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DISCUSSION: Dr. Charles Fisher noted that recent work has shown that adrenal and pituitary secretion is increased during REM sleep. This endocrine activity is regulated and modulated by the nonolfactory rhinencephalon which includes certain temporal lobe structures, the limbic system, and hypothalamus. These same structures regulate emotional and drive behavior, and also regulate sleep. Thus there is increased lability and variability of autonomic activities, increased endocrine function, a release of instinctual drives, and an altered state of consciousness, conditions similar to those postulated by Reiser as involved in psychosomatic dysfunction. Recently it has been reported that HCI secretion in patients with duodenal ulcer is markedly elevated during REM sleep and it has been suggested that coronary and asthmatic attacks occur during REM sleep. The normal increased variability of respiratory and cardiovascular function during this state may facilitate the opening of pathways for peripheral discharge from those dormant, medically pathogenic central nervous system circuits of which Reiser speaks.
Dr. Max Schur stressed the importance of examining the implications of multiple anlagen and genic linkages in psychosomatic illness. Expressed in analytic terms, there can be a linkage in predisposition between drive endowment and the anlage for certain apparatuses of primary autonomy such as motility and coördination, between the predilection for certain defense mechanisms and certain somatic apparatuses serving as the somatic source for stimuli which, through mental representation, gain the status of component instinctual drives. In psychosomatic disorders he believes we must consider not a genic factor but a constellation of multiple anlagen.