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Silverman presents detailed material from the intensive psychoanalytic treatment of eight patients who were physically healthy at the start of analysis, each of whom developed physical symptoms during analysis. He observed a number of psychological manifestations preceding the onset of the physical symptoms, which he considers cues for the forecasting of physical illness. Ten such cues are listed and discussed. Among these, 'exposure to critical psychological stress in an individual who in the past may have responded to psychologic stress with physical dysfunction' appears as an important characteristic.
On the basis of his findings Silverman suggests that persons exposed to critical psychological stress 'should seek medical consultation even if no gross somatic signs or symptoms are evident following such exposure'. If there are suggestive psychological manifestations even in the absence of somatic disease, such an individual should be followed from the 'physical standpoint' at frequent intervals, and limited goal type psychotherapy for relief could be instituted.
It appears to this reviewer that Silverman has unduly limited the goals and the potential for such research. To demonstrate the role of psychologic stress in the precipitation of physical illness and to direct attention to certain psychological manifestations as early signs of impending illness are certainly important achievements. Silverman, however, has not fully utilized his own material or the potential of psychoanalysis as a method for research (in depth psychology). Nor has he sufficiently cited relevant contributions of other investigators in this particular area of research.
Reports on similar phenomena—i.e., physical symptoms occurring during analyses of patients with character disorders—have