no diseases in general, there are only diseases of organs and cells. Virchow's outstanding achievements in the field of pathology, supported by his authority, became the reason for the dogmatic views of doctors on the problems of cellular pathology that are still relevant today. Virchow's influence on etiological thought is a classic example of a historical paradox, when the great achievements of the past become an obstacle to further development. Observation of histological changes in diseased organs, made possible thanks to the microscope and improved tissue staining techniques, determined the direction of etiological thought. Finding the cause of the disease has long been limited to the search for individual morphological changes in tissue. The idea that individual anatomical changes themselves could be the result of more general disorders arising from excessive stress or, for example, emotional factors, arose much later. A less particularistic theory - the humoral one - was discredited when Virchow successfully crushed its last representative, Rokitansky, and the humoral theory remained in the shadows until
before its rebirth in the form of modern endocrinology. (
Few people have understood this phase of medical development better than Stefan Zweig, a medical amateur. In his book Healing by the Spirit, he wrote:
“Disease has now come to mean not what happens to a person as a whole, but what happens to his organs... Thus, the natural and original mission of the doctor, the approach to the disease as a whole, is replaced by the much more modest task of localization and identifying the disease and comparing it with a certain group of diagnoses... This inevitable objectification and formalization of therapy in the 19th century went to the extreme - a third person came between the doctor and the patient - a device, a mechanism. To make a diagnosis, less and less often the insightful and synthesis-capable eye of a born doctor was needed...”
No less impressive are the reflections of the humanist Alan Gregg 2 . He puts the past and future of medicine in a broad perspective:
“The fact is that all organs and systems in a person are analyzed separately; The significance of this method is enormous, but no one is obliged to use only this method. What unites our organs and functions and keeps them in harmony? And what can medicine say about the superficial separation of “brain” and “body”? What makes a person whole? The need for new knowledge here is painfully obvious.
S t e fa and Z w e i g: Die Heilung durch den Geist (Healing by the Spirit). Leipzig, Insel-Verlag, 1931.
Al an G regg: "The future of medicine", Harvard Medical Alumni Bulletin, Cambridge, October 1936.
But more than just a necessity, it is a sign of things to come. Interaction with other sciences is necessary - psychology, cultural anthropology, sociology and philosophy, as well as chemistry, physics and internal medicine, in order to try to solve the problem of the brain-body dichotomy left to us by Descartes.
Modern clinical medicine has been divided into two heterogeneous parts: one is considered more advanced and scientific and includes all disorders that can be explained in terms of physiology and general pathology (for example, heart failure, diabetes, infectious diseases, etc.), while the other is considered less scientific and includes a large number of ailments of unknown origin, often of psychogenic origin. A feature of this dual situation - a typical manifestation of the inertia of human thinking - is the desire to drive as many diseases as possible into an infectious etiological scheme, in which the pathogenic factor and the pathological effect are interrelated in a fairly simple way. When an infectious or any other organic explanation is not applicable, the modern clinician is very inclined to console himself with the hope that sometime in the future, when the features of organic processes are better studied, the mental factor, which for the time being has to be recognized, will be completely eliminated. However, gradually more and more clinicians are beginning to recognize that even in the case of diseases that are well explained from a physiological point of view, such as diabetes or hypertension, only the last links of the causation are known.
chains, while the initial etiological factors still remain unclear. Under such conditions, accumulating observations speak of the influence of “central” factors, and the word “central” is apparently just a euphemism for the word “psychogenic”.
This state of affairs easily explains the strange discrepancy between the official-theoretical and real-practical attitudes of the doctor. In his scientific writings and presentations to colleagues, he will emphasize the need to learn as much as possible about the physiological and pathological processes underlying the disease, and will not seriously consider psychogenic etiology; however, in private practice he will not hesitate to advise a patient suffering from hypertension to relax, try to take life less seriously and not work too hard; he will try to convince the patient that the real cause of high blood pressure is his overactive, ambitious attitude towards life. The “split personality” of the modern clinician manifests itself more clearly than any other weak point in today’s medicine. Within the medical community, the practicing physician is free to adopt a “scientific” attitude, which is essentially a dogmatic anti-psychological position. Since he does not know exactly how this psychic factor works, since it contradicts everything he has learned in the course of medicine, and since the recognition of the psychic factor undermines the physico-chemical theory of life, the practitioner tries to ignore the psychics as far as possible
ical factor. However, as a doctor, he cannot ignore it completely. When he encounters patients, his medical conscience forces him to pay primary attention to this hated factor, the importance of which he instinctively feels. He has to take it into account, while he justifies himself with the phrase that medicine is not only a science, but also an art. He does not realize that what he considers medical art is nothing more than the deeper, intuitive - that is, non-verbalized - knowledge he has acquired over many years of his clinical practice. The importance of psychiatry, and in particular the psychoanalytic method, for the development of medicine is that it provides an effective method for studying the psychological factors of the disease.
The father of psychosomatics, Franz Gabriel Alexander, in his book “Psychosomatic Medicine,” talks in detail and in detail about the fact that the disease occurs at the intersection of three spheres - psychological, physiological and social.
Psychosomatics: How it works
In his opinion, the GENERAL SCHEME looks like this. There are two factors at play. physiological(an organ weakened by genetics or developmental conditions) and psychological(personality characteristics, internal conflicts and the usual set of emotions). And then the factor comes to them social(unfavorable situation), and triggers a reaction. You could say the stars aligned.
The most curious thing here is that the psychological factor - the type of initial psycho-emotional conflict - can be distant from the disease itself far in time.
That is, “in the beginning there was the word,” but man did not even know about it until some kind of shock occurred.
It turns out, in a sense, that inside each of us there is a kind of time bomb in the form of two factors - a weakened organ and a “nuclear conflict” (from the word “core, center”).
Nuclear conflict usually arises in childhood, as a result of the confrontation between the desires and feelings of the child and the demands of the family. . In general, the strongest intrapersonal conflicts develop in conditions of dependence necessary for survival, which occurs in childhood.
The child receives from his parents a certain attitude, which quietly lies dormant in the unconscious.. Over time, prolonged stress is superimposed on the previously received attitude, as a result of which real feelings are suppressed, and illness appears.
Let’s now “tell Alexander’s fortune” and try to figure out what “nuclear conflict” is behind this or that disease. I will try to be as brief as possible, because the description and study of each group of diseases in itself is a vast ocean. Let's assume that I will show you a “map of the planet” from a satellite.
SKIN DISEASES
The skin is both the boundary of the body and a sensory organ. She is both what protects us and what we come into contact with. Through touch we can convey love and tenderness. They can also become a source of pain. The skin turns red with shame, turns pale and sweats with fear, betraying us like a bad partisan.
Skin diseases are always problems with contact and boundaries.
It's always a conflicting message: "Touch me - don't touch me."
Somewhere deep down there may lie suppressed and self-directed anger towards those closest to us. To those who, while showing love, violated boundaries too much or, on the contrary, were cruelly rejected if they wanted to get closer.
An example is an overprotective mother who constantly not only stroked and caressed the baby, but also unceremoniously disposed of his things and personal space in adulthood.
But, since the woman was affectionate and vulnerable all the time, it was absolutely impossible to be angry with her, because “she’s a mother, and she does everything just for him.” At the moments of the next violation of boundaries, the teenager felt anger and guilt for this anger at the same time. It was impossible to realize and express these feelings. But at such moments in my life, neurodermatitis was especially strong.
Another, polar option is a very busy mother. She always left early and came when the child was already asleep. But, if the baby was covered with spots and sores, she stayed at home and smeared him with ointment, gently touching him with warm hands...
GASTROINTESTINAL AND NUTRITIONAL DISORDERS
Remember the phrase “without sparing your belly”? The words “belly” and “life” go hand in hand. During feeding, a child receives not only mother’s milk, but also warmth, attention, care, affection, pleasure and reassurance.
If the mother feeds on time, the child feels loved, protected, and enjoys life. A prolonged feeling of hunger makes you angry, and then greedily absorb more than you need. Stale, untimely, unloved food or too much of it makes you feel disgusted and sick.
Just think about how many feelings are associated with food! The range of psychosomatic diseases is also huge.
BULIMIA- insatiability, greed for food, as a metaphor a huge lack of love and security. “Eat now as much as you like, otherwise there may not be any later” - as a metaphor for longing for love and attention, rare and insufficient emotional contact with parents.
ANOREXIA- refusal to eat as rebellion as an extreme way to attract attention. Hunger strike as an expression of anger and resentment. “Maybe, at least this way you will pay attention to me, hear me, notice me. It’s me, and not your expectations and deeds!”
Ulcer of the stomach and duodenum– a disease of “people of Western civilization who live by aspirations and ambitions,” businessmen and hyper-responsible hard workers.
“I am stubborn and independent so much that I will chop off the branch I am sitting on to prove that I can cope with all difficulties on my own. I will even feed myself. Myself."
On the surface there is ambition, activity, independence, and in the depths there is a repressed desire for love and great resentment. This symptom says the following: “Once upon a time, I really wanted your love and care, but you rejected me in my weakness and noticed me only when I was independent. I will never be weak again. I can do everything myself."
RESPIRATORY DISORDERS
Do I need to say anything about the importance of breathing? Smooth and deep, it is associated with freedom, lightness and contentment. Difficult - with a burden of experiences, prohibitions, fear. Stopped - with anger and indignation. Inhalation is filling. Exhale – devastation, relaxation. Speech is a natural extension of breathing.
PRemember the phrase “stepped on the throat of your own song”? People who deprive themselves of the “right to vote” often develop colds with various complications.
A At the heart of bronchial asthma is the conflict between the need for love and the fear of rejection.“Don’t come so close to me, you’re not letting me breathe. But don’t go too far, I can’t do it without you,” says the child to an overly anxious, protective and demanding mother, who does not allow the child to express himself naturally, to cry where it hurts or hurts (“Why are you crying, calm down now!”) , show interest where something new appears.
The need for love and support is strong, but is suppressed because it threatens “suffocation”; anger is also impossible because it threatens rejection. So the asthmatic remains somewhere in the middle, between inhalation and exhalation, due to increased demands and expectations, unable to relax, experiencing attacks of suffocation.
CARDIOVASCULAR DISEASES
“Heart, you don’t want peace…” we sing when we fall in love. “A warm-hearted person” - we say about kind and sweet people. We like them, these sincere, always smiling people. We also say “the eyes are bloodshot with rage,” and we avoid those who show their displeasure and openly express anger.
In our world, being a “darling” is much more profitable than openly expressing your intentions, desires for power and control. “Girls don’t get angry”, “Boys should be able to control themselves.” And they grow up and learn to look decent in the eyes of others, to be nice and discreet.
What about anger and indignation? If a child has not been taught to express them constructively, to defend his boundaries in a civilized manner, and to respect his values, then he will learn to suppress anger in order to be a good, decent person. And the stronger the pressure of the environment, the higher the pressure column will rise.
“I want to be in charge here, control everything and put you in your place. I'm very, very angry, but it's not decent. I have to keep a good face. That’s why I’ll smile at you now,” the hypertensive patient will tell you. Not with words. Tonometer.
METABOLIC AND ENDOCRINE DISORDERS
Have you ever noticed your own development at the moment of development itself? Do you have an experience of how satiation occurs or are you faced with its result in the form of satiety?
Metabolic processes inside the body occur quietly and imperceptibly, showing us only the result: changes in mood and condition, drowsiness or vigor, activity or lethargy.
Detecting the pathology of metabolic processes is one of the most difficult tasks, because the “metabolic process” itself does not hurt. Sometimes a person has no pain at all, and only by indirect signs can one determine that something has gone wrong. The most common diseases in this spectrum are diabetes mellitus, hypo- and hyperfunction of the thyroid gland. The psychological factors that cause their occurrence are very different from each other.
HYPOTERIOSIS
I can’t help but quote “Thyroid hormone plays an important role in the growth process. Phylogenetically, it first appears in amphibians, in which it serves the function of stimulating metamorphosis.
Artificial administration of thyroxine accelerates the transition of the salamander from aquatic to terrestrial existence, from gill respiration to lung respiration. The evolutionary transition from aquatic to terrestrial existence is due to the development of the thyroid gland.” (F. Alexander, “Psychosomatic Medicine”)
So, the thyroid gland is an organ directly related to development. Hypothyroidism manifests itself externally as fatigue, lethargy, deterioration of attention and memory. Simply put, a person suddenly stops being active. He literally “gives up.” The reason for this may be simple disappointment, abandonment of your dreams. “Why strain and invest vital energy if your desires are placed on the altar of other people’s demands, norms and rules? I am declaring a sit-in.”
HYPERTERIOSIS
The thyroid gland looks like a shield. That's why it's called that.
The desire to be protected appears in a situation of threat. When a person is scared, his heart beats faster, his palms sweat, motor excitement appears and his metabolism accelerates. The release of thyroid-stimulating hormone, which is produced by the thyroid gland, has exactly the same effect on the body. According to the psychodynamic approach, hyperthyroidism can be triggered by a lack of security, a sense of security in childhood and mental trauma.
DIABETES
Literally translated as “flowing with sugar.” Joy and pleasure leave the body without being retained in it. And it is not possible to get them from the outside in the form of sweets. What could lead to such a sad picture? Sadness can. And also chronic stress and conflicts, being in constant tension and experiencing self-doubt, that you can be loved and needed.
Hunger, fear and feelings of emotional abandonment. These are the feelings that are always present in the background in the life of a diabetic. It's not a sweet life at all.
DISEASES OF THE MUSCULOCAL SYSTEM
Movement is life. Run, jump, strive forward, recognize, move and act. This is how energy and strength are manifested in a person. We like active adults. But children are annoying. “Sit down already, don’t run, don’t turn around, calm down. Become comfortable and obedient. Become manageable."
Tell me, how would you feel if you were put in a “straitjacket”? Indignation, anger, anger at those who dared to deprive you of your freedom.
What if these outrageously behaving people are your loving mom and dad? What to do then?
Where to put your destructive impulses?
That's right, physical activity and constant monitoring. Patience and humility on the outside, no matter what happens, and suppressed anger on the inside is what can become the internal basis for the occurrence of rheumatoid arthritis.
AUTOIMMUNE DISEASES
The immune system is designed to protect the body by destroying harmful micro-objects that get inside. How does it happen that one’s own organs begin to be perceived as something threatening, requiring suppression and destruction? It's simple. You are probably familiar with the erroneous division of emotions into negative and positive. Joy, pleasure, tenderness - leave it. We get rid of anger, disgust, envy. But, my friends, it doesn't work that way.
The emotional background, as well as the hormonal one, is the same in a person. You cannot “remove” one without changing the other. If there is a Persona, then there is a Shadow. Diseases of this spectrum arise when one of one’s own parts of the personality has been given a harsh sentence - to be destroyed.
I want to warn you against the immediate desire to blame your parents for all your troubles. Believe me, they raised you based on the resources they had. And if they knew how to raise you better, they would certainly do it. But everything turned out the way it did. published
©Natalia Emshanova
Sometimes it happens that an attempt to cope with a particular disease only with the help of traditional medicine ends in failure. This often disrupts the already unstable emotional state of the sick person, leading to despair and depression. Naturally, this state of affairs cannot be ignored. It has long been known that many diseases can be easily cured in a comprehensive manner. Medicine, for example, recognizes that the early stages of hypertension can be miraculously cured with the help of meditation. The only problem is that we are not used to treating health as a resource whose reserves are being depleted. Due to inattention to our well-being and lack of appropriate diagnostics, these early stages remain practically unnoticed by us.
Psychotherapy, and specifically psychotherapeutic work with psychosomatic processes, often comes to the aid of medicine.
Franz Alexander - psychosomatics was his area of scientific interest; he was absolutely sure of the connection between a person’s psychological state and his health.
Working with psychosomatics within the framework of therapy is not an easy process. Most of the mechanisms described below are not at all understood by clients. And this is the main difficulty in the psychotherapeutic approach to working with the disease. The therapist’s task is to first discover and then help convey to the client’s consciousness exactly his unique way of coping with personal psychological conflicts with the help of a particular disease. The task, it must be said, is not an easy one, so few specialists actually work with the body. It takes time, trust in the therapist, and a high degree of maturity of the client’s personality. A very good option when choosing a specialist is when a therapist who deals with psychosomatic problems is also a doctor by training. Quite often people come to psychotherapy from medicine. The condition is not mandatory, but desirable. After all, your health and longevity are at stake.
Psychosomatics of diseases: table by Alexander F.
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1. Skin diseases (neurodermatitis, eczema, urticaria, itching) |
The mechanism of skin diseases is as follows: on the one hand, the use of one’s body as a weapon in competition with others in order to attract attention and gain recognition. On the other hand, there is a feeling of guilt that arises as a result of this demonstration. Thus, the skin, which is the main instrument of such display of the body, becomes a place of punishment for the guilt felt by the person. In these diseases, scratching is of great importance. When combing, a person directs aggressive impulses that are intended for the environment, out of guilt, towards himself. Hives are directly related to unshed tears; often, as soon as the patient stops holding back the crying, the rash goes away. The cause of itching of the genitals and anus is restrained sexual arousal. In these cases, by scratching the anus and genitals, the individual gives himself unconscious sexual pleasure. | The feeling of guilt forces a person to direct aggressive impulses towards himself that were originally intended for the environment. |
| 2. Thyrotoxicosis (Graves' disease) | The fight against anxiety encourages a person to “knock out a fire with a fire” - to perform very frightening actions. A person demonstrates maturity, self-sufficiency, and self-confidence to others, while feeling fear, anxiety, and uncertainty. | The desire to take responsibility and be useful, despite self-doubt and dependence. Pseudo-maturity, excessive efforts to assume the maternal role through excessive concern for others, often younger brothers and sisters. |
| 3. Cardiac disorders (tachycardia and arrhythmia) | There is a close connection between anxiety, fear and human cardiac activity. However, it is not entirely clear why in some cases the body reacts with tachycardia, and in others with arrhythmia. It is likely that individual organic factors are involved in this complex process. | In fearful, enslaved, insecure people, hostility generates anxiety, which in turn increases hostility. It's a kind of neurotic vicious circle. |
| 4. Hypertonic disease | Experiencing hostility in a given situation, modern man has learned to restrain it. This happens because in our society it is unacceptable to freely express aggression. From early childhood we are faced with the requirement to control aggressive impulses. Hypertension is the result of this control. The inability to defuse his aggression forces the hypertensive patient to live in a state of constantly restrained anger. | Hypertension is a state of chronic tension that arises due to the inability of an individual to express his aggressive feelings adequately to the current situation. |
| 5. Vago-vasal syncope | There are two ways the body reacts to danger: attack the feared object or run away from it. In order for an individual to escape, the body prepares physiologically - by dilating blood vessels in the muscles. If a person restrains himself and escape cannot take place, internal bleeding occurs in the muscular system, the pressure drops to a critical level - the person faints. Interestingly, the above reaction only occurs in a standing position. It is impossible to faint while lying down. |
Experiencing strong fear and a strong desire to run away, a person restrains himself and remains motionless. The physiological response is triggered and interrupted by the desire to be socially approved. |
| 6. Migraine | It is believed that the cause of migraine is stretching of blood vessels. | The impulses of anger and envy towards people who are more successful are turned on themselves through the mechanism of guilt. The attack is provoked by repressed anger. As soon as you manage to recognize your feeling and find how to realize anger adequately to the situation, the attack passes in a couple of minutes. |
| 7. Bronchial asthma | The immediate cause of an asthma attack is narrowing of the bronchioles. This local spasm can be caused either by a specific allergen or by psychological reasons. | The attack is provoked by aggressive impulses arising towards the object of love and a subconscious prohibition on this aggression. Also, any action that reinforces a person’s independence revives the internal conflict between the desire to be independent, self-reliant and the desire for dependent, insecure behavior. |
| 8. Rheumatoid arthritis | Intense muscular reaction to emotional experience. The desire to patronize and care for loved ones consists of two contradictory tendencies: to dominate, rule and serve, to please, to satisfy other people's needs. A way to subjugate loved ones, taking care of them and sacrificing oneself. | An attempt to control aggressive impulses through muscle activity: physical labor, sports, housekeeping. Serving others as a way to ease remorse over aggressive impulses felt towards loved ones. Chronically pent-up anger leads to increased muscle tone and arthritis. |
| 9. Individual prone to injury | Such a person is impulsive and is not capable of a pause between momentary desire and action. The internal conflict unfolds around repressed aggression directed against power structures, people in power and remorse for this protest. Trauma seems to atone for the guilt for this protest. | Such a person is a rebel, he protests against any authority. Even the power of his own mind, self-control, and discipline fall under his protest. Sometimes the psychological cause of injury is the desire to avoid responsibility, the need for care, possibly monetary compensation. |
| 10. Diabetes | People suffering from diabetes experience serious difficulties in changing their infantile, irresponsible behavior to more mature and independent behavior. They tend to regress during this process to childish forms of behavior, their desire for maturity is carried out mainly in words. These are more passive and dependent than mature and self-sufficient people. | Internal conflict between a child's need to receive care and a more mature one to take care of and be responsible for other people. |
| 11. Stomach and duodenal ulcers | Chronic stimulation of an empty stomach, associated not with food intake, but with repressed desires to be loved and protected, leading to the formation of ulcers. | The body's reaction to anxiety and fear, in which the desire to be protected is equated with the desire to be fed. In case of danger, a person prone to peptic ulcer disease regresses into an infantile state. That is, it turns into a child turning to its mother for help, since one of the first sufferings of a baby is hunger, satisfied by the mother |
| 12. Chronic psychogenic constipation | With constipation, excrement is retained as if it were something very valuable. Typically, this occurs due to several preempted installations. First, the world around me is hostile and I have nothing to expect from it. I have to hold on to what I have with all my might. The second is an unconscious aggressive attitude towards people, as a reaction to a feeling of rejection. | A pessimistic attitude, distrust of the world and people, a feeling of being rejected and not loved. |
| 13. Anorexia | An unconscious feeling of anger as a result of emotional dissatisfaction. | Lack of love and attention. Refusal to eat is a child’s way of making parents pay attention, worry, and care. |
| 14. Bulimia | A passionate desire for love and an aggressive desire to absorb and possess is the unconscious basis of bulimia. The reason is the same emotional hunger, dissatisfaction. | Trying to satisfy emotional hunger by eating. |
Don’t forget that both medical treatment and work with the causes of psychosomatics are important: the table of diseases will help you understand the causes.