PSYCHOSOMAT1CS 



1727 



physiological processes, which accompany deep emotional 

 disturbances. . . . Using the physiological point of view, 

 therefore, I have considered emotions in terms of nerve im- 

 pulses, much as I might have considered the nerve impulses 

 from the 'motor area' of the cerebral cortex as they govern 

 the movements of skeletal muscles. 



As a piece of writing that was both authoritative 

 and popular in its appeal, Cannon's book had a wide- 

 spread influence. In helping to prepare the way for 

 psychosomatic medicine it made a twofold contribu- 

 tion. First, it increased a receptiveness in the minds of 

 physicians to look upon the importance of psychologi- 

 cal factors in bodily disease. Second, it stimulated 

 psychiatrists to see how their theory of the dynamics 

 of the psyche applied not only to mental disorders and 

 hysterical manifestations pertaining to the 'voluntary' 

 nervous system, but also to disorders and disease of 

 structures under the control of the autonomic nervous 

 system (70). 



By the middle 1930's the climate of medical opinion 

 was such that the word psychosomatic, given new 

 emphasis by Flanders Dunbar (14), was rapidly 

 seized upon. As early as 1939 there was established a 

 journal called Psychosomatu Medicine. In [942 there was 

 founded the American Psychosomatic Society for re- 

 search on psychosomatic problems. In the following 

 year there appeared the first textbook on psychoso- 

 matic medicine by Weiss & English (68). 



Psychosomatic Ih torders 



To provide background in regard to the role of 

 neurophysiology in psychosomatics, it is necessary to 

 indicate the nature of illnesses that physicians have 

 been predisposed to place in the psychosomatic 

 category. Psychosomatic illnesses may be subdivided 

 into those that are 'functional' and those that are 

 complicated by single or multiple lesions. Each of 

 these groups in turn may be further subdivided ac- 

 cording to whether the underlying mechanisms ac- 

 counting for the changes are considered primarily- 

 neural or neurohumoral. 



A diagnosis of a psychosomatic functional disorder 

 is usually made after excluding other etiological 

 factors. The patient presents himself with one or more 

 complaints; and if no cause beyond psychological 

 factors can be found to explain the symptomatology, 

 and provided there is no evidence of an underlying 

 psychosis, the condition is labeled as a psychoneurosis. 

 Fatigue, headache, palpitation of the heart, pains 

 around the heart, shortness of breath, nausea, vomit- 



ing, indigestion, diarrhea, constipation, backache and 

 joint pains are among the types of complaints that are 

 commonly attributed to functional disorders of psycho- 

 logical origin. Psychological factors are also fre- 

 quently inferred to be primarily responsible for dis- 

 turbance of function related to the glands of internal 

 secretion. Disorders of menstruation and lactation 

 may be cited as examples of such. Obesity, which was 

 formerly commonly attributed to glandular dysfunc- 

 tion, is nowadays considered in most cases to result 

 from overeating precipitated by emotional factors. 

 Finally, there are many illnesses with symptoma- 

 tologies so well recognized that they can be diag- 

 nustically labeled and in which, according to the 

 nature of the disease, there may be tissue changes of a 

 reversible or irreversible nature (70). A partial list of 

 diseases in which psychological factors are considered 

 m be of significant etiological importance includes 

 skin diseases such as urticaria and neurodermatitis, 

 migraine, hay fever, asthma, essential hypertension, 

 peptic ulcer, nonspecific ulcerative colitis, and rheu- 

 matoid arthritis. Some physicians have given emphasis 

 to the coincidence of episodes of severe emotional 

 disturbances and the onset of hyperthyroidism and 

 diabetes mellitus. 



ROLE OF NEUROPHYSIOLOGY IN PSYCHOSOMATICS 



In considering the role of neurophysiology in psy- 

 chosomatics, ii will be necessary to give further at- 

 tention to definitions and to point out their significance 

 in regard to some important methodological con- 

 siderations. 



Qtu tfions •>/' Definition awl Methodology 



In the opening section of this chapter, in arriving 

 at a formulation of what is meant by 'psyche' and a 

 'psychological process," advantage was taken of 

 Wiener's use of the word 'information.' As information 

 is information, not matter or energy, it is obvious that 

 the informational aspects of the psyche defy physical 

 measurement. It is equally evident that only the indi- 

 vidual himself can experience first hand the informa- 

 tion he derives from the internal and external environ- 

 ment. The communication of this information to 

 another individual requires that it find expression 

 through some form of behavior. In this respect both 

 man and animal are in the same category, and 

 scientifically, therefore, there is as much justification 

 for submitting the one as the other to psychological 



