Meetings of the Psychoanalytic Association of New York

February 27, 1978. A RECONSIDERATION OF TECHNICAL AND THEORETICAL ISSUES CONCERNING THE PSYCHOANALYTIC TREATMENT OF PATIENTS WITH PSYCHOSOMATIC DISORDERS. (Fourth Melitta Sperling Memorial Lecture.) Morton Reiser, M.D.

Limiting his remarks to patients with the "classical" psychosomatic disorders of essential hypertension, ulcerative colitis, and bronchial asthma, Dr. Reiser discussed

a variety of technical and theoretical issues in the analysis of such patients. He offered a brief historical review, noting that the early postwar enthusiasm for analyzing psychosomatic disorders waned with the realization that these patients sometimes develop serious, even fatal exacerbations of their illnesses during treatment. Lindemann felt that classical analysis was contraindicated in patients with ulcerative colitis because of possible psychosis or exacerbation. Alexander believed that classical analytic technique should be used only during periods of symptom quiescence. But Melitta Sperling favored forceful analytic work and confrontation of the patient's gratifying use of symptoms during exacerbation. The problem of whether the patient could tolerate the working through of the transference neurosis in a classically conducted analysis led to the question of whether, in such cases, classic analytic technique should be modified to make analytic work feasible. Since psychosomatic illnesses are characterized by multiple etiologies and a course marked by exacerbations and remissions, any attempt to discuss this question, or to formulate new questions amenable to analytic research, requires that a review of the newer neurobiologic and psychological research be undertaken.

Earlier theories of the etiology of psychosomatic illnesses implied a linear causal relationship between psychological conflicts and the subsequent illness. Alexander's theory, for example, postulated specific precipitating social situations, psychological conflicts, ego defenses, and constitutional physio