A Note on the Psychogenesis of Organic Symptoms

Some psychogenic organic symptoms such as tremor or blushing are the direct expressions of emotions or conflicts, while others are only their indirect results. Examples of the latter are (1) the effects of acting out, such as catching cold from throwing off the bed clothes during sleep, (2) the incidental soreness of an arm due to an hysterical tremor. This indirect type was described by Deutsch in 1922.1 He stated that psychogenic organic symptoms were not necessarily "conversions", but often represented a result of an organic process initiated by emotional disturbances. This distinction was stressed and clarified by Alexander in his theory of the etiology of peptic ulcer.2 His evidence indicates that the ulcer may be the more or less incidental result of years of gastric dysfunction arising largely from emotional tension of a specific kind. The clinical notes here presented illustrate this mechanism (emotion—appropriate physical expression—organic pathology) with special reference to activities during sleep.

They are taken from the analysis of a very intelligent married man of forty. The patient's surface attitude was a show of great superiority and independence. This was a compensation for hurt masculine pride—hurt by the fact that actually he was very dependent, always got people to make decisions for him and to give him things—the "get something for nothing" type. These desires, as expected, were expressed in his dreams in the infantile language of eating, being fed, aggressive biting, etc.,