86. The Role of Unconscious Mental Activity in the Development and Course of Clinical Somatic Syndromes. Editorial Introduction

Summary

The major theoretical approaches to the psychosomatic problem are set forth.

The wide recognition of the dependence of man's health and illnesses on the emotional strain of his experiences is noted; at the same time it is pointed out that scientific concepts of this dependence (regularities, mechanisms) are scantily developed. The reasons for this paradox are analyzed (difficulties of investigation stemming from the relationship of pathogenic emotion with (a) the elusive parameter of the "significance" of experiences, (b) the masking effect of "psychological defence" with which the subject responds to a mental trauma and (c) the presence in this defence of both conscious and unconscious components.

The divergences of opinion as to precisely which experiences may prove especially pathogenic and the way of conceptualizing the mechanism of psychological defence are described. In this connection the concept of the mechanisms of psychological defence based on the ideas espoused by D. N. Uznadze's school is stated (the conception of defence as a repatterning of psychological sets with the object of removing the significance to the subject of his traumatic experience).

The concepts of psychological defence as developed within the theory of psychoanalysis are compared with those maintained in Soviet literature. It is stressed that the latter are of a more generalized character.

The latter half of the paper deals with the special mechanisms by which a tense emotional experience exerts its influence on the body. In this connection the notion of conversion ("body language", somatic symbolism) is considered along with the idea of "fatal physiological relations" (autohypnosis) which was advanced against it by I. P. Pavlov (in his controversy with P. Janet). The evolution undergone by both approaches over the past decades is traced. The basic principles prevalent in Soviet literature, which determine the understanding of psychosomatic relations, are formulated (pseudosymbolism in conditions of hysterical disorder; the influence of the functional components involved in the structure of the organic syndrome on the course of the dis-ease, the immediate organic consequence of a mental trauma, emerging on the principle of "second impact" as conceived by A. D. Speranski.

In conclusion, evidence is presented in support of the special significance of a tense emotion as a "risk factor" and the possibilities of predicting - under definite methodological conditions - the subsequent development of psychosomatic disorders. The principle of the dependence of the course of the disease on the patient's active attitude to his/her condition, as well as to the inner world and objective environment, is advanced as a general idea. It is believed that the principle in question will considerably influence the further elaboration of the psychosomatic problem.

A brief description is also given - from the standpoint of the above considerations - of the papers included in the 5th section.

Литература

1. Павлов И. П.. Полн. собр. соч., т. I, М. -Л., 1951, с. 197.

2. Павлов И. П., Полн. собр. соч., т. III, кн. 2, М" 1951, с. 209, 211.

3. Ротенберг В. С., Аршавский, В. В., Журнал ВНД, 2, 1976.

4. Engel G., Schmale A., J. Am. Psychoanal. Assn., 1967, 15, 344-365.n

5. Freud S., Psychical (or mental) treatment (1905), Stand. Ed., 7,287-288, L., 1953.

6. Green W., Psychosom. Med.. 6, 873, 1968.

7. Lipowski. Z., Psyhosom. Med., 4, 1968.

8. Valabrega J., Rev. Med. Psychosom., 1966, 8, 1. 1-9.

9. In: Wittkower, E., Cleghorn, R. (Eds), Res. Devel. in Psychosom. Med., Ph.: lad. -Montr., pp. 267-280.