Organ-Psychosis

By Erich Stern

Freud, in the early days of his scientific career, was rather sceptical about the possibilities for the usefulness of psychoanalytic theory and methods in the understanding and treatment of organic illness. But some of his students and followers (most prominently among them Heinrich Meng) saw very early that there were in this area not only possibilities but important challenges for psychoanalysis.

Meng formulated his hypothesis by stating that every physical illness of extended duration, which was resistant to the usual methods of treatment, had to be considered as a psychologic problem. He wrote farther: “Psychoanalytic therapy is—in my estimation—not the method of choice for a definite type of illness with organic manifestations but a procedure which might be considered for every sick person. Organic therapy has to be terminated under certain circumstances to be replaced by psychologic therapy: in the same way, it happens that during psychotherapy destructive tendencies are freed and that such a process necessitates different treatment methods. The goal is to initiate different changes in the total person, so that the individual will be enabled to meet the demands of his drives, his conscience and his environment and that the emotional defense system can function again adequately in the personal and social areas.”

In the search for the psychologic roots of these illnesses one tried at first to categorize them on the same level with neurotic disturbances. This is correct beyond doubt for many of them. But his observations and research led Meng to the understanding that there is a group of disturbances in which the psychogenic changes are much more extensive than what is generally found in neuroses and that they are close to what we usually find in psychoses. In neurosis, the ego is only secondarily affected. If somatic disturbances appear, they are only of secondary nature, and the instinctive conflicts are settled through these organic symptoms.