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The alternation of psychological symptoms with psychosomatic ones has long and frequently been noted. However, as Dr. Sperling suggests, little has been done to detail the metapsychological determinants which permit the symptoms to substitute for one another under certain circumstances and to coexist under others. The commonly accepted idea that each may serve as a defense or screen to hide the other is a generalization which is descriptively and clinically valid but which has limited, if any, theoretical or pragmatic value. It may perhaps be more misleading than correct.
Dr. Sperling calls on her clinical experience in the analysis of psychosomatic symptoms and phobias, noting the alternation of symptoms, their apparent substitutive, defensive functions, and their occasional coexistence, and she finds an explanation in the pregenital fixations of patients who have hidden “phobias” screened by somatic symptoms (for example, colitis). Traumata in the anal-sadistic phase of development,
Dr. Sperling believes, account for both the somatic symptoms and the “phobias.” She finds similar (unconscious) meaning in both sets of symptoms, and implies that both are resolved by interpretation.
It is significant when a clinician of Dr. Sperling's experience and competence describes and explains a certain group of clinical occurrences. In this instance in particular it is not only a matter of the clinical phenomena of certain disease processes and their explanation; Dr. Sperling also clearly implies that patients with severe somatic ills respond favorably with remarkable consistency to analytic interpretation by a competent analyst. Many of the patients Dr. Sperling refers to are not only severely ill, but have also failed to respond to the previous administrations of other physicians (including other analysts). One of the inferences which I draw from my reading of Dr. Sperling's paper is that if the psychoanalytic practitioner would apply his tool properly he would be rewarded b