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Ascent from chaos: a psychosomatic case study, by Peter E. Sifneos. Cambridge, Mass., Harvard University Press; London, Oxford University Press, 1965. pp. xiii + 163. 27s.
The treatment of schizophrenia, with its acute crises, and necessity for periods of inpatient care, creates special difficulties for the analyst. No less are the problems posed by the psychosomatic illnesses. Here there is the need of collaboration with the physician, and sometimes the surgeon also, starting early in the condition and maintained over a number of years. Few facilities for this exist, and except in special circumstances the referral for psychotherapy usually occurs when the condition is in chronic form, after many years, and when all other methods are failing to control the symptoms. These two books are therefore of considerable practical interest, since they give detailed accounts, in one case of the extensive research work carried out by the Amsterdam group comprising physicians, psychiatrists, psychologists, and physiologists, and in the other of the combined treatment of one particular case at the Massachusetts General Hospital.
In their planned studies of the part that emotional factors play in the aetiology of disease, the Dutch tried to evaluate the specificity of the personality traits and the emotional conflicts in evidence at the time of onset and during the disease. Psychosomatic patients, they found, tended to control and inhibit all direct emotional expression of these conflicts, and developed diffuse tension. Sociopathic or psychoneurotic reaction patterns of behaviour in the face of conflict and frustration were inhibited and the somatic reaction patterns appeared to develop as a substitute.
The twenty-one papers cover a variety of studies, with observations on ulcerative colitis and asthma, on blood-pressure changes under emotional influences, on somato-types, syndrome shift, and suppression, on the correlation of psychological variables, and the results of group psycho