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Non-state educational institution

Higher professional education

"Moscow Institute of Physical Culture and Sports"

Course work

in the discipline: “General Psychology”

on the topic: “Franz Alexander. Psychosomatic medicine"

Introduction

The name of Franz Alexander, an American psychoanalyst of Hungarian origin, is well known throughout the world. He is recognized as one of the founders of psychosomatic medicine (psychosomatics). However, until now, none of Alexander’s works, with the exception of a book on the history of medicine written together with Shelton Selesnik, have been published in Russian. This is explained by the psychoanalytic foundation of his approach to the analysis of the causes of diseases and their treatment, which in Soviet time looked especially unacceptable in psychosomatics - a discipline that is directly in contact with the ideologically dangerous problem of the connection between soul and body. Only now does the Russian-speaking reader get the opportunity to appreciate the strict logic and depth of ideas of this classic manual.

Alexander, Franz Gabriel. short biography

Alexander, Franz Gabriel January 22, 1891 (Bucharest) - March 8, 1964 (Palm Springs, USA). Franz G. Alexander's father was a professor of philosophy. All three of Franz's sisters were older than him. After completing his medical studies in Göttingen, Alexander worked at the Institute of Hygiene in Budapest in 1913; in 1914 he was called up for military medical service, finally working in a bacteriological field hospital treating malaria. Then Alexander works at the psychiatric clinic of the University of Budapest. Alexander begins to become increasingly attracted to Freud's views. In 1919 he went to Berlin, becoming the first student at the Berlin Psychoanalytic Institute. Alexander receives training analysis from Hanns Sachs. At first, Alexander became an assistant at the institute, and from 1921, a member.

The decision to become a psychoanalyst was not easy for Alexander, because he was very attached to his father, and while studying in Göttingen he met Husserl and Heidegger. The time spent in Berlin was very productive for Alexander. The following works were published: “Metapsychological Way of Vision” (1921), “Castration Complex and Character; Study of Transient Symptoms”, for the latter Alexander was the first to receive the prize established by Freud. In 1926, Alexander's first book was published, compiled from his lectures at the Berlin Psychoanalytic Institute: "Psychoanalysis of the Whole Personality. Nine Lectures on the Application of Freud's Theory of the Self to the Doctrine of Neuroses." Alexander's interest then turned to the application of psychoanalysis to criminology. In 1929, together with Hugo Staub, he published the work “The Criminal and His Judge.” The book's subtitle is provocative: "A Psychoanalytic Approach to the World of Criminal Law."

While still working in Berlin, Alexander became very interested in the therapeutic applications of psychoanalysis. At the Salzburg Congress (1924), Alexander made a report “Metapsychological image of the healing process.” Despite the medical-therapeutic position presented in it, in the 1927 discussions about amateur analysis, he rather shared the traditional approach.

In 1929, Alexander, at the invitation of the University of Chicago, moved to the United States, becoming a professor of psychoanalysis at the Faculty of Medicine. But the faculty doctors opposed him. Before moving to Boston, Alexander managed to create the Chicago Psychoanalytic Society. In Boston, Alexander publishes the book The Roots of Crime, and also becomes director of the newly created Institute of Psychoanalysis, independent of the Chicago Psychoanalytic Society. Great support was provided by the Rockefeller Foundation. For 24 years, Alexander was director of the institute, focusing primarily on psychosomatic research.

Alexander's goal was to create short-term therapy to shorten the time of psychoanalytic treatment. In 1949, Alexander's work Psychoanalytic Therapy appeared, in which Alexander tried to introduce the principle of flexibility, corrective emotional experience and “planning” of psychotherapy into psychoanalytic therapy. Alexander met with powerful rejection from American psychoanalysts and, disappointed that most of the members of his institute did not want to give up membership in the American Psychoanalytic Association, left Chicago to create and head the psychiatric department in Los Angeles at Mt. Sinai-Hospital.

Shortly before Alexander's death, the Franz Alexander Chair in Psychophysiology and Psychosomatic Medicine was created at the University of Southern California. The first head of the department was Alexander himself. The last book Alexander wrote further demonstrated his intellectual breadth; although many psychoanalysts believed that he expanded the boundaries of psychoanalysis too much, that his psychoanalysis moved too far into illness-centered psychotherapy. Yet it is impossible to deny Alexander's enormous influence over more than thirty years on American psychiatry and psychoanalysis. Alexander is one of the most significant figures in American psychoanalysis. Alexander's tendency to include psychoanalysis in the university and his preference for the medical aspect of psychoanalysis fit particularly well into the American psychoanalytic tradition.

"Psychosomatic Medicine" by Alexander Franz

Franz Alexander's "Psychosomatic Medicine" bears the imprint of the personality of its author - a professional in both psychoanalysis and medicine. In 1919, having already received his medical education, he became one of the first students at the Berlin Psychoanalytic Institute. His first book, Psychoanalyse der Gesamtpersoenlichkeit (1927), which developed the theory of the superego, was praised by Freud. In 1932, he helped found the Chicago Psychoanalytic Institute and became its first director. A charismatic leader, he attracted many European psychoanalysts to Chicago, including Karen Horney, who was appointed assistant director of the Institute. Sharing most of Freud's positions, Alexander, however, was critical of the theory of libido and showed great independence in developing his own concepts, and also supported the unorthodox ideas of other psychoanalysts. In general, his position is characterized as intermediate between orthodox Freudianism and neo-Freudianism. In the history of psychoanalysis, Alexander stands out for his special respect for the scientific approach and precise methods, and that is why the Chicago Psychoanalytic Institute, which he continuously directed until 1956, was the center of numerous scientific studies on the role of emotional disorders in a variety of diseases. Although the psychosomatic direction began to take shape in medicine long before Alexander, it was his work that played a decisive role in recognizing emotional stress as a significant factor in the emergence and development of somatic diseases.

The formation of psychosomatics in the 30s of the twentieth century as an independent scientific discipline was not a simple consequence of the invasion of psychoanalysis into somatic medicine in the process of expanding its sphere of influence, just as it penetrated, for example, into cultural studies. The emergence of psychosomatic medicine was predetermined, firstly, by the growing dissatisfaction with the mechanistic approach, considering a person as a simple sum of cells and organs, and secondly, by the convergence of two concepts that have existed throughout the history of medicine - holistic and psychogenic. Alexander's book summarized the experience of the rapid development of psychosomatics in the first half of the twentieth century, and the most interesting thing about it, undoubtedly, is the concentrated presentation of the methodology of a new approach to understanding and treating diseases.

The basis of this methodology, running throughout the book, is the equal and “coordinated use of somatic, that is, physiological, anatomical, pharmacological, surgical and dietary, methods and concepts, on the one hand, and psychological methods and concepts on the other,” in which Alexander sees the essence of the psychosomatic approach. If now the area of ​​competence of psychosomatic medicine is most often limited to the influence of psychological factors on the occurrence and development of non-mental diseases, that is, the line coming from the psychogenic concept, then Alexander was a proponent of a broader approach , coming from the holistic concept. According to this approach, the mental and somatic in a person are inextricably linked with each other, and understanding the causes of diseases is impossible without a joint analysis of these two levels. Although the holistic approach is currently not directly rejected, it often goes out of sight both researchers and doctors - probably due to the complexity of following his methodology, which requires not only a good knowledge of both the psyche and somatics, but also an understanding of their interrelated functioning, the latter difficult to formalize, necessary in scientific research and in clinical practice, and easily escapes the scope of scientific analysis, especially in the context of the ongoing differentiation and specialization of branches of medicine. In this regard, the significance of Alexander's book, in which holistic psychosomatic methodology is not only formulated and substantiated, but also illustrated with numerous examples of its specific application, has perhaps only increased in our days.

Alexander's predecessors and contemporaries described many different kinds of correlations between the emotional sphere and somatic pathology. The most deeply developed theory in this area was Flanders Dunbar's theory of specific personality types. This researcher showed that the psychological portrait ("personal profile"), for example, of patients suffering from coronary heart disease and patients prone to frequent fractures and other injuries, is fundamentally different. However, as in any other area scientific knowledge, statistical correlation provides only initial material for studying the mechanisms of the phenomenon. Alexander, who has great respect for Dunbar and often cites her work, draws the reader's attention to the fact that the correlation between character and susceptibility to disease does not necessarily reveal the real chain of causation. In particular, between character and predisposition to a certain disease there may be an intermediate link - a specific lifestyle to which people with a certain character are prone: for example, if for some reason they are inclined to professions with a high level of responsibility, the direct cause of the disease may be occupational stress, and not the character traits themselves. Moreover, psychoanalytic research can reveal the same emotional conflict under the guise of apparently completely different personality types, and it is this conflict, from Alexander’s point of view, that will determine the disease to which the individual is most prone: for example, “the characteristic emotional pattern of an asthmatic can be identified in individuals with completely opposite personality types, who protect themselves from the fear of separation using various emotional mechanisms." Thus, thanks to his reliance on the psychoanalytic method, Alexander does not stop at discussing statistical correlations between external indicators of mental and somatic functioning, which have very limited value in relation to the main task - treating the patient, and goes much further, trying - although not always successfully - to identify deep-seated mechanisms of pathology.

The theoretical foundation of this manual is mainly the theory of psychosomatic specificity, or specific conflicts - the most famous concept of Alexander. According to it, the type of somatic illness is determined by the type of unconscious emotional conflict. Alexander proceeds from the fact that "each emotional situation corresponds to a specific syndrome of physical changes, psychosomatic reactions, such as laughter, crying, blushing, changes in heart rate, breathing, etc.," and, moreover, " emotional impacts can stimulate or suppress the work of any organ." Psychoanalytic research reveals that many people have unconscious emotional stress that persists for a long time. It can be assumed that in such cases, changes in the functioning of physiological systems will persist for a long time, leading to disruption of their normal functioning and ultimately provoking the development of the disease. Moreover, since various physiological changes are observed in different mental states, the result of various long-lasting unconscious emotional states will be different pathological processes: high blood pressure - a consequence of suppressed anger, dysfunction of the gastrointestinal tract - a consequence of frustration dependent inclinations, etc. Striving to be an objective researcher, Alexander recognized that the key provisions of his theory required additional verification and justification. Unfortunately, the theory of specific conflicts never received clear experimental confirmation, including in numerous studies specifically devoted to this led by Alexander Institute. However, it was not refuted. It continues to be considered one of the leading psychosomatic theories.

A feature of Alexander's approach was the emphasis on unconscious emotional tension, which, from a psychoanalytic point of view, is more pathogenic because it cannot find a way out in conscious actions. In this way, his approach differs from non-psychoanalytic ones, including those that prevailed in Soviet, and even those that prevail in modern Russian medicine, in which the influence of only conscious mental processes that are accessible to direct observation and description is analyzed. On another level, the opposite of Alexander's approach is a non-specific concept. According to it, the emergence and development of pathology is caused by prolonged conditions of stress, however, the specific form of pathological changes does not depend on the type of stress, but on which organs or systems in a given individual are more vulnerable. Criticizing the specific concept, supporters of the nonspecific concept especially emphasize the lack of complete correlation between the specifics of a psychosomatic disease and the personality of the patient. Apparently, there is no antagonism between all these concepts: some cases may be more consistent with one of them, others - with another. As noted above, the incomplete correspondence between the disease and the external characteristics of the personality is easily explained if unconscious conflicts are taken into account, as Alexander proposed. However, he by no means made a fetish out of psychic influences, recognizing the large role of somatic factors. In particular, he noted that typical emotional constellations characteristic of a certain somatic disease (for example, ulcers) can also be found in a person who does not develop this disease, from which he concluded that the presence or absence of a disease depends not only on emotional , but also from somatic factors that have not yet been sufficiently identified. He turned out to be right - in recent decades, the important role of genetic factors independent of the psyche in determining the individual vulnerability of physiological systems has been convincingly demonstrated.

Most of the space in the book is devoted to the application of the psychosomatic approach and the theory of specific conflicts to specific diseases. Although Alexander, based on a holistic approach, was against identifying a separate group of psychosomatic disorders (in any somatic disease one can find both somatic and mental factors!), the range of diseases he considered almost exactly coincides with what is now generally classified in this group. solid clinical material, including his own observations, data obtained by employees of the Chicago Psychoanalytic Institute, and numerous data from other researchers, he builds a well-thought-out scheme of psychosomatic genesis for each disease. The given case histories perfectly illustrate the ways of using the psychoanalytic method to identify underlying disorders of hidden emotional conflicts and treat these conflicts, and ultimately the disease as a whole.

Excessive optimism and confidence in his approach seemed to have let Alexander down - he often, without sufficient grounds, considered the mechanisms of diseases to be quite well understood, which in fact have been little clarified to this day. Because of this, the chapters devoted to specific diseases look, despite the constant reliance on clinical material, somewhat lightweight and are less convincing than the theoretical part. Thus, the connection between psychogenic constipation and anal-sadistic tendencies, although it will not raise doubts among many psychoanalytically oriented specialists, is unlikely to seem fully proven to others. Alexander's widely known hypothesis about the role of repressed anger in the formation of chronically high blood pressure is generally very convincing, but even it does not have unambiguous experimental confirmation, and many questions related to it are still not clarified. The situation is no better with other psychosomatic hypotheses: although clinical data in favor of one or another of them are periodically reported, it is still too early to draw definitive conclusions. Finally, the effectiveness of psychoanalytic treatment of psychosomatic disorders has apparently been exaggerated: according to modern experts, many psychosomatic patients are simply unable to adequately express their emotions, and therefore classical psychoanalytic techniques often do not improve their condition.

At the same time, we should not lose sight of the fact that these flaws in Alexander’s book are a consequence of the extreme complexity and poor development of the subject. And the understanding of this subject over the past half century, alas, has advanced very little. One reason for this is that most research in the field of psychosomatics unreasonably ignores the methodological principles developed by Alexander. This is manifested either in focusing on only one side, somatic or mental, or in limiting the analysis to the calculation of correlations of somatic and psychological indicators, on the basis of which only the most superficial conclusions about causal relationships are made. Conducting large-scale “correlation” studies is now a task accessible to a wide range of specialists: having data from clinical examinations of patients, you only need to supplement them with “psychology” - connect the psychological “profiles” of the individual, drawn by one of the psychometric tests, and then calculate how they are related to each other with a friend. There are now a great variety of psychometric tests, as well as methods of statistical analysis, and both are easily implemented in computer programs; As a result, the productivity of the researcher, in comparison with the times of Alexander, increases monstrously. However, if the descriptions of the mechanisms of psychosomatic pathology proposed by Alexander were often too speculative, then correlation studies, capturing only individual strokes in the complex picture of psychosomatic interactions, often do not clarify anything at all. The result is extremely little progress in understanding the psychosomatic nature of diseases.

It should be noted that Alexander was clearly wishful thinking, believing that the “laboratory era of medicine,” which was characterized by reducing the goal of medical research to identifying “more and more details of basic physiological and pathological processes,” had already ended. On the contrary, the “tendency he noted to squeeze more and more diseases into the etiological scheme of infection, where the connection between the pathogenic cause and the pathological effect seems relatively simple,” does not seem to be going to weaken at all: more and more new hypotheses that this or that other disease - stomach ulcer, cancer, etc. - caused by some pathogenic microorganism, the scientific and other public meets with genuine interest. One of the reasons for the continued prosperity of the “laboratory approach” is due to the fact that the understanding of human physiology has increased not only quantitatively, but also qualitatively over the past half century. The discovery of many details of physiological mechanisms at the cellular and molecular level served as the basis for new advances in pharmacology, and the huge profits of pharmaceutical concerns, in turn, became a powerful factor supporting physiological research; a vicious circle has developed. This powerful system, which develops according to the principle of positive feedback, largely determines the modern face of “laboratory” medicine.

It is curious that the role of physiological mechanisms has begun to be recognized as leading even in the etiology and pathogenesis of mental illnesses. This was led to enormous progress in uncovering the mechanisms of information transfer between brain cells and associated successes in the pharmacological correction of mental disorders. The need for a broader, systemic understanding of the disease is not denied; on the contrary, sometimes it is even elevated to dogma, but the real orientation of research, medical education, and the organization of medicine contributes very little to this. As a result, many researchers and doctors are actually guided by the principle of reductionism - reducing phenomena of a higher order to lower ones. Instead of considering a healthy and sick organism as a psychosomatic unity, in which both cellular mechanisms and interpersonal relationships in which the individual is included are important - an approach substantiated and developed in detail by Alexander - narrow specialists try to resolve all issues without going beyond their favorite physiological level. At the same time, under the banner of a holistic approach, completely amateurish ideas are most often put forward, ridiculous in theoretical terms and ineffective in practice, having nothing in common with truly scientific approach the author of this book. Thus, the advent of the psychosomatic era, contrary to Alexander's expectations, is still delayed.

The reader not connected with medicine and physiology must be warned that many of the “somatic” details of the hypothetical mechanisms of pathogenesis proposed by Alexander are undoubtedly outdated to one degree or another. Even such a seemingly simple phenomenon as ulceration is understood today completely differently than in the time of Alexander, and instead of one disease, about three dozen types of peptic ulcers are now distinguished, differing in the physiological mechanisms of the occurrence and development of the pathological process. A lot has become known about the hormonal regulation of physiological processes, about immune processes (which play, in particular, an important role in arthritis), and progress in understanding the mechanisms of heredity is absolutely colossal - it is worth at least remembering that the carrier of the genetic code was established after the appearance of this books! However, the most valuable thing in the book is not the descriptions of the hypothetical mechanisms of specific diseases, although they contain many subtle observations and completely indisputable conclusions, but the methodology behind them for penetrating into the psychosomatic nature of diseases.

Psychosomatics in the modern understanding

Psychosomatics is one of the branches of clinical psychology. Uses a synthesis of ancient traditions in the treatment of physical and mental illnesses and modern scientific ideas in the field of medicine and psychology.

In the modern understanding, psychosomatic medicine is considered as a method of treatment and the science of the relationship between mental and somatic processes that closely connect a person with environment.

The fact that in certain somatic diseases, for example, in bronchial asthma, a more or less obvious connection is found between external and internal conflicts and the appearance of symptoms of the disease, led to their definition as psychosomatic.

Psychosomatics arose in the historical and medical aspect as the antithesis of a one-sided organocentric perception of the disease, which separates a person from the world around him. Psychosomatics assumes that a sick person should be considered as a living and acting being, with all his inter-human relationships and interactions with the world, with its cultural norms and values.

In modern psychosomatics, a distinction is made between predisposition, resolving and delaying factors for the development of the disease. Predisposition is an innate, and under certain conditions, acquired readiness, which results in the form of a possible organic or neurotic disease. The impetus for the development of such a disease is difficult life situations. If neurotic or somatic diseases manifest themselves, they develop according to their own laws, which, however, are closely related to environmental factors (the importance of disease-promoting factors, for example, in chronic diseases, became known only in Lately). Statement of the presence of a psychosomatic illness does not lead to denial of the main diagnosis. If today we talk about a psychosomatic biopsychosocial disease, then this only indicates a connection: predisposition - personality - situation.

medicine psychosomatic Alexander

Psychosomatic disorders

Psychosomatic disorders can be divided into the following large groups:

1. Conversion symptoms.

The neurotic conflict receives a secondary somatic response and processing. The symptom is symbolic in nature; the demonstration of symptoms can be understood as an attempt to resolve the conflict. Conversion manifestations mostly affect voluntary motor skills and sensory organs. Examples are hysterical paralysis, paresthesia, psychogenic blindness and deafness, vomiting, and pain phenomena.

2.Functional syndromes.

This group contains the predominant part of “problem patients” who come to the appointment with a motley picture of often vague complaints that may affect the cardiovascular system, gastrointestinal tract, musculoskeletal system, respiratory organs or genitourinary system. The doctor's helplessness regarding these symptoms is reflected, among other things, in the variety of concepts that refer to these complaints. It's about about functional disorders of individual organs or organ systems, any tissue changes, as a rule, are not detected. Unlike conversion symptoms, a single symptom has no specific meaning, being a nonspecific consequence of a violation of bodily function. Alexander described these bodily manifestations as accompanying signs of affect without the nature of expression and designated them organ neuroses.

3. Psychosomatic diseases in a narrower sense (psychosomatosis).

They are based on a primary bodily reaction to a conflict experience, associated with morphologically established changes and pathological disorders in organs. The corresponding predisposition may influence the choice of organ. Historically this group includes classic paintings psychosomatic diseases:

Bronchial asthma

Ulcerative colitis

Essential hypertension

Neurodermatitis

Rheumatoid arthritis

Duodenal ulcer.

Conditions for the development of disease in psychosomatic diseases.

In modern psychosomatic pathogenesis, multifactoriality is recognized in the explanation of psychosomatic diseases. Somatic and mental, the influence of predisposition and environment, the actual state of the environment and its subjective processing, physiological, mental and social influences in their totality and in addition to each other - all this matters as a variety of effects on the body, described as factors that interact between themselves.

For psychogenic diseases, i.e. neuroses, and somatic functional disorders of a neurotic nature, H. Schepank, in a large review devoted to the results of a long-term study of heredity and environment, assessed the importance of variance components. Heredity factors come first (30%). Then comes early development (25%), and finally, if you combine all three subsequent factors (childhood - 15%, life events - 15%, social influences - 10%, others - 5%), then in 40% of cases it matters interaction with the environment in later life.

In most somatic diseases, hereditary factors play an important role. For most psychosomatic complaints and symptom complexes, one has to look for a formative influence (“why here?”), i.e. an organ with a hereditarily determined predisposition (disposition). Whether the disposition will manifest itself, whether it will turn into manifestations of the disease (“why now?”) depends on the further course of life, the difficulties and relief that the person experiences. And whether the disease caused by the disposition will again go into a latent form depends on further living conditions, on the success of treatment and, no less often, on social support from others.

It is kind of visual natural experiment with the birth of twins, which modern methods research allows us to find answers to questions about the interdependence of predisposition and environmental influences.

Neuroses and psychosomatic diseases.

If, along with hereditary factors, we describe as pathogenic a certain organ-specific readiness of the patient’s response to homogeneous environmental influences (for example, to the early loss of an attachment figure), then a number of questions arise. In particular, why does this lead to a psychosomatic disease in one case, and to a neurotic disease in another?

Epidemiological data indicate a higher frequency of psychosomatic disorders in lower social strata.

In conversations with psychosomatic patients, the psychotherapist often encounters severe resistance to attempts to carefully clarify the history of life and illness. This is due to several reasons. The leading role of somatic causes is not only more acceptable for the patient, but is also deeply rooted in public consciousness under the influence of medical installations.. Mental illness brings a sense of responsibility to oneself, sometimes stigmatization, somatic illness - on the contrary, a feeling of relief. Many patients experience this feeling when they learn about the organic nature of their disease, although this often means a more severe prognosis. Targeted assistance is expected to be provided by the doctor, and the patient’s own experiences and behavior are not taken into account.

One can imagine a psychosomatic illness as a genetically different form of overcoming mental conflict, which with early childhood replaces another, possibly verbal, elimination of the conflict. We can talk about the “emotional illiteracy” of psychosomatic patients, their emotional lack of education. A psychosomatic patient speaks and operates in “bodily” formulations, expressing himself in the language of organ psychosomatic symptom formation.

The question of whether there is a specific family type of environmental influence that predisposes to certain psychosomatic diseases or to psychosomatic rather than neurotic ones can only be answered in future research. The methodological solution to this issue encounters great difficulties.

With bronchial asthma, empirical studies always describe an overly caring mother, in the same way, an increase in the incidence of obesity is associated not only in adults, but also in children with belonging to a certain segment of the population or ethnic group, including parents and more distant relatives in a given family.

Frequency of psychosomatic complaints and diseases

If we regarded all people with somatic complaints without an organic basis, which are most likely due to mental or social conflicts, as psychosomatic patients, this would lead to too many psychosomatic cases. Typically, somatic complaints of this kind are defined as autonomic disorders (autonomic dystonia, psycho-vegetative syndrome, autonomic lability, functional disorders, etc.).

Anyway great importance depends on whether the person considers himself sick. Karl Jaspers notes in this regard that what might generally be considered a disease depends less on the opinion of the doctor than on the judgment of the patient and on the prevailing cultural environment opinions. Disease, according to Jaspers, is a social concept, not a scientific one. This means that there is no generally accepted concept and clear delineation of the disease that can be given completely objectively.

The same case of psychosomatic illness may be assessed differently in a research center, by a general practitioner and in an epidemiological study. How strongly these data depend not only on the structure and location of the clinic, but also on the definition of “psychosomatic” and the diagnostic technique is shown by the spread of data in 11 studies in Germany from 5.1 to 66.8%. Such data on the percentage of psychosomatic patients among all people who consult a doctor are obtained as a result of various research methods.

As for the disease state, there was no correlation between the presence of severe symptoms of the disease and the tendency to consider oneself as sick.

There is no specifically “psychosomatic” treatment. The psychosomatic approach to treatment involves taking into account, along with biological, psychological and social factors. A doctor who adheres to this approach tries, during a medical examination, to obtain information about the patient’s current and past life, his personality traits, feelings, attitudes, relationships with other people, which requires awareness not only of biological, but also psychological and social sciences. A holistic therapeutic approach is to see the patient as a sick person, and not just a particular disease. In some cases, along with biomedical treatment, it is advisable to turn to specialists in psychotherapy, biofeedback and other similar techniques. Typically, however, some variation of such techniques is used by the attending physician as part of a holistic psychosomatic approach.

Conclusion

Most people are self-conscious about their physical appearance and have little knowledge of how their body functions and how its functioning relates to their personality. IN Western culture In general, it is customary to avoid physical contact. Body psychotherapy includes a physical dimension in the group experience and is a counterbalance to approaches that emphasize the first half of the mind-body formula. Therefore, body therapy techniques are used as an auxiliary in treatment focused on verbal interaction between the therapist and the patient.

Reich therapy, bioenergetic psychotherapy, Rolfing, primal therapy and other variations of body therapy methods are powerful psychotherapeutic tools that are used to bring about emotional release and radical changes in the human body, his feelings and personality as a whole.

The effectiveness of these methods and the possibility of their abuse are the reasons why a lot of speculation and controversy arises around the psychocorrectional groups where they are practiced. However, the tasks of these groups are not so different from those faced by groups that use other psychotherapeutic approaches, for example, Gestalt groups, in which feelings are comprehended through awareness of them.

Body-based psychotherapy is suitable for most participants. The exception is uncommunicative people who may seek body-based psychotherapy to avoid the need to improve their traditional communication skills. Another exception is individuals with a pathological need for physical contact and even inflicting pain on other people.

One of controversial issues relevant to body psychotherapy is the question of catharsis. Most adherents of this method believe that until emotions are discharged, they accumulate somewhere in the body. Thus, it seems that emotions are a certain substance, a kind of genie in a bottle, which effectively emerges from it as soon as they are formed suitable conditions. However, it is more likely that memories, rather than emotions, are stored in the nervous system, and when they emerge, they cause feelings corresponding to them. In this case, catharsis is associated not with energetic release, but with the reproduction of what is stored in memory, with the emergence of emotions that correspond to these memories, and with physiological reactions to these emotions.

When emotions are expressed in physical actions, this is, of course, accompanied by some reduction in tension in the body. But what’s more important is that experiencing deeply buried emotions helps you overcome the habit of avoiding them. This process expands a person's emotional repertoire and teaches that control over feelings can be weakened without any dire consequences. The subsequent integration of all the experiences gained helps to achieve a new level of self-understanding.

In conclusion, it remains to express the hope that a wide range of specialists and simply curious readers will be able to greatly benefit from the works of Alexander Franz. All of them will be able to get acquainted in the author's presentation with Alexander's famous hypothesis about the psychogenesis of organic diseases, which is recognized as the most deeply developed of all ever put forward. It may be of particular interest to domestic doctors specializing in the field of psychosomatic medicine, since the possible meaning of the unconscious revealed by the author mental conflicts in the etiology of somatic disorders - this is exactly what, for ideological reasons, was tabooed in the Soviet school of psychosomatics. Both doctors and psychologists and psychoanalysts will be able to get acquainted with many subtle observations from clinical experience. For all of them, it will undoubtedly be interesting to know how exactly one of its founders understood the goals and essence of psychosomatic medicine. And, of course, a brilliant anti-reductionist analysis of the interaction between soul and body, insightfully and logically carried out by an excellent practitioner, is a real find not only for professional philosophers and methodologists.

Bibliography

S.L. Shishkin. Preface to the Russian edition of the book: F. Alexander. Psychosomatic medicine. - M.: Gerrus, 2000.

“The History of Psychology in Persons,” ed. Karpenko L.A., M. 2005.

Karvasarsky B.D. “Psychotherapeutic Encyclopedia” St. Petersburg: ZAO Publishing House “Peter”, 2002.

Kulakov S.A. Basics of psychosomatics. - St. Petersburg, 2003.

Materials from the site www.psychol-ok.ru

Materials from the site www.koob.ru

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BBK 88.4 A46

Franz ALEXANDER PSYCHOSOMATIC MEDICINE IT "S PRINCIPLES AND APPLICATIONS

Translation from English S. Mogilevsky Artist's serial design D. Sazonova The series was founded in 2001

Alexander F. ",

A 46 Psychosomatic medicine. Principles and practical application. /Trans. from English S. Mogilevsky. - M.:

Publishing house EKSMO-Press, 2002. - 352 p. (Series “Psychology Without Borders”).

ISBN 5-04-009099-4

Franz Alexander (1891-1964) - one of the leading American psychoanalysts of his time. In the late 40s - early 50s. he developed and systematized the ideas of psychosomatics. Thanks to his work on the emotional causes of hypertension and stomach ulcers, he became one of the founders of psychosomatic medicine.

In his main book, he summarizes the results of seventeen years of work devoted to the study of the influence of psychological factors on body functions, on the occurrence, course and outcome of somatic diseases.

Based on data from psychiatry, medicine, Gestalt psychology, psychoanalysis, the author talks about the relationship between emotions and diseases of the cardiovascular system, digestive system, metabolic disorders, sexual disorders, etc., revealing his understanding of the body as an integrated system.

For psychiatrists, psychologists, doctors, students of all these specialties.

© ZAO Publishing House EKSMO-Press. Translation, design, 2002

ISBN 5-04-009099-4

To my colleagues at the Chicago Institute of Psychoanalysis

PREFACE

This book, which is based on an earlier publication "Medical value of psychoanalysis" has two goals. It attempts to describe the basic concepts on which the psychosomatic approach to medicine is based and to present existing knowledge regarding the influence of psychological factors on body functions and their disorders. The book does not provide a comprehensive review of the many anecdotal observations published in the medical literature concerning the influence of emotions on illness; it presents only the results of systematic studies.

The author is convinced that progress in this area requires the adoption of a basic postulate: psychological factors influencing physiological processes should be subjected to the same detailed and thorough study as is customary in the study of physiological processes. Referring to emotions in terms such as anxiety, tension, emotional instability is outdated. The actual psychological content of emotion should be studied by the most advanced methods of dynamic psychology and have a correlation with somatic reactions. Only those studies that adhered to this methodological principle were included in this book.

ALEXANDER FRANTZ

Another postulate characterizing this work is that psychological processes are fundamentally no different from other processes taking place in the body. At the same time, they are physiological processes and differ from other bodily processes only in that they are perceived subjectively and can be conveyed verbally to others. They can therefore be studied by psychological methods. Every bodily process is directly or indirectly influenced by psychological stimuli, since the body as a whole is a unit, all parts of which are interconnected. The psychosomatic approach can therefore be applied to any phenomenon occurring in a living organism. This versatility of application explains the claims of a coming psychosomatic era in medicine. There can now be no doubt that the psychosomatic point of view offers a new approach to understanding the organism as an integrated mechanism. The therapeutic potential of the new approach has been established for many chronic diseases, and this gives hope for its further application in the future. "

Chicago, December 1949.
GRATITUDE

The psychosomatic approach is a multidisciplinary method in which psychiatrists collaborate with experts in various fields of medicine. This book is the result of my seventeen years of collaboration with colleagues at the Chicago Institute of Psychoanalysis and other medical specialists.

I would like to thank Dr. I. Arthur Mirsky for his assistance in evaluating some of the physiological data, particularly in the chapters on hormonal mechanisms, anorexia nervosa, hypertension, thyrotoxicosis, and diabetes mellitus, and for preparing the illustrations and Miss Helen Ross, Drs Thomas Szasz and Dr George Ham, who read the manuscript and made valuable comments. The chapter on thyrotoxicosis is based on research work conducted by me in collaboration with Dr. George Ham and Dr. Hugh Carmichael, the results of which will be published in « JournalofPsychosomaticMedicine».

Some of the book's chapters are based on previously published articles. I would like to thank Dr. Carl A. L. Binger and Dr. Paul B. Hoeber for permission to reprint in this book portions of articles previously published in « PsychosomaticMedicine» (F. Alexander: “Psychological Aspects of Medi ALEXANDER FRANTZ

cine", "Emotional Factors in Essential Hypertension", "Psychoanalytic Study of a Case of Essential Hypertension", "Treatment of a Case of Peptic Ulcer and Personality Disorder"; F. Alexander & S.A. Portis: “A Psychosomatic Study of Hypoglycaemic Fatigue”), Dr. Sidney Portis for permission to partially reprint my chapter published in « DiseasesoftheDigestiveSystem», National Security Council of Chicago for permission to reprint my article published in « CurrentTopicsmHomeSafety», and Drs. Lago Galdston and Henry H. Wig-gins for permission to reprint portions of my article “Present Trends in Psychiatry and Future Outlook”, published in « ModernAttitudesinPsychiatry», Columbia University Press, which served as the basis for parts of the introduction and the first five chapters.
Part 1 GENERAL PRINCIPLES

CHAPTER 1

INTRODUCTION

And again, the focus of medical attention is on the patient - a living person with his troubles, fears, hopes and disappointments, who represents an indivisible whole, and not just a set of organs - liver, stomach, etc. Over the past two decades, the main attention has been paid to the causal role of emotional factors in the occurrence of the disease. Many doctors began to use psychological approaches in their practice. Some serious conservative clinicians believe that this trend threatens the hard-won foundations of medicine. Authoritative voices are heard claiming that this new “psychologism” is incompatible with medicine as a natural science. They would like medical psychology to be reduced to the tact and intuition of the doctor in caring for the patient, which has nothing to do with the Scientific method based on physics, chemistry, anatomy and physiology.

Nevertheless, from a historical perspective, such interest in psychology is nothing more than a revival of previous, pre-scientific views in an updated scientific form. The priest and the doctor did not always share the care of a person’s physical and mental health. There were times when care for the sick was concentrated in the same hands. Whatever the explanation healing power doctor, evangelist or holy water, le11

The therapeutic effect of their intervention was very significant, often even more noticeable than that of many modern drugs, the chemical analysis of which we can carry out and the pharmacological action of which we can evaluate with a high degree of accuracy. The psychological component of medicine was preserved exclusively in a rudimentary form (in the process of the relationship between the doctor and the patient, carefully separated from the theoretical foundations of medicine) - mainly as a convincing and comforting influence of the doctor on the patient.

Modern scientific medical psychology is nothing more than an attempt to put the art of healing, the psychological impact of the doctor on the patient, on a scientific basis, making it an integral part of therapy. Apparently, the therapeutic success of the physician (doctor or priest, as well as the modern medical practitioner) in modern practice is largely due to the existence of some kind of emotional connection between the doctor and the patient. However, this psychological function The medical profession was largely ignored in the last century - a period when medicine became a true natural science, based on the application of physical and chemical principles to a living organism. This is the fundamental philosophical tenet of modern medicine: the body and its functions can be understood in terms of physical chemistry in the sense that living organisms are physicochemical machines, and the ideal of the physician is to become an engineer of the human body. Therefore, recognition of the existence psychological mechanisms and psychological

This approach to the problems of life and illness could be perceived as a return to the ignorance of those dark times when illness was considered the work of an evil spirit and treatment was an exorcism evil spirits from a sick body. It was considered natural that new medicine based on laboratory experiments, must carefully protect its newly acquired scientific aura from such outdated mystical concepts as psychological ones. Medicine, that nouveau riche among the natural sciences, has in many respects adopted the attitude typical of the nouveau riche who wishes to forget his humble origins and becomes more intolerant and conservative than a true aristocrat. Medicine is becoming intolerant of everything that resembles its spiritual and mystical past, while at the same time its older sister, physics, the aristocrat of the natural sciences, has undergone a much more thorough revision of fundamental concepts, affecting the very core of science - the validity of the concept of determinism.

These remarks are not intended to diminish the significance of the achievements of the laboratory period in medicine - the most brilliant stage in its history. The orientation of medicine towards the physicochemical approach, which was characterized by a scrupulous analysis of the smallest aspects of the subject of study, became the reason for significant progress in medicine, examples of which are modern bacteriology, surgery and pharmacology. One of the paradoxes historical development lies in the fact that the more significant the scientific merits of any method or principle, the more it inhibits the subsequent development of science. Due to the inertia of human thinking, ideas and methods whose value has been proven in the past do not remain in science for long, even if their benefits obviously turn out to be harmful. In the history of the exact sciences, for example physics, you can find a lot similar examples. Einstein argued that Aristotle's ideas regarding motion stalled the development of mechanics for two thousand years (76). Progress in any field requires reorientation and the introduction of new principles. Although these new principles may not contradict the old ones, they are nevertheless often rejected or accepted only after a long struggle.

A scientist in this regard has no less prejudices than any layman. The same physicochemical orientation to which medicine owes its outstanding achievements becomes, due to its one-sidedness, an obstacle to further development. The laboratory era in medicine was characterized by its analytical attitude. This period was characterized by a specific interest in particulars, in understanding particular processes. The advent of more precise methods of observation, in particular the microscope, opened up a new microcosm, creating the possibility of unprecedented penetration into the smallest parts of the body. In the process of studying the causes of diseases, the localization of pathological processes became a fundamental goal. In ancient medicine, the humoral theory prevailed, which stated that body fluids were carriers of diseases. The gradual development of dissection techniques during the Renaissance made it possible to accurately examine the organs of the human body, and this led to the emergence of more realistic,

but at the same time also more localizationist etiological concepts. Morgani in the middle of the 18th century argued that the sources of various diseases are located in certain organs, for example, in the heart, kidneys, liver, etc. With the advent of the microscope, the location of the disease became even more defined: the cell became the location of the disease. The main merit here belongs to Virchow, who argued that there are no diseases in general, there are only diseases of organs and cells. Outstanding Achievements Virchow in the field of pathology, supported by his authority, became the reason for the dogmatic views of doctors on the problems of cellular pathology that are still relevant today. Virchow's influence on etiological thought is a classic example of a historical paradox, when the great achievements of the past become an obstacle to further development. Observation of histological changes in diseased organs, made possible thanks to the microscope and improved tissue staining techniques, determined the direction of etiological thought. Finding the cause of the disease has long been limited to the search for individual morphological changes in tissue. The idea that individual anatomical changes themselves could be the result of more general disorders arising from excessive stress or, for example, emotional factors, arose much later. A less particularistic theory - the humoral one - was discredited when Virchow successfully crushed its last representative, Rokitansky, and the humoral theory remained in the shadows until

before its rebirth in the form of modern endocrinology. (

Few people have understood this phase of medical development better than Stefan Zweig, a medical amateur. In his book Healing by the Spirit, he wrote:

“Disease has now come to mean not what happens to a person as a whole, but what happens to his organs... Thus, the natural and original mission of the doctor, the approach to the disease as a whole, is replaced by the much more modest task of localization and identifying the disease and comparing it with a certain group of diagnoses... This inevitable objectification and formalization of therapy in the 19th century went to the extreme - a third person came between the doctor and the patient - a device, a mechanism. To make a diagnosis, less and less often the insightful and synthesis-capable eye of a born doctor was needed...”

No less impressive are the reflections of the humanist Alan Gregg 2 . He puts the past and future of medicine in a broad perspective:

“The fact is that all organs and systems in a person are analyzed separately; The significance of this method is enormous, but no one is obliged to use only this method. What unites our organs and functions and keeps them in harmony? And what can medicine say about the superficial separation of “brain” and “body”? What makes a person whole? The need for new knowledge here is painfully obvious.

S t e fa and Z w e i g: Die Heilung durch den Geist (Healing by the Spirit). Leipzig, Insel-Verlag, 1931.

Al an G regg: "The future of medicine", Harvard Medical Alumni Bulletin, Cambridge, October 1936.

But more than just a necessity, it is a sign of things to come. Interaction with other sciences is necessary - psychology, cultural anthropology, sociology and philosophy, as well as chemistry, physics and internal medicine, in order to try to solve the problem of the brain-body dichotomy left to us by Descartes.

Modern clinical medicine has been divided into two heterogeneous parts: one is considered more advanced and scientific and includes all disorders that can be explained in terms of physiology and general pathology (for example, heart failure, diabetes, infectious diseases, etc.), while the other is considered less scientific and includes a large number of ailments of unknown origin, often of psychogenic origin. A feature of this dual situation - a typical manifestation of the inertia of human thinking - is the desire to drive as many diseases as possible into an infectious etiological scheme, in which the pathogenic factor and the pathological effect are interrelated in a fairly simple way. When an infectious or any other organic explanation is not applicable, the modern clinician is very inclined to console himself with the hope that sometime in the future, when the features of organic processes are better studied, the mental factor, which for the time being has to be recognized, will be completely eliminated. However, gradually more and more clinicians are beginning to recognize that even in the case of diseases that are well explained from a physiological point of view, such as diabetes or hypertension, only the last links of the causation are known.

chains, while the initial etiological factors still remain unclear. Under such conditions, accumulating observations speak of the influence of “central” factors, and the word “central” is apparently just a euphemism for the word “psychogenic.”

This state of affairs easily explains the strange discrepancy between the official-theoretical and real-practical attitudes of the doctor. In their scientific works and presentations to colleagues, he will emphasize the need to learn as much as possible about the physiological and pathological processes underlying the disease, and will not seriously consider psychogenic etiology; however, in private practice he will not hesitate to advise a patient suffering from hypertension to relax, try to take life less seriously and not work too hard; he will try to convince the patient that real reason high blood pressure lies in his overactive, ambitious attitude towards life. The “split personality” of the modern clinician manifests itself more clearly than any other weak point in today’s medicine. Within the medical community, the practicing physician is free to adopt a “scientific” attitude, which is essentially a dogmatic anti-psychological position. Since he does not know exactly how this psychic factor works, since it contradicts everything he has learned in the course of medicine, and since the recognition of the psychic factor undermines the physico-chemical theory of life, the practitioner tries to ignore the psychics as far as possible

ical factor. However, as a doctor, he cannot ignore it completely. When he encounters patients, his medical conscience forces him to pay primary attention to this hated factor, the importance of which he instinctively feels. He has to take it into account, while he justifies himself with the phrase that medicine is not only a science, but also an art. He does not realize that what he considers medical art is nothing more than the deeper, intuitive - that is, non-verbalized - knowledge he has acquired over many years of his clinical practice. The importance of psychiatry, and in particular the psychoanalytic method, for the development of medicine is that it gives effective method studying the psychological factors of the disease.

The patient as a person with his anxieties, fears, hopes and despair, as a whole, and not just as a carrier of organs - a diseased liver or stomach - again becomes a legitimate object of medical interest. In the last two decades, the role of emotional factors in the occurrence of diseases has received increasing attention. more attention. Among doctors, a psychological orientation is being established. Some good conservative clinicians view this as a threat to the hard-won foundations of medicine, and there are influential voices warning physicians that the newfound “psychologism” is incompatible with medicine as a natural science. They would prefer that medical psychology remain limited to the realm of medical art, tact and intuition in dealing with the patient, as distinct from the strictly scientific method of therapy based on physics, chemistry, anatomy and physiology.

However, in the light of a historical perspective, this psychological interest is nothing more than a revival of previous pre-scientific ideas in a new, scientific form. Caring for a suffering person was not always shared between the priest and the doctor. Once upon a time, healing functions, mental and physical, were united in one hand. Whatever the explanation for the healing power of the medicine man, or the evangelist, or the holy water of Lourdes, there can hardly be any doubt that all of them often achieved amazing healing effects, in some respects even more impressive than many of our medicines. which we can analyze chemically and whose pharmacological effects we know with certainty. This psychological aspect Medicine survives only in a rudimentary form as the art of medicine and the ability to approach the patient, carefully separated from the scientific aspect of therapy and perceived mainly as relating to the influence of the doctor on the patient through consolation and suggestion.

Modern scientific medical psychology is only an attempt to put the art of medicine, the psychological impact of the doctor on the patient, on a scientific basis and make it an integral part of therapy. There can be little doubt that a large share of therapeutic success in the healing profession - the medicine man and priest, as well as the modern medical practitioner - is due to the vague emotional connection between the healer and his patient. However, this psychological function of the physician has been largely ignored in the last century, when medicine became a truly natural science based on the application of the principles of physics and chemistry to the living organism. The basic philosophical postulate of modern medicine states that the body and its functions can be understood from the perspective of physical chemistry, that living organisms are physicochemical mechanisms, and the ideal of a doctor is to become an engineer of the body. The recognition of psychological forces, that is, a psychological approach to the problems of life and illness, seems to some people to be a return to the ignorance of the Middle Ages, when illness was considered the act of an evil spirit, and therapy consisted of a spell, expelling an evil spirit from a sick body. It is quite natural that the new medicine, based on laboratory experiments, jealously defended its newly acquired scientific aura against such outdated mystical concepts as those of psychology. Medicine, that newcomer among the natural sciences, has in many respects taken the position typical of an upstart who wants to make people forget their low origins and becomes more intolerant, arrogant and conservative than a genuine aristocrat. Medicine became intolerant of anything reminiscent of its spiritual and mystical past, while its elder brother, physics, the aristocrat of the natural sciences, carried out a thorough revision of its fundamental concepts, calling into question even the key principle of science, the universal suitability of determinism.

These remarks are not intended to detract from the achievements of the laboratory period in medicine, the most outstanding phase in its history. Physico-chemical orientation, characterized by the precise study of fine details, has led to significant progress in medicine, as exemplified by modern bacteriology, surgery and pharmacology. One of the paradoxes of historical development is that the greater the scientific value of a method or principle, the more it will inhibit subsequent development. The inertia of the human mind causes it to cling to ideas and methods that have proven their worth in the past, even if they have already served their purpose. Many examples of this can be found in the history of the development of exact sciences such as physics. Einstein argued that Aristotle's ideas about motion delayed the development of mechanics for two thousand years. Progress in each field requires reorientation when new principles are introduced. Although these new principles may not contradict the old ones, they are often rejected or accepted only after a difficult struggle for acceptance.

The scientist in this respect is as limited as the man on the street. The same physicochemical orientation to which medicine owes its greatest achievements has become, due to its one-sidedness, an obstacle to further development. The laboratory era of medicine was characterized by an analytical approach. Typical of this period was a specialized interest in the details of mechanisms and in understanding private processes. The discovery of more subtle methods of observation, especially observation using the microscope, revealed a new microcosm, providing an unprecedented opportunity to study the smallest parts of the body. When considering disease cases, the main goal was the localization of pathological processes. In ancient medicine, the humoral theory prevailed, which stated that body fluids are carriers of disease. The gradual development of autopsy techniques during the Renaissance made it possible to accurately examine parts of the human body, and thus led to the development of more realistic, but at the same time more localized etiological concepts. Morgagni, in the mid-eighteenth century, argued that many diseases are localized in certain organs, such as the heart, kidneys, liver, etc. With the advent of the microscope, the localization of the disease was further limited: the location of the disease became the cell. It was Virchow, to whom pathology owes so much, who proclaimed that there are no systemic diseases, but only diseases of organs and cells. His great achievements in pathology and his authority established a dogma in cellular pathology that influences medical thinking to the present day. Virchow's influence on etiological thinking is a classic example of the historical paradox that the greatest achievements of the past become the greatest obstacles to further development. The observation of histological changes in diseased organs, made possible by the microscope and sophisticated tissue staining techniques, determined the pattern of etiological thinking. The search for the causes of the disease has long remained limited to the search for local morphological changes in tissues. The concept that such local anatomical changes could themselves arise from more general disorders that develop as a result of pathology of function, excessive stress, or even emotional factors was not to be discovered until much later. The less narrow humoral theory, which was discredited when Virchow successfully defeated its last representative, Rokitansky, had to await its revival in the form of modern endocrinology.

Few have understood the meaning of this phase of medical development better than the non-medical Stefan Zweig. In his book Healing by Spirit he writes:

Now disease no longer means what happens to the whole person, it means only what happens to his organs... Therefore, the original and natural mission of the doctor, approaching the disease as a whole, is replaced by the smaller tasks of localizing the disease, identifying it and classifying it as an already established group of diseases... This inevitable objectification and technicalization of therapy in the nineteenth century went to the extreme, because a third entirely mechanical thing, the apparatus, began to be placed between the doctor and the patient. The insightful, creatively synthesizing understanding of the born physician became less and less necessary for diagnosis...

Equally impressive is the statement of humanist Alan Gregg, who views the past and future of medicine from a broad perspective:

The single whole that is human existence was divided into parts and systems for study. This method cannot be criticized, but no one should be satisfied with its results alone. What keeps our various organs and many functions in harmony and union with each other? What can medicine say about the hasty separation of “mind” and “body”? What makes an individual, as the word itself implies, indivisible, whole? The need for deeper knowledge here is painfully obvious. But stronger than just need is the anticipation of future changes. Psychiatry is in motion, neurophysiology is developing, neurosurgery is flourishing, and the star still shines over the cradle of endocrinology... Participation in resolving the problem of the dichotomy of soul and body, left to us by Descartes, must be sought from such fields of knowledge as psychology, cultural anthropology, sociology and philosophy , as well as chemistry, physics and therapy.

Thus, modern clinical medicine was divided into two heterogeneous parts - one considered more advanced and scientific and including all disorders that can be explained in terms of physiology and general pathology (for example, organic heart disease, diabetes, infectious disease, etc.) .d.), and another, considered less scientific, which includes a huge conglomerate of disorders of unclear, often mental origin. Characteristic of this ambivalence - a typical manifestation of the inertia of the human mind - is the tendency to squeeze more and more diseases into the etiological scheme of infection, where the connection between pathogenic cause and pathological effect seems comparatively simple. When the infectious or other organic explanation fails, the modern clinician only consoles himself with the hope that at some future time, when organic processes have been studied in more detail, the psychic factor, which is reluctantly recognized, will eventually be eliminated. But at the same time, more and more clinicians are gradually coming to understand that even in disorders that have a satisfactory physiological explanation, such as diabetes or essential hypertension, only the last links in the causal chain are known, and the primary etiological factors still remain unclear. In these, as in other chronic conditions, the accumulated observations seem to point to "central" factors, the expression "central" apparently being a mere euphemism for "psychogenic" factors. This state of affairs easily explains the peculiar discrepancy between the official theoretical and real practical attitudes of the doctor in his work. In scientific publications and in speeches to medical groups, he will emphasize the need to know more and more details of basic physiological and pathological processes and will refuse to take psychogenic etiology seriously; However, in private practice, he will not hesitate to advise a patient suffering from hypertension to try to relax, take life less seriously, avoid overwork, and will try to convince the patient that his overly active and ambitious attitude towards life is the real source of high blood pressure. This “split personality” of the modern clinician most clearly reveals the weak point of modern medicine. Within the medical community, a practicing physician can afford to feign a “scientific” attitude that is, in fact, purely dogmatic and anti-psychological. Since he does not know exactly how the psychic element works, so contrary to everything he has learned during medical training, and since the recognition of the psychic factor seems to destroy the coherence of the physico-chemical theory of life, such a practitioner tries as far as possible , do not take into account the mental factor. However, as a doctor, he cannot completely ignore it. When he encounters patients, his therapeutic conscience forces him to pay special attention to this hated factor, the importance of which he instinctively feels. He has to deal with it, but in doing so, he justifies himself with the phrase that medical healing is not only a science, but also an art. He is not aware that what he calls medical art is nothing other than the deeper, more intuitive, that is, non-verbalized knowledge that he has acquired through many years of clinical experience. The importance of psychiatry, especially the psychoanalytic method, for the development of medicine lies in the fact that it provides effective ways research into psychological factors of diseases.

Psychosomatic Medicine: Principles and Practical Applications, Alexander Franz
This work is central to the work of F. Alexander.

It summarizes the experience of the rapid development of psychosomatics in the first half of the 20th century and outlines the methodology of a new, psychoanalytic approach to understanding and treating diseases.

Read the book Psychosomatic Medicine online

Franz Alexander (1891-1964) - one of the leading American psychoanalysts of his time. In the late 40s - early 50s. he developed and systematized the ideas of psychosomatics. Thanks to his work on the emotional causes of hypertension and stomach ulcers, he became one of the founders of psychosomatic medicine.

In his main book, he summarizes the results of seventeen years of work devoted to the study of the influence of psychological factors on body functions, on the occurrence, course and outcome of somatic diseases.

Based on data from psychiatry, medicine, Gestalt psychology, psychoanalysis, the author talks about the relationship between emotions and diseases of the cardiovascular system, digestive system, metabolic disorders, sexual disorders, etc., revealing his understanding of the body as an integrated system.

For psychiatrists, psychologists, doctors, students of all these specialties.

© ZAO Publishing House EKSMO-Press. Translation, design, 2002

ISBN 5-04-009099-4

To my colleagues at the Chicago Institute of Psychoanalysis

PREFACE

This book, which evolves from an earlier publication, The Medical Value of Psychoanalysis, has two purposes. It attempts to describe the basic concepts on which the psychosomatic approach to medicine is based and to present existing knowledge regarding the influence of psychological factors on body functions and their disorders. The book does not provide a comprehensive review of the many anecdotal observations published in the medical literature concerning the influence of emotions on illness; it presents only the results of systematic studies.

The author is convinced that progress in this area requires the adoption of a basic postulate: psychological factors influencing physiological processes should be subjected to the same detailed and thorough study as is customary in the study of physiological processes. Referring to emotions in terms such as anxiety, tension, emotional instability is outdated. The actual psychological content of emotion should be studied by the most advanced methods of dynamic psychology and have a correlation with somatic reactions. Only those studies that adhered to this methodological principle were included in this book.

ALEXANDER FRANTZ

Another postulate characterizing this work is that psychological processes are fundamentally no different from other processes taking place in the body. At the same time, they are physiological processes and differ from other bodily processes only in that they are perceived subjectively and can be conveyed verbally to others. They can therefore be studied by psychological methods. Every bodily process is directly or indirectly influenced by psychological stimuli, since the body as a whole is a unit, all parts of which are interconnected. The psychosomatic approach can therefore be applied to any phenomenon occurring in a living organism. This versatility of application explains the claims of a coming psychosomatic era in medicine. There can now be no doubt that the psychosomatic point of view offers a new approach to understanding the organism as an integrated mechanism. The therapeutic potential of the new approach has been established for many chronic diseases, and this gives hope for its further application in the future. "

Chicago, December 1949.

GRATITUDE

The psychosomatic approach is a multidisciplinary method in which psychiatrists collaborate with experts in various fields of medicine. This book is the result of my seventeen years of collaboration with colleagues at the Chicago Institute of Psychoanalysis and other medical specialists.

I would like to thank Dr. I. Arthur Mirsky for his assistance in evaluating some of the physiological data, particularly in the chapters on hormonal mechanisms, anorexia nervosa, hypertension, thyrotoxicosis, and diabetes mellitus, and for preparing the illustrations and Miss Helen Ross, Drs Thomas Szasz and Dr George Ham, who read the manuscript and made valuable comments. The chapter on thyrotoxicosis is based on research work I conducted in collaboration with Dr. George Ham and Dr. Hugh Carmichael, the results of which will be published in the Journal of Psychosomatic Medicine.

Some of the book's chapters are based on previously published articles. I would like to thank Dr. Carl A. L. Binger and Dr. Paul B. Hoeber for permission to reprint in this book portions of articles previously published in Psychosomatic Medicine (F. Alexander: “Psychological Aspects of Medi ALEXANDER FRANTZ

Cine", "Emotional Factors in Essential Hypertension", "Psychoanalytic Study of a Case of Essential Hypertension", "Treatment of a Case of Peptic Ulcer and Personality Disorder"; F. Alexander & S.A. Portis: "A Psychosomatic Study of Hypoglycaemic Fatigue"), Dr. Sidney Portis for permission to partially reprint my chapter published in "Diseases of the Digestive System", Chicago National Security Council for permission to reprint my article published in " Current Topics m Home Safety" and Drs. Lago Galdston and Henry H. Wiggins for permission to reprint portions of my article "Present Trends in Psychiatry and Future Outlook", published in Modern Attitudes in Psychiatry, Columbia University Press, which served as the basis for parts of the introduction and the first five chapters.

Part 1 GENERAL PRINCIPLES

INTRODUCTION

And again, the focus of medical attention is on the patient - a living person with his troubles, fears, hopes and disappointments, who represents an indivisible whole, and not just a set of organs - liver, stomach, etc. Over the past two decades, the main attention has been paid to the causal role of emotional factors in the occurrence of the disease. Many doctors began to use psychological approaches in their practice. Some serious conservative clinicians believe that this trend threatens the hard-won foundations of medicine. Authoritative voices are heard claiming that this new “psychologism” is incompatible with medicine as a natural science. They would like medical psychology to be reduced to the tact and intuition of the doctor in caring for the patient, which has nothing to do with the Scientific method based on physics, chemistry, anatomy and physiology.

Nevertheless, from a historical perspective, such interest in psychology is nothing more than a revival of previous, pre-scientific views in an updated scientific form. The priest and the doctor did not always share the care of a person’s physical and mental health. There were times when care for the sick was concentrated in the same hands. Whatever explains the healing power of a doctor, an evangelist, or holy water, le11

The therapeutic effect of their intervention was very significant, often even more noticeable than that of many modern drugs, the chemical analysis of which we can carry out and the pharmacological action of which we can evaluate with a high degree of accuracy. The psychological component of medicine was preserved exclusively in a rudimentary form (in the process of the relationship between the doctor and the patient, carefully separated from the theoretical foundations of medicine) - mainly as a convincing and comforting influence of the doctor on the patient.

Modern scientific medical psychology is nothing more than an attempt to put the art of healing, the psychological impact of the doctor on the patient, on a scientific basis, making it an integral part of therapy. Apparently, the therapeutic success of the physician (doctor or priest, as well as the modern medical practitioner) in modern practice is largely due to the existence of some kind of emotional connection between the doctor and the patient. However, this psychological function of the physician has been largely ignored in the last century - a period when medicine became a true natural science, based on the application of physical and chemical principles to the living organism. This is the fundamental philosophical tenet of modern medicine: the body and its functions can be understood in terms of physical chemistry in the sense that living organisms are physicochemical machines, and the ideal of the physician is to become an engineer of the human body. Therefore, recognition of the existence of psychological mechanisms and psychological

Psychosomatics- a branch of psychology that studies the relationship between mental experiences and bodily reactions of the body. The disease brings us one or another symbolic message - we just need to learn to understand the language in which it speaks to us through its symptoms.

Psychosomatic diseases are diseases the causes of which are more the mental processes of the patient than any direct physiological causes. If medical examination cannot detect a physical or organic cause of the disease, the disease is classified as psychosomatic.

Psychosomatic approach begins when the patient ceases to be only a carrier of a diseased organ and is considered holistically. Then the psychosomatic direction can also be considered as an opportunity for “healing”. The main goal is to find connections in time between the onset of somatic manifestations and reliable life situations.

All methods and methods of work are aimed at unfolding the energy, sensations and experiences that are blocked in the symptom. i.e. directly in the client’s body. To study ways of interacting with the outside world through illness. Search and formation of new, healthy manifestations through awareness, sensation, feelings, search for an object and action.

Psychosomatics helps:

• find the root of the problem of psychosomatic disorder;
• hear and understand your own body signals;
• learn to express suppressed emotions and feelings;
• speak openly about your needs;
• build relationships with others in a healthy way without using symptoms.
• understand the causes of illnesses of your loved ones;
• understand why the disease is beneficial for you;
• learn to independently cope with the symptoms of the disease;
• resolve intractable life situations without getting sick.
• learn to speak and hear people close to you;
• help your children build healthy relationships and be healthy;
• live a more fulfilling and creative life.

From the history of psychosomatics:

Psychosomatics - “Psychosomatic” translated from Greek means “psycho” - soul and “soma, somatos” - body. The close relationship between the mental and the somatic has been noticed and studied for several centuries, since the times of Hippocrates and Aristotle. This term was introduced into medicine in 1818 by the German psychiatrist Johann Heinroth, who was the first to say that negative emotion, remaining in memory or regularly repeated in a person’s life, poisons his soul and undermines his physical health. With the works of S. Freud in the late 19th and early 20th centuries, a systematic study of the mutual influence of the psyche and body in the picture of the disease begins. He is known to have argued that memories repressed as a result of psychic trauma and the psychic energy associated with them can, through conversion, manifest themselves in somatic symptoms. Freud also pointed out that "somatic readiness" is an important influence - a physical factor that is important for the "choice of organ"

The term “psychosomatic” finally took root in medicine thanks to the Viennese psychoanalysts (Deutsch 1953), and from that time on, psychosomatic medicine was designated as “applied psychoanalysis in medicine.” A huge contribution to the study and development of psychosomatics was made by Deutsch, Flanders Dunbar, Franz Alexander, Adler, Sondi...

Franz Alexander (01/22/1891 - 03/08/1964) Hungarian-American psychoanalyst. One of the creators of psychosomatic medicine, founder and leader of the “Chicago School” of psychoanalysis. Professor of Clinical Psychiatry at the University of Southern California (1957). Winner of the Sigmund Freud Prize (1921) of the International Psychoanalytic Association and other scientific awards and honors. President of the American Psychological Association (1938). Editor-in-Chief of the Journal of Psychosomatic Medicine (1939). President of the American Society for Research in Psychosomatic Problems (1947). Author of more than 120 articles. “Psychoanalysis of the Whole Personality,” 1927; “Psychoanalytic Therapy,” 1946, co-author. with T. French; “Fundamentals of Psychoanalysis”, 1948; "Psychosomatic medicine. Its principles and application", 1950; "Dynamic Psychiatry", 1952, co-author. with G. Ross; “History of Psychiatry”, 1966, co-author. with Sh. Selesnik. In the Russian translation “Man and his soul: knowledge and healing from antiquity to the present day”, 1995, etc.

Franz Alexander graduated from the Faculty of Medicine of the University of Budapest (1913). He studied a wide range of various psychological problems, including the negative consequences of raising children in excessive severity or pampering. Studied and typified emotional conflicts. During the First World War, Alexander was a military doctor (1914 - 1918). After the war, he took up psychotherapy and psychoanalysis and worked as an assistant at the Neuropsychiatric Clinic of the University of Budapest (1919 - 1920). Alexander worked and taught at the Berlin Psychoanalytic Institute (1924 - 1925), where he practiced short courses of psychoanalytic therapy along with standard ones.

Alexander formulated the principle and created a model of “corrective emotional experience,” according to which a psychoanalyst can consciously and actively regulate his own emotional reactions and direct his influence on the patient in order to counter his unproductive attitudes.

Franz Alexander interpreted neurosis obsessive states, conversion hysteria and manic-depressive psychosis as various forms of disruption of the interaction between the repressive functions of the ego and repressed drives.

Alexander differentiated the concepts of “guilt” and “shame” according to their emotional content and functional results. In 1930, he was invited to lecture at the University of Chicago, where he became the first professor of psychoanalysis. Soon he moved to the USA and in 1932 he organized and headed the Chicago Institute of Psychoanalysis, which he directed until 1956.

Franz Alexander founded the first psychosomatically oriented psychoanalytic laboratory, where, together with his colleagues, he studied and described conflict models of illnesses manifested in various personality types, studied social disorganization and a number of criminological problems. In the late 40s - early 50s. Alexander developed and systematized the ideas of psychosomatics. He became one of the founders of psychosomatic medicine. He developed a functional theory of personality, within the boundaries of which he established four main personality functions:

• perception of subjective needs (internal perception);
• perception of information from the surrounding world (external perception or “sense of reality”);
• integration of external and internal perceptions (entailing planning actions to satisfy subjective needs);
• control of voluntary motor behavior (executive function “I”).

Alexander completed a series of works on the emotional causes of hypertension and stomach ulcers, which are considered classics of psychosomatics and psychosomatic medicine. From 1956, for a number of years, he was director of the Psychiatric and Psychosomatic Research Institute in Los Angeles. He was considered the leading psychoanalyst in the United States.

“The term “psychosomatics” should be used only to illustrate a methodological approach in research and therapy, which means the simultaneous and coordinated use of somatic - that is, physiological, anatomical, pharmacological, surgical and dietary - methods and concepts, on the one hand, and psychological methods and concepts - on the other. The emphasis here is on the expression "consistent use", showing that two methods are used in the conceptual framework of causal sequences." Alexander Psychosomatic medicine.

Therapists about psychosomatics:

I'm like a former medical worker, I want to help clients avoid going to the hospital. Learn to listen to your body's signals and not put off your symptoms until later.

Personally, understanding my body's reactions helps me stop symptoms from developing.

There are good results in working with panic attacks, with migraines, with pain of various localizations, with gynecological problems.

For me, psychosomatics is the likelihood of meeting with inner world man, with his hidden resources, with his ways of interaction, with his secret desires to be seen, heard, recognized. Meetings with his impossibility, with his desire to change his life and his world, to become healthier!