Meetings of the New York Psychoanalytic Society

February 8, 1966. TOWARD AN INTEGRATED PSYCHOANALYTIC-PHYSIOLOGICAL THEORY OF PSYCHOSOMATIC DISORDERS. Morton F. Reiser, M.D.

Despite the rich accretion of new facts in psychophysiology and neurophysiology and rapid expansion of psychoanalytic ego psychology, a satisfactory integrated formulation of the mind-body interrelationship has not been achieved. Dr. Reiser suggests the approach of developing parallel psychological and physiological theories which may lead to an ultimate integration through the gradual convergence of the two theoretical lines.

As a central conceptualization from the recent psychoanalytic literature, the author presents Schur's thesis that there is an interdependence between the normal developmental desomatization of responses and the ego's faculty to use secondary processes and to neutralize sexual and aggressive energies. Conversely, the resomatization of responses follows from ego regression with the relative prevalence of primary processes and deneutralization of sexual and aggressive energies. The conflicts involved derive from all phases but are predominantly pregenital in character and accordingly the essential traumatization is thought to have occurred early, perhaps in the perinatal or earliest neonatal period. Engel and his co-workers have emphasized the role of object loss and the reactive affects of helplessness and hopelessness as central issues in psychosomatic disorders. Schmale has suggested the importance of the role of separation. These psychological dimensions are general in character and do not indicate why an individual develops one disease rather than another, nor why a psychosomatic disorder results rather than a predominantly psychological one. Grinker, Deutsch, and Schur tend to see choice of organ system as dependent mainly on genic factors or early psychophysiological fixations. Mirsky has identified the hypersecretion of pepsinogen into the blood as the genetically determined physiological condition necessar