PSYCHOSOMATICS 



[ 739 



the archicortex. It is therefore conceivable that 

 through the interplay of the neocortex and limbic 

 cortex by way of the central gray and reticulum of 

 the midbrain, thought may generate or inhibit emo- 

 tion, and emotion may facilitate or paralyze thought. 

 If this were so, it would be expected that this would 

 be one of the neural mechanisms by which the frontal 

 lobes contribute to the anticipatory aspects of emo- 

 tion. In this connection one might also speculate 

 that a neural circuit is hereby provided whereby an 

 individual can size up his own feelings in such a way 

 as to be able to project himself into the situation of 

 others and to identify his feelings with theirs. Such 

 insight (empathy) is necessary for the foresight that 

 looks to the needs of others, as well as the self. 



In the final section there will be an opportunity to 

 consider the indispensable role of memory and learn- 

 ing mechanisms in psychosomatic processes. 



In the light of what has been said about the ani- 

 malistic brain formed by the limbic system, it is 

 probable that even in man it is incapable of dcalim; 

 with language. In man this would present a problem 

 of communication between limbic and neocortical 

 systems that could be compared to that faced by a 

 rider and his horse: 



Both horse and man are very much alive to one another 

 and to their environment, yet communication between 

 them is limited. Both derive information and act upon it in 

 a different way. At times the horse ma) shy and bolt for 

 reasons at first inexplicable to his rider. But the patient and 

 sympathetic horseman will try to find out and understand 

 what it is that causes the panic, so he can avoid the disturb- 

 ing situations in the future or reassure and train the beast 

 to overcome them. One may think of psychotherapy as serv- 

 ing in a similar capacity, helping the intellectual faculties 

 of the patient to ferret out the disturbing factors in his life's 

 situation so they can be dealt with and controlled in an in- 

 telligent fashion. In the case of the psychosomatic patient 

 one suspects this helps to prevent excessive 'neighing' on 

 the streets of slow-moving traffic to the viscera (35). 



THE PROBLEM IN REGARD TO FORMATION OF LESIONS 



Acute Emotional States 



Instances abound in which it has been shown in 

 both animal and man that emotional states precipi- 

 tated by environmental situations are associated with 

 profound changes of visceral and viscerosomatic ac- 

 tivity. For the physiologist. Cannon's book Bodily 

 Changes in Pain, Hunger, Fear, and Rage (11) has become 

 a classic reference in this regard. Such observations 



have led to the little-disputed clinical assumption 

 that chronic emotional disturbances may be concur- 

 rently complicated by a variety of functional disorders. 

 Where there is already existing disease, there seems 

 to be no doubt also that in some instances acute emo- 

 tional states precipitate the formation of a lesion. This 

 appears to be clearly evident, for example, in some 

 cases of coronary thrombosis, and one is reminded of 

 Cannon's demonstration that conditions of emergency 

 are followed by shortening of the clottinsj time of the 

 blood. But it has yet to be convincingly demonstrated 

 in animal or man that emotional states have an im- 

 mediate effect of inducing lesions in previously 

 healthv tissue. 



Chronic Emotional States 



When considering the delayed or chronic effects of 

 emotion, one is faced by a situation complicated by 

 many intervening variables. There is good circum- 

 stantial evidence that several alterations of neuro- 

 endocrine function which do not manifest themselves 

 immediately are traceable to psychological factors. 

 In discussing 'psychosomatic phenomena' in animals, 

 Beach (5) has offered illustrations of how environ- 

 mental disturbances appear to have an adverse effect 

 on fertility and lactation. In the field of s,\ necologv 

 and obstetrics, there is abundant evidence that emo- 

 tional disturbances tan be correlated with disorders 

 of the menstrual cycle and of lactation (70). But as in 

 the case of the acute situation, there is no solid evi- 

 dence that the formation of lesions in healthy tissue 

 can be attributed to the delayed or chronic effects of 

 emotion. 



G nil Adaptation Syndioiin' 



In connection with his much publicized 'general 

 adaptation syndrome,' Sclye (60) has suggested that 

 psychological 'stress' may precipitate widespread 

 lesions through pituitary adrenocortical mechanisms. 

 The argument is based on the following experimental 

 developments. He found that when rats were exposed 

 to a wide variety of damaging agents, there was a dis- 

 charge not only of adrenal medullary but also of 

 adrenal cortical hormones, and that concurrently 

 there appeared to be an increase in the animal's 

 resistance to the noxious agents. He saw in this a corre- 

 lation with the demonstration by Hartmann et al. 

 that 'cortin' raised the resistance of tissues to infection. 

 Subsequently it was shown that in the absence of the 

 hypophysis, there failed to be a release of the adrenal 



