University of Michigan Medical and Nursing School - Aequanimitas Yearbook (Ann Arbor, MI)

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PSYCHOSOMATIC OR SOMATOPSYCHIC Prior to the ascendance of Freudian psychology, little attention was paid in medicine to the effect of the psyche or the somag presently, opinions are being published in the medical journals to the effect that up to 909 of patients seen by the practitioners are suffering from a psychophysiologica1 disorder. The time may now be ripe for a re-examination of our concepts and for a nudge to the pendulum toward a more balanced position. As an example, let me raise the question of allergy. A multitude of objective biochemical and physiological abnormalities, such as elevated blood histamine level, altered serotonin metabolism, depressed serum potassium, depressed tissue and serum calcium, as well as EEG and triple response abnormalities have been demonstrated in the allergic state, Many workers have stressed the mental symptoms of lack of concentration, forgetfulness, and the mental symptoms of lack of concentration, forgetfulness, con- fusion and decreased learning capacity and their psychological sequelae of frustration, irritability, hostility, aggressiveness, para- noid ideas and compulsiveness. Competent investigators have pointed out the frequency of complaints like tension, fatigue, headache, tremulousness, urinary frequency, facial tics and paresthesias. Some of these manifestations may be related to disturbances in histamine and serotonin metabolism, which have only recently been elucidated. Yet the bewildering array of diffuse complaints often make the patient appear neurotic. 28

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v C 1 is . 425343- .,' ' 5 If if x Q 1' I 1' 'Y I fi Y 'Ric S When it is found, however, that after the identification and removal of the responsible allergen, a regular Dr. Jekyll-Mr. Hyde trans- formation has taken place fassuming other factors have been properly controlledl and the patient becomes calm, relaxed, con- fident a.nd energetic, then we must look elsewhere for an explanation. The fact that many of these patients improve with psychotherapy cannot be taken as proof of a primary etiologic role, one might as well postulate that all diseases which respond to steroid ad- ministration are caused by a primary lack of intrinsic corticoids. In our scientific enthusiasm over the discovery of the cortico- hypothalamic-pituitary-adrenal axis, we often tend to slight the benerable milieu interne. The miraculous personality transformations of ulcerative colitis patients after colectomy are too well known to require elaboration. The experiments in human starvation conducted at the University of Minnesota have demonstrated profound personality changes as a result of enzymatic and vitamin deficiencies. The psychotomimetics, tranquilizers and psychic energizers point to the importance of the biochemical and pharmacological environment. There can be no question that psychophysiologic disorders con- stitute an important problem in medicine, we must, however, resist the impulse of affixing this diagnosis after only a cursory investigation-with often admittedly gross tools-has failed to show organic disease. Harold R. Styler '63 29