Meeting of the New York Psychoanalytic Society

May 24, 1955. COMMENTS ON THE METAPSYCHOLOGY OF PSYCHOSOMATIC DISORDERS. Max Schur, M.D.

Based on the analytic studies of various dermatoses, the author considers his findings applicable to many of the psychosomatic disorders. The genetic aspects

of the ego's reaction to danger are the result of complex influences of development and are subject to regression to the infantile precursors which are diffusely discharged. With maturation homeostatic processes are stabilizing factors, and secondary thought processes emerge with the replacement of action with thought, the greater use of integrated automatic muscular activity, and a reduction of vegetative discharge phenomena leading to what is called increasing 'desomatization of response'. Dr. Schur advances a hypothesis which 'assumes the interdependence of the ego's faculty to use secondary processes and to neutralize energy, and the desomatization of responses. It assumes on the other hand that resomatization of responses is tied up with the prevalence of primary processes and the use of deneutralized energy.'

A biphasic reaction of the adult ego is considered: reality testing to differentiate between potential or present danger, and the ego's reaction to this danger. When the ego reacts regressively to an evaluation of danger, there is loss of the capacity for secondary process thinking, use of nonneutralized energy, failure of desomatization with the emergence of infantile types of diffuse discharge phenomena. From a selected controlled regression, with controlled anxiety, to complete regression, with uncontrolled anxiety, there is a complementary series of responses with differences in somatic discharge phenomena. A similar explanation with a like complementary series is offered for hostile affects and explains why anger and rage have somatic discharge phenomena. The economic equilibrium is further strained by the narcissistic regression which follows the somatic symptoms. Only by considering all these f