Psychosomatic Diseases in Children and Adolescents1

In her opening remarks, Pavenstedt suggested that psychoanalytic study of the developments of early childhood offers a most fruitful approach to furthering our knowledge of psychosomatic disorders. This view was shared by members of the panel and other discussants who centered their interest upon early ego development. Discussion revolved about the dominant theme of endogenous and exogenous factors that foster or hinder early ego development. Pathology in the neonate was seen by all as the crucial determining factor in the genesis of psychosomatic illness.

Regression which dominates the psychopathologic phenomena of all psychosomatic disorders was discussed from different vantage points, but always central to the discussion was an evaluation of the quality of defect in the neonate's physiopsychologic state. The neonate's ability to achieve somatic and psychologic homeostasis to his distorted first orientation to need-gratification experiences regardless of incomplete fulfillment of earliest libidinal levels, was a focus for all discussion. It is noteworthy that all contributors spoke of regression to a state of development before the oral stage—a preconflictual primary functional level. It was most interesting and refreshing that in a full day's discussion of psychosomatic diseases there was no mention of specificity of the current conflict as a determinant of the type of psychosomatic illness manifested. Instead, the immediate conflict was seen by all as merely a precipitant and not as playing a determining role as to the type of illness manifested. Irene M. Josselyn, for example, specified, and the others inferred, that any conflict exerting sufficient stress may precipitate regression, the psychosomatic manifestations of which are determined by the above-mentioned neonatal vicissitudes.

Josselyn's report of her study of cases of ulcerative colitis had as its goal the testing of the hypothesis that psychosomatic illness has its roots in the experiences of th