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This book presents recent concepts of psychosomatic illness from the points of view of self psychology and object-relations theory.
In reviewing the evolution of psychoanalytic concepts regarding psychosomatic illness, Dr Taylor cites the early specificity theories, which linked particular diseases with specific psychological factors. Flanders Dunbar attributed disease to specific personality configurations. Her work was criticized because she did not conduct psychoanalytic examinations of patients, but relied largely on case records and personality profile studies, which reflected only superficial layers of personality. Alexander named specific intrapsychic conflicts which he believed were associated with psychosomatic illness. He related conflicts over dependency to overactivity of the parasympathetic division of the autonomic nervous system, and conflicts over aggressiveness to overactivity of the sympathetic division. With his research colleagues, Alexander later proposed a multifactorial model, which made more room for the influence of postulated physiological vulnerabilities. These investigators also pointed out interpersonal factors; for example, certain psychological traits of their patients tended to elicit responses from other persons that reinforced the patients' psychopathology. Still other writers tried to delineate specific patterns of response to stress; to some extent, these stress-response theories neglected the unconscious meaning of a given stressor and a given patient's varied response to varied stressors.
With the rise of ego psychology, theorists began to study regression: not just regression of mental functions, but regression of physiologic functions from later, more differentiated patterns to earlier, more primitive patterns of physiologic response. If organic dysfunction had been associated in early life with a phase-specific instinctual conflict, conflict in later life could provoke regression to the earlier instinctual phase, with