Discussion of Melitta Sperling's Article, Migraine Headaches, Altered States of Consciousness and Accident Proneness: A Clinical Contribution to the Death Instinct Theory

If there is a “terra incognita” in the area of psychoanalytic clinical research, it is surely in the field of the psychosomatic disorders. Even a cursory perusal of the journals of our science shows a paucity of these types of cases that is surely a remarkable paradox to the clinical frequency of such problems and the huge amount of human suffering they entail. This predilection of ours to neglect this kind of case for treatment and research is an interesting phenomenon in itself and worthy of examination. Our colleagues often chide us that in choosing psychiatry, and in particular, psychoanalysis, as a profession we are exercising a recoil from the matter, uses and concerns of Medicine. There is even a current joke about it which goes so:

“Query: ‘How do you define a psychiatrist?‘

Answer: ‘A Jewish doctor who is afraid of blood.‘“

If it is even a little bit true that as analysts we may recoil from the sanguinary aspects of Medicine because we are not well enough identified with the role of physician or that we may shirk from the plea for immediate and demonstrable relief that patients make with medical ailments and which our science can rarely effect; whatever the reasons, they merit our thought, attention and examination. I, myself, have wondered if this recoil exists because of the frequent difficulty I have had in the referral of patients with such disorders to analytic colleagues. Few categories of patients are harder to “sell.” I have wondered if this is so because the patient with a psychosomatic problem makes a maximal call, not only upon our analytic skill, but also upon a medical knowledge that may have either always been peripheral to interest in psychiatry, or which, if present, has atrophied through desuetude. Perhaps these patients arouse an insecurity in the analyst, removed as he often is from active contact with Medicine, evoking an insecurity that is most easily handled by the refusal of such patients.

However this may be, let me say what a pleasure i