On a Differentiating Mechanism of Psychosomatic Disorder1

It was Freud, as might be expected, who took the initiative in studying psychosomatic disorder, and indeed it was in this field that he began his psycho-analytic work. But he confined himself mainly to conversion-hysteria (where symbolism is in evidence) and did not devote himself in a comparable way to the general field of enquiry (where symbolism is highly doubtful).2 This was opened up in the second quarter of this century by later psycho-analysts, Alexander (1943) and Deutsch (1939a), (1939b) who have provided two of the very few theories in the field. Then, rather more than a decade ago, came the theory of Selye (1952), which was endocrinological so far as mechanism was concerned. In 1952 I (1953) tried to form a specific theory on the general problem. And the next year Wolff (1953) produced a theory centering on an idea like Selye's, which Wolff, however, made more definite and infused with psychological content. In addition there is Groen's (1957) non-specific framework.

In the sense in which theories are understood in science, i.e. groups of testable hypotheses possessing a high degree of specificity and power of explaining mechanisms in some detail, there are very few psychosomatic theories. There are, however, several highly important ideas that have been put forward, which have not been developed, at any rate as yet, into theories capable of answering specific questions about mechanism. Though not theories, these ideas are of central importance, in that they are very likely to have a fundamental bearing on the enquiry, and should therefore find a place in a well developed theory. Ideas that may prove to be indispensable are: Head's (1911–1912) body-schema; internal objects, as introduced by Freud but taken in the more specific form they assume with Melanie Klein; Garma's (1950) biting mother-imago (which is evidently an application of Klein's concept); Alexander's (1935) directional attitudes;3 and Kardiner's (1941) 'action-syndro