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We do not know the full extent of psychological influences that may be operative in a pathological process. But there is little doubt that the diseases in which emotional conflicts play a considerable or even decisive part by far outnumber those where this is not the case. Evaluations of the proportion of cases with emotional conflicts range from 30 to 80 per cent of all patients consulting a physician. It is strange, therefore, that only few psychoanalysts seem to be actively interested in psychosomatics. Quite often one hears, although it is seldom expressed in print in our literature, that psychoanalysis may be an adequate instrument for the treatment of psychoneuroses, but is of little use in the field of the organic diseases which are biological processes and as such fully dissociated from the emotional sphere. I do not believe that this view is in keeping with a modern concept of illness.
In the past two or three decades the small group of psychoanalysts who have undertaken systematly studies of the whole range of somatic diseases have come to some relatively specific hypotheses. It is remarkable that the views of the individual workers converge, and considerable contributions towards a metapsychology of psychosomatic diseases have been made. Other parts of this vast field, it is true, are still unexplored.
As a stimulus for our discussion, I wish to propose a hypothesis which I have called the bi-phasic defence. I shall try to explain how a psychoneurotic development paves the way and actually provides the essential preconditions for almost all kinds of chronic diseases which we have learned to recognize as being influenced by psychological conditions.
When looking out for pathogenic factors we have to keep in mind that while our psychsomatic model allows us to differentiate between "somatic" and "psychic" factors by applying clinical methods of observation, both groups tend to form "complementary series", as Freud called them. The same is expressed in