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Confusion prevails regarding the degree of emotional participation in many organic disorders, and contemporary methodology fails to establish the validity
of many psychosomatic concepts. Perhaps case selection explains the differences in results under conditions of comparative control (hospitals, clinics) versus private practice. Hoch stresses that symbolic and 'elementary' (physiologic) experiences or manifestations are not two different functions but constitute a hierarchy with subjective and with objective aspects. The subjective (symbolic) is not a shadow of the objective (physiologic) or vice versa; the interrelationship is rather that of two sides of one coin. He believes, in disagreement with Alexander, that the vegetative nervous system can be used also for symbolic expression, as in pseudocyesis and hypnotic stigmatization. Some patients alternate between vegetative symptomatology and the more typical neurotic or psychotic manifestations: if one mode of tension discharge is blocked, the other takes over. Hoch also questions the belief that certain emotional conflicts or certain dynamic configurations have the degree of specific system affinity sometimes claimed for them.