PSYCHOSOMATICS 



! 737 



Relevance to Specific Psychosomatic Problems 



primitive psychological processes. The impression 

 is gained clinically that patients with alleged psycho- 

 somatic illness show an exaggerated tendency to 

 regard the external world as though it were part of 

 themselves. In other words internal feelings are 

 blended with what is seen, heard or otherwise sensed 

 in such a way that the outside world is experienced as 

 though it were inside. In this respect there is a resem- 

 blance to children and primitive peoples. A form of 

 this confusion existing in childhood is morbidly ex- 

 pressed by the following statement of an adolescent 

 girl with epilepsy. Speaking of her first seizure which 

 occurred in childhood upon going into bright sun- 

 light, she said, "I had ;i I'unm laslc in m\ mouth of the 

 sun." There are numerous examples in Frazer's 

 Golden Bough illustrating how primitive man con- 

 ceived of various things in the external world as either 

 part of himself or products of himself. In books on 

 psychosomatic medicine one will find an abundance 

 of case material showing comparable tendencies in 

 patients with diseases that are recognized to be 

 greatly influenced l>\ psychological factors (70). The 

 onset of ulcerative colitis has often been noted to bear 

 a relationship to grief. In referring to .1 recently de- 

 ceased parent, a patient may point to the belly and 

 say, "He's right here." There may be expressed the 

 feeling of the need to net rid of, to defecate out, what 

 is felt to represent the dead person inside (48). 



The alimentary tract appears to be inextricably lied 

 up with these primitive psychological processes, 

 presumably because the mouth provides a natural 

 entrance and the anus a natural exit for what is 

 magically incorporated from the outside world. In 

 this connection food and other edible objects may 

 serve as representations of something in the external 

 world that is desired to be assimilated into the self, 

 or mastered and destroyed like a pre> or enemy. The 

 cannabalistic warrior in disposing of his victim takes 

 pains to eat the organs that he associates with strength 

 and other virtues of combat. In psychosomatic medi- 

 cine, it has been learned through the patient's sub- 

 jective associations that food may have a multiplicity 

 of meanings in relation to feelings of anger, fear, rejec- 

 tion, grief, etc. A patient with obesity and high arterial 

 pressure said, "I'd eat without realizing it, whenever 

 I would get nervous and upset." Her next associations 

 were to a mean landlady who was making life miser- 

 able for her. "It seemed if I could chew up and swallow 

 it, I'd get rid of what was bothering me." 



These considerations indicate but superficially the 



basis for the assumption that primitive psychological 

 processes are at work in psychosomatic illness wherebv 

 disturbances in the external world are symbolically 

 internalized and given expression through the mouth, 

 gut and other viscera. As a result environmental dis- 

 turbances seem to be coped with on a primitive 

 visceral level, instead of being resolved at the higher 

 level of organized thought, speech and action. This is 

 believed by some to be at the core of psychosomatic 

 illness. 



PRIMITIVE PSYCHOLOGICAL PROCESSES AND BRAIN MECH- 

 ANISMS. The psychiatric uncovering of primitive 

 psychological processes in psychosomatic illness re- 

 quires one to think in terms of cerebral mechanisms 

 that might account for such manifestations. In 1949 

 in a paper called 'Psychosomatic Disease and the 

 Visceral Brain,' the author (33) considered the 

 anatomy and physiology of the limbic system in the 

 light of this problem. In an elaboration of Papez's 

 proposed mechanism of emotion, emphasis was placed 

 on the cytoarchitectural difference between the rela- 

 tively primitive limbic cortex and the highly elabo- 

 rated neocortex. Attention was called particularly 

 to the very primitive character of the bippocampal 

 formation which shows a uniformity o! organization 

 from mouse to man (including the overlapping of its 

 afferenl fiber systems) and which occupies a strategic 

 position within the limbic s\sicm. Reasons were 

 given for the inference thai its overlapping afferent 

 systems conveyed sensory data from all the intero- 

 and exteroceptive systems. It was further emphasized 

 that this part of the brain, in contrast to the neocortex, 

 has large connecting tracts with the hypothalamus. 

 These considerations, together with the clinical and 

 behavioral evidence then available, were the basis 

 for the speculation that this limbic cortex interprets 

 experience largely in terms of "feeling.' It was sug- 

 gested that the crudity of the analyzing mechanism 

 and the overlapping of incoming impressions from 

 the nose, mouth, viscera, sex organs, eye, ear and 

 body wall might account for the often seemingly 

 paradoxical overlapping of affective reactions, such 

 as those associated with orality and sexuality, as 

 well as the state of confusion between external and 

 visceral awareness that allows outside situations to be 

 experienced as though they were inside. 



It was the broad implication of this paper that the 

 limbic lobe, which is found as a common denominator 

 in the brains of all mammals, is also, physiologicallv 

 speaking, a common denominator of emotional mech- 

 anisms, whereas the neocortex might be likened to 



