Meetings of the Psychoanalytic Association of New York

DISCUSSION: Dr. Ira Mintz presented several dramatic examples of anniversary reactions and said that patients are often unaware of the connection between the important anniversary and the onset of physical illness or the exacerbation of symptoms. The role of the unconscious meaning of events must be explored if we are to understand these phenomena in more than just a superficial way. In

evaluating neuroendocrine studies, we must understand that organic vulnerability may be an important factor, but it is not sufficient to explain psychosomatic phenomena. In Luparello's work, asthmatic attacks were induced and aborted with the same saline solution, first described to the patient as allergenic and then as medicated. Dr. Mintz then described three patients with severe ulcerative colitis. In their treatment, bouts of negative transference produced attacks of colitis; effective interpretations resulted in a cessation of the attacks. Stubborn episodes of severe bleeding in all three patients responded dramatically to interpretation. In these patients, when changes occurred in the transference, in the defensive systems, in object relations, in the tendency to regress, and in the capacity to tolerate frustration and emotional distress, there were also changing endocrine responses related to the cessation of symptoms. The crucial feature was the clinical responsiveness to interpretation. This responsiveness occurred regardless of the additional multidetermined genetic and physiological factors intimately associated with the disease. Dr. Howard Schwartz addressed what he called the problem of "the subtle and overt resistances to the treatment of psychosomatic patients among many analysts." He noted that the medical profession is paying increasing attention to the role of psychological factors in medical disease, even as the psychoanalytic profession seems to be losing interest in psychosomatics. While agreeing with Dr. Deutsch that there is an overly simplified