John C. Nemiah

Psychosomatic illness: a problem in communication.

The transcripts of recorded clinical psychiatric interviews with 20 patients (8 women and 12 men) suffering from psychosomatic illness were studied to ascertain the nature of their mental content and

Denial Revisited: Reflections on Psychosomatic Theory

Certain clinical observations cast doubt on the validity of the traditional psychological explanation of psychosomatic disorders, which invokes the concept of a psychodynamic conflict derived from psychoanalytic theory. Psychosomatic patients appear to be unable to describe feelings in words, show a marked paucity of fantasy, and do not make significant internal psychological changes in these areas in the course of psychodynamically oriented psychotherapy. It is suggested that neurophysiological hypotheses may be more useful for understanding psychosomatic processes and specifically that disturbances in the function of the palleostriatral dopamine tract are related to psychosomatic disorders. Testable inferences from this hypothesis are proposed, including the suggestion that clinically and neurophysiologically, schizophrenia and psychosomatic disorders are the obverse of one another.

Psychology and Psychosomatic Illness: Reflections on Theory and Research Methodology

The term ‘denial’, as commonly used in respect to patients with psychosomatic disorders, implies that the widely observed absence of affect and fantasy, in such patients, is the result of psychological defense mechanisms. Careful observation of the mental functioning of those with psychosomatic disorders discloses a basic incapacity in patients with these illnesses to experience or express affect and related fantasies that is different from that seen in patients with psychoneuroses, in whom psychological defense mechanisms are clearly operating. It is suggested that the phenomena seen in psychosomatic patients are not primarily the result of psychodynamic conflicts but can be better understood in neurophysiological concepts, and that further understanding of psychosomatic processes is to be sought for in an increased knowledge of brain function.

A reconsideration of psychological specificity in psychosomatic disorders.

In this paper, the author identifies the evolution of the specificity hypothesis in the psychogenesis of psychosomatic illness across the last half century. Specifically identified is the distinction made between the mechanism of conversion and that of vegetative neurosis. Considerable attention is addressed to the personality features thought to be common to all psychosomatic patients and the refinement of this theory over the past 40 years, including the present interest in alexithymia. These concepts are explored in the consideration of a man who sustained two different specific conflictual environmental situations. The author emphasizes that our present formulations lead us to focus on the person with the illness and the processes that lead to that illness in the patient.

Respiratory disease in U.S. soft-coal miners: Clinical and etiological considerations: A study of 30 cases☆

Abstract Thirty soft-coal miners with respiratory disease volunteered for hospital study. An attempt was made to characterize their disability as to its clinical features, etiologic correlation with work exposures, ageing, and to such insults as smoking habits and intercurrent infection. While this group is too select and too small to allow broad generalizations or definite conclusions, several points appear certain and suggest profitable lines of study for the epidemiologist. 1. (1) In this series, varying syndromes of respiratory disease, which are characterized by combination of clinically detectable bronchitis, respiratory insufficiency measurable by lung-function study, and discrete or conglomerate X-ray pneumoconiosis, support the concept that disabling pulmonary disease of soft-coal miners is not only a penumoconiosis arising from dust deposition in the parenchyma of the lung. It is rather a disease of the respiratory tract which may be due to inhalation of harmful chemicals and dust during work interacting with other individually determined factors, such as physiological ageing, smoking habits, and infection. 2. (2) Chemical fumes encountered in underground mining are a factor to be considered in the production of disabling respiratory disease in United States soft-coal miners. 3. (3) Two biopsy-proven cases of silicosis emphasize the crucial importance of knowledge of the character of the dust inhaled in correctly assessing work-related pulmonary disease in under ground miners. 4. (4) There was little correlation among the indices used here (chest X-ray, cardiac catherization, lung-function tests, biopsy) in establishing a correct diagnosis of respiratory disease with or without important disability. 5. (5) The low incidence of overt emotional illness in these thirty ill coal miners is striking. The tendency of this group to deny the seriousness of their physical symptoms provides a possible hindrance to the public health goal of early detection and prevention of respiratory disease, if case-finding and avoidance of further exposures depends on the initiative of the individual miner to report early symptoms or to change his employment.