A Psychosomatic Theory Based on the Concepts of Mastery and Resolution of Tension

The purposes of this presentation are to stimulate a renewal of medical interest in the concept of physioneurosis as a companion piece to psychoneurosis, to offer a conception of physioneurosis based on the concepts of mastery and resolution of tension, and to present certain clinical data derived from psychoanalytic practise as the basis for the theoretical inferences made.

The concept of physioneurosis was introduced by Kardiner (7). In studying ego reactions to serious traumata, he recorded an entire series of autonomic phenomena, including epilepsy, associated with the inhibitions following such traumata. To these autonomic phenomena he applied the name of physioneurosis. He considered the autonomic discharge as the one avenue of aggression left open to the individual after the traumatized ego had become too inhibited and contracted to operate normally. He applied the term physioneurosis to all the somatic, non-ideational symptoms. In 1936, Daniels (2) described the autonomic phenomena in a case of diabetes with neurosis as physioneurotic. Kardiner, in discussing Daniels' case, advanced the hypothesis that the physioneurosis was the end result of a series of inhibitions. In outlining a course for future research he pointed to the need for locating the ego inhibitions.

In his more recent work, Kardiner (8) described his concept of the action syndrome and applied the term physioneurosis to the disturbances of the body ego action syndrome. His concept of the traumatic neurosis is that, (1) as a result of the trauma the individual's unconscious conception of himself is altered, (2) the meaning of the outer world becomes altered, and (3) the internal regulating apparatus governed by the autonomic system is thrown out of consonance with the voluntary system, which is now blocked partially or completely. He holds that there is one constant always present in the traumatic neurosis, i.e., that the motility is always blocked or guarded while the need tensions which can onl