Henry M. Fox

Psychological observations of patients undergoing mitral surgery: A study of stress☆

Summary Thirty‐two patients with mitral stenosis who had mitral surgery were interviewed by psychiatrists preoperatively and also postoperatively. An understanding of long‐term adaptation to progressive limitation of activities provided the necessary background for the recognition of emergency defenses as they developed in the hospital situation both before and after operation. The interviewing technique focused on emotionally meaningful material concerning the adjustment to limitation of activities and on the feelings and phantasies about the operation. Complete tape recordings were made of all the interviews. This information was then condensed to the essential preoperative and postoperative observations and charted with a brief interpretation of the psychological defenses illustrated by each case. The most important medical and surgical events during hospitalization were also reviewed. The patients were grouped according to the clinical classification of Harken and Dexter as follows: Group I, o; Group II, 5; Group III, 18; Group IV, 9 (in 4 of these, mitral insufficiency rather than mitral stenosis was predominant). There were 23 females and 9 males. The median age was 37 years. The medical histories were summarized and charted. The effect on the patient of learning that he had heart disease depended on the stage of his emotional development, his life circumstances, and his personality. The awareness of dyspnea was found to be a realistic response to the increasing disturbance of the cardiovascular function but was also influenced by experiences to which the patient was psychologically vulnerable. The attitude of the patients toward limitation of activity was influenced by the meaning of the illness to them. Long‐term psychological defenses included narcissism, submission to a higher power, and activity. Emergency defenses included immobilization, hysterical amnesia or depersonalization, belligerence, excitement, and desperate denial. In some instances the stress was so severe that the patients seemed virtually defenseless and were close to panic. In others the psychological defenses were inadequate and unsuccessful to such an extent that the patients bordered on psychosis. All of these complained of pain to such an exaggerated extent that it seemed to represent a masochistic clinging to suffering. The transference to the surgeon is described and psychotherapy is discussed.

CONCURRENT OBSERVATIONS OF BEHAVIOR CHANGES AND OF ADRENOCORTICAL VARIATIONS IN A CYCLOTHYMIC PATIENT DURING A PERIOD OF 12 MONTHS

Excerpt I. REVIEW OF LITERATURE II. PSYCHOLOGIC BACKGROUND The Patient Overactivity Depression Projection Family Previous Episodes Hospitalization for Depression Interval Between Hospitalization fo...

Adrenal steroid excretion patterns in eighteen healthy subjects, tentative correlations with personality structure.

&NA; A correlative study of adrenal steroid excretion patterns and personality in 18 healthy young college men indicated (1) that the 24‐hr. urinary excretion rates of 17‐hydroxycorticosteroids and 17‐ketosteroids were relatively constant over a period of 5 wk.; (2) that individuals maintained the same relative position throughout this period of observation in regard to the others within the group studied according to an identifiable steroid excretion pattern; and (3) that the level of output of 17‐hydroxycorticosteroids could, in a general way, be related to certain aspects of personality. The analysis of variance technique was used to analyze the data statistically. The subjects were studied psychologically by means of tape‐recorded personal interviews with senior psychiatrists and also by psychological tests of perception including the Rorschach. The steroid values of the individual subjects did not vary significantly from day to day; nearly all of the variance was produced by the differences in mean levels from one subject to another. The 17‐hydroxycorticosteroid rather than the 17‐ketosteroid levels were used as a basis for psychophysiological correlation. The data suggested the tentative hypothesis that the more a person reacts emotionally, the higher the level of the 17‐hydroxycorticosteroids. The more guarded the individual, the more that control is exercised over feelings, the lower the 17‐hydroxycorticosteroids. At one extreme of a psychophysiological continuum are the individuals with vivid personal feelings who experience a sense of emotional urgency and, at the other extreme, those who.are relatively guarded and withdrawn.

Psychophysiological correlation of 17-ketosteroids and 17-hydroxycorticosteroids in 21 pairs of monozygotic twins ☆

Abstract Twenty-one pairs of healthy monozygotic male twins of college age have been observed in an attempt to correlate individual personality structure with characteristic and relatively enduring patterns of pituitary adrenocortical function. Ten pairs of comparable dizygotic male twins have been studied by the same methods. High levels of 17-OHCS excretion were found in individuals with forceful yearnings for close personal involvement or with active defenses against the threat of intimacy. Individuals with low 17-OHCS levels were more effectively isolated by well-organized neurotic defenses. High 17-KS levels were found in energetic, ambitious individuals with strong aggressive drives and equally strong defenses against them. Those with low 17-KS were over-controlled with apparently limited innate drive endowment. A one way analysis of variance was computed for both monozygotic and dizygotic. twins. The F ratio indicated that height, 17-KS mean values, and day-to-day variation in 17-KS might be influenced by genetic factors. The intra-class correlation in 17-OHCS means was just as great in dizygotic as in monozygotic pairs but the correlation in 17-KS means in monozygotic pairs was much higher than in dizygotic pairs. A contingency table was constructed by grouping the variation in 17-OHCS and 17-KS into quartiles. In 14 out of the 21 pairs of monozygotic twins both members of the pair were in the same quartile for 17-OHCS and 17-KS and both members of all the other pairs were in adjoining quartiles. The pyschological characteristics shared by all of the subjects in each contrasting quartile suggest meaningful correlations of steroid patterns with different but interrelated quantifiable ranges of psychological response corresponding respectively to the mean levels of the 17-OHCS and of the 17-KS.

Psychiatric Consultation on Medical Patients for Internists.

Excerpt A well-trained psychiatrist can evaluate the effect of the patients earlier history on his response to recent stress and thus help to clarify the medical diagnosis. The pattern of the pati...