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This 'textbook in embryo', as the author calls it, reviews a twelve year period of study which was carried on under grants from the Josiah Macy, Jr. Foundation, through the Departments of Medicine, Surgery, and Psychiatry of the Columbia University College of Physicians and Surgeons. The Introduction presents statistics on the lengthening life-span and the consequent shift from the medicine of acute disease to that of chronic disease in which neurotic factors play a disproportionately larger rôle. These statistics indicate the need for corresponding changes in the emphasis in medical education.
The first chapter deals with the psychosomatic history, the second with special techniques of examination to supplement the psychosomatic history, the third with a general review of hospital admissions during the study. These chapters demonstrate that many clinical errors can be corrected by adequate history procedures alone (pp. 19–20). On pages 28 et seq., the nature of an adequate psychosomatic history is made clear, the level which it should strive to reach, and the circumstances under which unconscious material must be probed and where it can be held in abeyance. The psychosomatic history is never focussed exclusively on symptoms, environment, or history. Specifically it must describe a process of inner evolution, to wit, the evolution of chronic conflicts, the repressed components of the personality, the patterns of discharge of this repressed source of energy through organ systems or through behavior, and finally the patient's methods of defense against anxiety and other repressed emotions. Indeed, every medical and surgical anamnesis should bring out in this way the patient's preparation for illness (p. 39), through the influence of constitutional, physiological, and experiential factors (summarized in what the author calls the 'Psychosomatic Profile [vide infra]). The anamnestic procedures which medical students learn are far from this.
The author demonstrates