You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
October 26, 1981. PSYCHOANALYTIC OBSERVATIONS ON THE PREDICTION OF PHYSICAL ILLNESS. Samuel Silverman, M.D.
Dr. Silverman emphasized the need for an approach to the prediction and prevention of physical illness that would include psychological predictors. He referred to the 1923 work of Scholz and Pfeiffer who reported that "nervousness" preceded the diagnosis of cancer of the tail of the pancreas. After World War II, recognition of the role of emotion in physical illness increased. The emphasis was on the etiological aspects, and, unfortunately, the trend was toward the "packaging of personality traits and assigning them to a particular somatic disease—a simplistic and superficial approach."
Dr. Silverman's data were derived from studies of patients seen in extensive consultation or therapy (mostly psychoanalysis) to evaluate the predictive aspects of psychological factors. He considers psychological stress and its often unrecognized unconscious significance as a necessary but insufficient predictor of physical illness. He found that the "psychological matrix" of these patients contained a number of different predictors: heredity, somatic identification, insufficiency of psychological homeostatic mechanisms, transference manifestations, and dreams. They are important in determining the type of response to stress, including the possibility of physical illness. Dr. Silverman gave clinical examples illustrating each predictor but cautioned that these cases should not be seen as demonstrating a review of all such signals.
Heredity is important in any psychological "risk-profile." It may indicate which organ system will be involved. For example, a patient with a strong family history of glaucoma presented with a competitive struggle which involved his father. Upon winning, he developed a corneal inflammation. He also revealed intense guilt over his hostility.
The process of "somatic identification" may point to the organ system which will malfunction. Somatic