A review of the literature pertinent to the incidence and significance of psychosomatic disorders among psychotic patients is presented and a survey is reported pertaining to the incidence of psychosomatic syndromes existing in patients admitted to the Boston State Hospital during the year beginning April 1, 1948, and ending March 31, 1949.

During this period of time there were 1348 admissions to the Boston State Hospital, of whom 314 were discharged as being nonpsychotic. Of the remaining 1034 psychotic patients 578 were in the age group 16-60 with which we were concerned. A total of 20 patients of this group were discovered to have psychosomatic disorders--an incidence of 3.4 per cent. The incidence in the nonpsychotic group was 4.5 per cent. The incidence of psychosomatic disorders was then quite low in this total population--and lower in the psychotic than in the nonpsychotic group.

The psychosomatic disorders which these 20 patients had were headache, hypertension, dermatitis, mucous colitis, asthma, peptic ulcer, and epilepsy.

The patients were classified into three groups according to the relation between psychosomatic disturbance and psychosis. Category I included those patients whose psychosomatic disorders subsided or disappeared with the onset of or during the psychosis; patients whose symptoms fluctuated with variations in the material and processes uncovered during the course of psychotherapy; and patients whose psychosomatic disorder became worse as the psychosis began to improve. Category II includes patients with psychosomatic syndromes that were unaffected by the psychosis as well as patients from whom no correlating material could be obtained because contact could not be established with the patient. Category III includes patients whose psychosomatic disorders were aggravated during the course of the psychosis.

No correlation was found to exist between the specific psychosomatic and psychotic diagnoses. Thus although headache was the most common psychosomatic disorder and occurred in 6 of the 11 schizophrenic patients, it also occurred in 2 of 3 manic-depressive patients. It is to be noted, however, that those patients who had headaches prior to the psychosis did tend to be relieved of their headaches even when the psychosis improved.

Certain phenomena, such as obesity and transient elevation of blood pressure were observed but it is hoped will be made subjects of further study. The obese patients all maintained an extremely defensive attitude about their obesity warding off any discussion of it with persistence and rigidity. The patients with transient hypertension all demonstrated this phenomenon on admission to the hospital indicating that these psychotic patients were capable of reacting to a new situation at least in a physical way.

Many common psychosomatic disorders did not appear in the patients admitted during the year's admissions surveyed.

This study suggests that psychosomatic and psychotic disorders do not occur in the same person very frequently as clinical entities. It would appear that the psychotic individual does not very often use a psychosomatic disorder as a mechanism of defense.

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Labels: psychosomatic

Munchausen syndrome is a psychiatric disorder in which those affected feign disease, illness, or psychological trauma in order to draw attention or sympathy to themselves. It is in a class of disorders known as factitious disorders which involve "illnesses" whose symptoms are either self-induced or falsified by the patient. It is also sometimes known as hospital addiction syndrome.

n Munchausen syndrome, the affected person exaggerates or creates symptoms of illnesses in themselves in order to gain investigation, treatment, attention, sympathy, and comfort from medical personnel. The role of "patient" is a familiar and comforting one, and it fills a psychological need in people with Munchausen's. It is distinct from hypochondria in that the patient is aware that he is exaggerating, while sufferers of hypochondria actually believe they have a disease.

There is some controversy on the exact causes of the syndrome, but an increased occurrence has been reported[citation needed] in healthcare professionals and close family members of people with a chronic illness such as manic depression.

Individuals with the Munchausen pattern of behaviour may be admitted to many hospitals under many medical teams.

Labels: Munchausen syndrome

Illness as Metaphor is a nonfiction work written by Susan Sontag and published in 1978. She wrote it during her own fight against breast cancer and challenged the "blame the victim" mentality behind the language society often uses to describe diseases and those who suffer from them.

Drawing out the similarities between public perspectives on cancer (the paradigmatic disease of the twentieth century), and tuberculosis (the symbolic illness of the nineteenth century), Sontag shows how both diseases have become associated with personal psychological traits. In particular she demonstrates how the metaphors and terms used to describe both syndromes lead to an association between repressed passion and the physical disease itself. She notes the peculiar reversal that "With the modern diseases (once TB, now cancer), the romantic idea that the disease expresses the character is invariably extended to assert that the character causes the disease – because it has not expressed itself. Passion moves inward, striking and blighting the deepest cellular recesses."

This subject is expanded upon in Sontag's 1988 work

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Psychosomatic disorder, now more commonly referred to as psychophysiologic illness, is an illness whose symptoms are caused by mental processes of the sufferer rather than immediate physiological causes. If a medical examination can find no physical or organic cause, or if an illness appears to result from emotional conditions such as anger, anxiety, depression or guilt, then it might be classified as psychosomatic.

History

Sigmund Freud famously studied psychosomatic illnesses, which informed his theories of the unconscious mind and repression. Many identifiable illnesses have previously been labelled as 'hysterical' or 'psychosomatic', for example asthma, allergies, false pregnancy, and migraines. Some illnesses are under debate, including multiple chemical sensitivity, Gulf War syndrome, and chronic fatigue syndrome. Some people suggest that stigmatics suffer a psychosomatic illness based on identifying with the biblical crucified Jesus


Modern connotations

The term "psychosomatic" has developed a negative connotation in modern medicine, being confused with malingering, mental illness or outright fakery. Psychosomatic pain is difficult to differentiate from the above conditions but actual psychosomatic pain is real pain caused by unconscious mind rather than symptoms of illness or injury. Psychosomatic illness can result from problems with relationships, stress or other non-physical causes, often influenced by external factors or individuals.

Labels: psychosomatic