A Psychoanalytic Observation on Essential Hypertension*

Apart from those arterial hypertensions which occur in the presence of organic pathology of the circulatory system, and of which the mechanism is found in increased cardiac activity and minute volume of blood; or increased blood volume or viscosity; or, most commonly, increased peripheral resistance; there are a considerable number of cases of so-called essential hypertension, characterized by arterial hypertension without organic accompaniments to account for it.

Essential hypertension is so called because the etiology and mechanism are not yet known. It has been remarked that the condition often occurs in business men who work hard, drink hard and smoke hard. There is noted a familial tendency to the disorder. It often is discovered in young manhood, frequently persists, and ocasionally appears to result after a time in organic lesions of arteriosclerotic type. No therapy has been found up to this time consistently effective in modifying essential hypertension. However, a variety of treatments have been reported to produce transient reduction of the hypertension. Certain of the cases come to diagnosis because of symptomatic complaints; others, however, are found accidentally in the course of routine examinations. Spontaneous remissions are known to occur in a considerable proportion of young patients, but the conditions under which the disorder disappears have not been determined.

It has often been assumed that there might be a “nervous” element in such functional disturbances. In general we know that the vasomotor system is unstable in its behavior in many neurotics. But we also know that these neurotic blushings, palpitations, etc., do not commonly lead to essential hypertension. The time has passed when an appeal to “nervousness” is sufficient to explain symptoms. We must be able to relate the particular symptomatic disturbance to a definite emotional situation. Furthermore, we must show the