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To illustrate the psychogenic origin of certain types of organic dysfunction and to demonstrate a psychotherapeutic approach to such disorders, Dr. Ernst Simmel reports the following case:
The patient, a German man of fifty, an engineer on the merchant marine ship Seine, was admitted to the Schloss Tegel Sanitorium in the terminal stages of cardiac decompensation. There was a history of alcoholism. He suffered from intense dyspnoea, frequent anginal attacks, and was pulseless for prolonged periods. His face was bloated and cyanotic, his lips were blanched, and his skin sub-icteric. There was a generalized anasarca: a massive oedema of the extremities and of the genitalia, and a marked ascites. The heart was enlarged and a systolic murmur was heard over the entire precordium, both second sounds were accentuated–the pulse was scarcely perceptible, and the blood pressure very low. The lungs and the enlarged liver showed signs of chronic passive congestion. The patient voided small quantities of urine containing 6 to 13 per cent of albumin.
Cardiac stimulants and diuretics were administered but proved to be ineffectual. Anginal episodes became frequent, the respirations were shallow, the periods of pulselessness prolonged, and the cyanosis intense. The patient's condition was so critical that psychotherapeutic measures were undertaken as a last resort.
During various phases of the treatment, the following history was elicited. The patient was the oldest son of a cruel father and a grasping, stern mother who had antagonized him. Until the age of sixteen he had been beaten for enuresis. Although he had personal difficulties with his colleagues on the Seine, he was really happy only when on board the ship, and on leave he found it difficult to return to his family. He had been married to a nagging, frigid woman, whom he had divorced after she had been unfaithful to him with several soldiers during the war, when he was away at sea. In order to put an end to her