Alexander Franz - Psychosomatic medicine: Principles and practical application. "Psychosomatic Medicine" by Alexander Franz

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Name: Psychosomatic medicine. Principles and practical application.
Franz Alexander, Mogilevsky S.
The year of publishing: 2002
Size: 1.29 MB
Format: doc
Language: Russian

The presented book by Franz Alexander in translation “Psychosomatic Medicine. Principles and Practical Application” consists of two basic parts, the first of which discusses general principles the issue covered, the development and principles of various areas of psychiatric science are presented modern stage, the second part characterizes emotional factors in various diseases of a somatic nature.

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Storozhakov G.I., Shamrey V.K.
The year of publishing: 2014
Size: 1.38 MB
Format: pdf
Language: Russian
Description: The practical guide "Psychosomatic spectrum disorders. Pathogenesis, diagnosis, treatment" edited by Storozhakova G.I., et al., discusses the anatomical and physiological foundations of psycho... Download the book for free

Name: Psychiatry. Scientific and practical reference book
Tiganov A.S.
The year of publishing: 2016
Size: 50.5 MB
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Language: Russian
Description: The reference guide "Psychiatry. A scientific and practical reference book" edited by Tiganova A.S., examines the entire spectrum of psychiatric pathology, which is a practical guide for practitioners... Download the book for free

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Barlow D., Eidemiller E.G.
The year of publishing: 2008
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Zharikov N.M., Khritinin D.F., Lebedev M.A.
The year of publishing: 2014
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Fesenko Yu.A.
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Name: General psychopathology
Marilov V.V.
The year of publishing: 2002
Size: 4.06 MB
Format: djvu
Language: Russian
Description: The book “General Psychopathology”, edited by V.V. Marilov, examines general issues in the study of psychiatric disorders. Pathological states of perception, thinking disorders are presented... Download the book for free

Name: Practical guide on the use of ICD-10 in psychiatry and narcology
Churkin A.A., Martyushov A.N.
The year of publishing: 2010
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Name: Analytical psychopathology. 3rd edition
Tsirkin S.Yu.
The year of publishing: 2012
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Non-state educational institution

Higher professional education

"Moscow Institute 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 preference for medical aspect psychoanalysis.

"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 studies scientific research the role of emotional disorders in various 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, which runs 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 not currently rejected outright, it often escapes the attention of both researchers and clinicians - probably due to the difficulty of following its methodology, which requires not only a good knowledge of both the psyche and somatics, but also an understanding of them interconnected functioning. The latter is difficult to formalize, necessary in scientific research and 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 psychological picture("personal profile"), for example, patients suffering from coronary heart disease and patients prone to frequent fractures and other injuries, are fundamentally different. However, as in any other field of 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 cover of an outwardly completely various types personality, 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, protecting 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 influences can stimulate or suppress the work of any organ." Psychoanalytic research reveals in many people unconscious emotional tension 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 their disruption normal operation and ultimately triggering the development of the disease. Moreover, since various physiological changes are observed in different mental states, it is also the result of various long-term unconscious emotional states There will be various pathological processes: high blood pressure - a consequence of suppressed anger, dysfunction of the gastrointestinal tract - a consequence of frustration of dependent tendencies, 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 has not received clear experimental confirmation, including in numerous studies of the institute headed by Alexander specifically dedicated to this. 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 shown.

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 calculating correlations of somatic and psychological indicators, on the basis of which only the most superficial conclusions are made about causal connections. 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, unwinding 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 - an approach substantiated and developed in detail by Alexander - narrow specialists try to solve all the issues without going beyond the limits of 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 theory and ineffective in practice, which have nothing in common with the truly scientific approach of 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 industries 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 the environment.

The fact that with certain somatic diseases, for example, with bronchial asthma, a more or less obvious connection is discovered between external and internal conflicts and the appearance of symptoms of the disease, which 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, has become known only recently). 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. We are talking about functional disorders of individual organs or organ systems; as a rule, any tissue changes are not detected. Unlike conversion symptoms, an individual 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 pictures of 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 we combine all three subsequent factors (childhood - 15%, life events - 15%, social influences - 10%, other - 5%), then in 40% of cases interaction with the environment matters 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.

An illustrative example is a kind of natural experiment with the birth of twins, which, with modern research methods, allows one 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 to respond to homogeneous environmental influences (for example, early loss object of attachment), 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 the public consciousness under the influence of medical attitudes. 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 a mental conflict, which from early childhood replaces another, possibly verbal, overcoming 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.).

In any case, whether the person considers himself sick is of great importance. 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 opinion in a given cultural environment. 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 current and past life the patient, the characteristics of his personality, feelings, attitudes, relationships with other people, which requires awareness not only in biological, but also in 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, it is generally common 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 the controversial issues related to body psychotherapy is the issue 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 kind of substance, a kind of genie in a bottle, which effectively emerges from it as soon as the right conditions arise. 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

Posted on Allbest.ru

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about the author

Alexander was born in the winter of 1891. It happened in Budapest. The boy studied in Germany, where he studied with Karl Abraham. Years later he was invited to become a professor of psychoanalysis. This was done by his friend and part-time head. After this significant event, Franz Alexander for a long time worked at the Chicago Institute. Much later, he co-founded the systems theory community. Note that he was one of the first researchers who became part of this group.

The hero of our article is considered an outstanding psychoanalyst with Hungarian roots. He is also considered one of the creators of psycho-oriented criminology and psychosomatic medicine. He died on Women's Day - March 8th. It happened in 1964 in California.

Activity

The name of Dr. Franz Alexander is inextricably linked with the emergence of psychosomatics. It is he who is considered the founder, because in his works he paid the greatest attention to this issue. He himself processed all the experience, which allowed him to put forward the fundamental principles of psychosomatics at the beginning of the last century. He also described his methodology in some detail and argued for the need for a mental approach to the interpretation and treatment of many ailments and diseases. IN modern world his works are recognized as classics, which had a huge influence on the development of psycho-emotional intelligence in humans.

What is it about?

Franz Gabriel Alexander outlined his main ideas in his book Psychosomatic Medicine. But we will try to understand what psychosomatics is, what its main provisions are and what the essence of this teaching is.

Note that when translated from Greek, this term is divided into two separate words, namely “body” and “soul”. At the moment, psychosomatics is recognized as a separate direction in medicine and psychology, which searches for relationships between psychological causes and the occurrence of certain diseases in the human body. Within this direction, researchers are looking for various relationships between individual personality characteristics, for example, constitutional features, character, personality traits, behavior style, propensity for one or another type of conflict and diseases to which this person is prone. Alternative medicine assures that absolutely all ailments that arise in a person are based on some psychological conflicts that arise in the thoughts, soul and unconscious.

Ailments

Franz Alexander outlined his ideas in some detail in his main work. The principles of psychosomatic medicine and their application are considered in close connection. Thus, he identified some ailments that are absolutely somatic, that is, caused by certain psychological factors. These ailments include:

Colon irritation.
Arterial hypertension.
Migraine.
Dizziness.
Panic attacks.
Bronchial asthma.

Current state of affairs

At the moment, such a branch of knowledge as veterinary psychoneurology is actively developing. It appeared due to the fact that new modern methods research, very interesting ideas were proposed from outstanding scientists. This branch of knowledge deals with the search for relationships between the functioning of the nervous system and its effect on organs. As we understand, 80% of the key provisions in this discipline are based precisely on the provisions of psychosomatics.

Psychosomatic diseases

Franz Alexander’s book “Psychosomatic Medicine” states that psychosomatic illnesses are those diseases that appear more due to certain psychological processes that occur with a sick person than due to physiological reasons. Moreover, this type of disease includes those that official medicine cannot detect even with the most thorough research. It is also believed that basically all diseases arise as a result of such emotional experiences as melancholy, guilt, rage, and anxiety.

Causes

Franz Alexander studied psychosomatic medicine rather superficially, because he was the founder of this branch of knowledge. But today, quite interesting theories and thoughts have emerged that are guided by Alexander’s ideas. For example, psychologist L. LeCron identified several reactions that, in his opinion, may be the causes of psychosomatic diseases. Let's look at them in more detail:

Conflict situations. The fact is that some symptoms and illnesses can be caused by conflicts that fight within one person. Very often, a personality conflict lies in the fact that the conscious part holds one opinion, while the unconscious part of a person holds a completely different or even opposite opinion. Because of this, a struggle begins between the conscious and the unconscious, which sometimes only leads to a temporary victory for one side or the other. But sometimes the unconscious part begins to play against the rules, so to speak, and causes certain ailments. Perhaps the reason is that a person needs to reflect and pay attention to certain aspects of his life.
Language of the body. Sometimes a person who is at the limit of emotions uses certain words that can affect his body in one way or another. For example, phrases such as “I can’t digest this situation”, “he creates unnecessary headache“,” “I can’t influence this because my hands are tied,” etc. All these are thought forms that, with proper emotionality, can influence certain structures of our body, causing rapid breathing or headaches.
Benefit or motivation. This is very interesting variety, the essence of which is that some health problems, to one degree or another, bring a certain benefit to a person or motivate him to certain actions. It is known that a person does not consciously understand this. But on an unconscious level, he stimulates himself in this way. At the same time, everything happens quite realistically. A person experiences real pain and real symptoms, but at the same time he achieves certain goals of which he may not be aware.

Past and identification

Sometimes the cause of illness can be a difficult experience from the past. Very often, diseases evoke somatic memories from childhood, because this period is the most innocent and unprotected. The interesting thing is that this can be either a long-term negative experience or a separate episode that had an impact on the unconscious part of the personality. Franz Alexander saw psychosomatic medicine as a way to deal with such experiences, because he argued that negative thought forms have a specific place in the body. If you do not process your experience, do not work with it and do not transform it into neutral memories, then sooner or later it will gain its power and cause one or another illness.

Franz Gabriel Alexander considered psychosomatic medicine as one of the ways to deal with psychological attachment. For example, there is an interesting idea that when you have a strong connection with another person, that is, when you are attached to him and identify yourself with him, you can experience severe discomfort. The most negative situation occurs when this person has died or is on the verge of death.

Suggestion and guilt

Sometimes a person simply begins to believe in his illness, even if it is just beginning and can be avoided quite easily. This happens in cases where an authoritative doctor or a representative of a non-author talks about the disease. traditional medicine, whom a person trusts very much. Then he simply accepts the idea that he is very sick and suppresses any criticism. Thus, the thought form is immediately transferred to human unconscious and influences him.

Sometimes pain can occur because a person feels guilty for something and decides to punish himself. He does not consciously understand this, but unconsciously he does everything in order to experience a certain punishment. It makes it easier to bear the feeling of guilt, but it greatly complicates a person’s normal life and often drives him into depression.

Treatment

Franz Alexander proposed to consider psychosomatic medicine in conjunction with official science. Thus, he believed that psychosomatic diseases should be treated with psychotherapy and certain medications. In the modern world, representatives of alternative medicine provide treatment with antidepressants, tranquilizers, and psychotherapy. Note that very often psychosomatics is confused with hypochondria. The main difference is that psychosomatic patients actually experience real symptoms and the disease can progress, while hypochondriacs experience only illusory symptoms.

So, we understand what the principles of psychosomatic medicine formulated by Franz Alexander are based on. Feedback on the application of these principles allows us to look at the situation comprehensively and form a personal opinion about it. Each person has his own instinct, as well as analytical thinking, which will tell him whether there is a grain of truth in these statements.

Today, quite a large number of people make money by talking about psychosomatics, without actually even knowing who the founder of this trend was. That is why, if you are interested in this topic, it is better to refer to the classic work of the hero of our article. It will help you study the topic from the inside, analyze the information and think critically about it, so as not to fall for the tricks of modern doctors.

FRANZ ALEXANDER
PSYCHOSOMATIC MEDICINE IT'S PRINCIPLES
AND APPLICATIONS
NEW YORK
FRANZ ALEXANDER
PSYCHOSOMATIC MEDICINE
PRINCIPLES AND PRACTICAL APPLICATION

Property of the Professional Medical Association of Psychotherapists, Psychologists and Social Workers

BBK 88.4 A46
Franz ALEXANDER PSYCHOSOMATIC MEDICINE IT "S PRINCIPLES AND APPLICATIONS
Translation from English by S. Mogilevsky Serial design by artist D. Sazonov Series 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.
BBK 88.4
© 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 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, as well as for the preparation of the illustrations and Miss Heen Ross, Drs Thomas Szasz and 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 Carmichae, 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. Car A. L. Binger and Paul B. Hoeber for permission to reprint in this book parts of articles previously published in Psychosomatic Medicine (F. Aexander: "Psychoogica Aspects of Medi ALEXANDER FRANTZ
cine", "Emotiona Factors in Essentia Hypertension", "Psychoanaytic Study of a Case of Essentia Hypertension", "Treatment of a Case of Peptic Ucer and Personality Disorder"; F. Aexander & S.A. Portis: "A Psychosomatic Study of Hypogycaemic 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. ago Gadston and Henry H. Wig-gins for permission to reprint parts of my article " Modern tendencies 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
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 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 pharmachologic effect which we can estimate 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 bet on scientific basis the art of healing, the psychological impact of the doctor on the patient, 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 the engineer of the human body. Therefore, recognition of the existence of 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 to be the work of evil spirit and the treatment was the exorcism of evil spirits from the diseased body. It was considered natural that new medicine, based on laboratory experiments, should 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, one can find many similar examples. Einstein argued that Aristotle's ideas about 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. Virchow's outstanding achievements 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 by 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 thoughts of the humanist Alan Gregg2. 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 Heiung durch den Geist (Healing by the Spirit). Leipzig, Inse-Verag, 1931.
A an G regg: "The future of medicine", Harvard Medica Aumni Buetin, 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 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.), 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 some other organic explanation is not applicable, the modern clinician is very apt to console himself with the hope that sometime in the future, when the features organic processes will be better studied, the mental factor, which so far 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 his scientific writings 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 the real cause of high blood pressure is 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.
CHAPTER 2
THE ROLE OF MODERN PSYCHIATRY IN THE DEVELOPMENT OF MEDICINE
Psychiatry, the most neglected and least developed branch of medicine, was destined to introduce a new synthetic approach to medicine. During most of the laboratory period of medicine, psychiatry remained a fairly isolated field, with little contact with other medical specialties. Psychiatry dealt with the mentally ill, an area in which conventional conventional therapies were least effective. The symptomatology of mental illness differed in unpleasant ways from somatic disorders. Psychiatry dealt with delusions, hallucinations, and emotional disturbances—symptoms that could not be described in conventional medical terminology. Inflammation can be described using physical concepts such as swelling, increased temperature and certain micro changes at the cellular level. Tuberculosis is diagnosed by identifying the presence of specific changes and certain microorganisms in the affected tissues. Pathology mental functions is described using psychological terminology, and therefore, understanding of etiology based on modern medical concepts has been difficult to apply to mental disorders. This distinguishing feature separated psychiatry from the rest of medicine. In an effort to bridge this gap, some psychiatrists try to explain mental symptoms with unfounded assumptions about the presence of hypothetical somatic disorders; a similar trend still exists to some extent today.
Perhaps the most scientific way out of this impasse was the attempt to create a more accurate and systematic description of mental illness. If the psychiatrist was unable to explain the symptoms of mental illness using other medical disciplines, he at least tried to give a detailed and systematic account of his observations. A similar trend was characteristic of the period of descriptive psychiatry. It was then that such names as Kahlbaum, Wernicke, Babinsky and, finally, Kraepelin appeared, who gave modern psychiatry the first reliable and extensive system for describing mental illnesses.
At the same time, the leading luminaries of medicine of the 19th century stubbornly tried to apply the principles of localizationism set forth by Morgani and Virchow to psychiatry. That the brain is the seat of mental functions was known, at least in general terms, as early as ancient Greece. With increasing knowledge about the physiology and anatomy of the brain, it has become possible to localize various perceptual and motor systems in different cortical and subcortical areas of the brain. This, coupled with the development of histological techniques, gave rise to the hope that understanding of mental functions and diseases can provide knowledge of the complex cellular structure of the brain (brain cytoarchitecture). The studies of Cajal, Golgi, Nissl, Alzheimer, Apati, von Lenossek and many others are indicative. which provided extremely detailed and refined information regarding the histological structure of the brain. These studies were predominantly descriptive, they were characterized by the functional significance of anatomical structures, especially the higher parts of the brain, which remained practically unstudied. In no other medical discipline was there such a strong division between morphological and. functional knowledge, as in the field of brain research: where, in what place in the brain, thought processes and emotions are located and how memory, will and thinking are related to the structure of the brain - all this was practically completely unstudied and even now only a little more is known about it.
For these reasons, many outstanding psychiatrists of that time were primarily neuroanatomists and only secondarily -1 powerless from the fact that they could not fit their clinical observations into the picture of the anatomy and physiology of the brain known to them. Some have tried to overcome this barrier by theorizing about the psychological significance of brain structure; The German physiologist Max Verworn called such theories “brain mythology.” The division between morphological and physiological knowledge of the brain is aptly illustrated by the remark of a physiologist who, after listening to a histological report by Karl Schaffer, a famous psychiatrist and neuroanatomist, said: “These neuroanatomists remind me of a postman who knows the names and addresses of people, but has no idea what they do."
At the turn of the century, the state of affairs in psychiatry was characterized by a discrepancy between anatomical and functional knowledge. On the one hand, neuroanatomy and pathology were well developed, on the other hand, there was a reliable method for describing mental illness, but these areas were isolated from each other. A different situation existed with regard to a purely “organic” understanding of the nervous system. In a direction close to psychiatry - neurology - anatomical knowledge was successfully combined with functional knowledge. The localization of the centers of coordination of voluntary and involuntary movements was carefully studied. Disorders of such complexly organized actions as speech, grasping and walking were often correlated with both a disruption of the parts of the nervous system responsible for the innervation of the corresponding areas, and with a disruption of peripheral nerve connections between the central parts of the nervous system and the affected motor organs. In that
In a sense, neurology applied the principles of Morgani and Virchow, becoming a respected and precise medical discipline, while psychiatry remained a dark and unclear field.
At the same time, attempts to connect the brain with the psyche, and
psychiatry - with the physiology and anatomy of the brain remained a utopia and continues to this day
remain a utopian idea.
Virchow's principle in relation to mental illness was not as effective as in other areas of medicine. The vast majority of personality disorders - schizophrenic and manic-depressive psychoses - described by Kahlbaum, Kraepelin, Bleuler and other major clinicians could not be determined using a microscope. Careful histological examinations of the brain during autopsies of psychotic patients did not reveal any significant changes at the microscopic level. Thus, doctors were stumped. Why does the brain of a patient, whose external behavior and emotional reactions differ markedly from the norm, not reveal any consistent histological abnormalities even with the most thorough examination? A similar question has arisen in relation to many other psychiatric conditions, such as psychoneuroses and behavioral disorders. The first glimmer of hope for unifying knowledge about brain structure and mental disorders came when it was discovered that progressive paralysis, suspected to be a consequence of syphilis, leads to tissue damage in the central nervous system. When Noguchi and Moore finally proved the syphilitic origin of progressive paralysis, there was hope that psychiatry would eventually take its rightful place among other medical disciplines. And although it has been known for many years about the existence of structural changes in brain tissue in senile dementia and Alzheimer's disease, only the discovery of Treponema pallidum in the brain of a patient with progressive paralysis opened the way for etiologically oriented therapy.
In etiology, there is a generally accepted classical model: the disease syndrome arises as a result of dysfunction of an organ, which in turn is the result of damage to cellular structures, which can be detected at the microscopic level. Damage is attributed to various causes, of which the most important are: infection, that is, the introduction of microorganisms into the organ, as occurs with tuberculosis; exposure to chemicals, as in poisoning, and the effect of mechanical damage, as with fractures or bruises. In addition, aging - the degradation of any organism with age - is also considered an important causative factor of the disease.
At the beginning of the century, similar etiological views also prevailed in psychiatry. Concussions and bleeding due to pressure were examples of mechanical causation of mental dysfunction; alcoholism and other types of substance abuse served as examples of chemical etiology; and senile dementia is a specific condition expressed in the progressive degeneration of brain tissue, a result of aging. And finally, when Noguchi announced his discovery in 1913, syphiliticism
Nervous system disorders, especially progressive paralysis, characterized by profound personality changes, could act as counterparts to bacterial invasion of other organs, as, for example, in pulmonary tuberculosis.
Today a psychiatrist can walk with his head held high
head; he finally had the opportunity to offer the patient laboratory methods of diagnosis and treatment. Before the advent of Ehrlich's chemotherapy for post-syphilitic diseases, the role of the psychiatrist consisted of simple guardianship over the patient and, at most, careful monitoring of him. The therapy that previously existed in this area was either magical, like exorcism in the pre-scientific era, or completely ineffective, like electro- or hydrotherapy, so popular at the end of the last century and at the beginning of this one. Ehrlich's discovery of salvarsan contributed exceptionally to raising the prestige of psychiatry. As a real causal therapy, it began to satisfy all the requirements of modern medical philosophy. It was aimed at eliminating the identified specific cause of the disease, the pathogenic microorganism. It began to use a potent chemical substance designed to leave the body intact while destroying the pathogenic factor. Under the influence of this discovery, hopes grew, so that soon the entire field of psychiatry began to use methods from other medical fields of research and therapy. (The results of chemotherapy for progressive paralysis turned out to be less satisfactory than initially expected. The place of chemotherapy was subsequently taken by more effective pyrogenic therapy, and then by penicillin.)
Other important discoveries also offered bright prospects. Another classic example of causation organic treatment in a psychiatric condition - this is an explanation of the symptoms of mental retardation with myxedema by inhibition of function thyroid gland and the successful treatment of the disease with a thyroid transplant performed by Horsley (the operation was later replaced by the ingestion of thyroid extract).
In hyperthyroidism, chemical and surgical methods also influence mental symptoms. The example of these two diseases clearly shows that the endocrine glands influence mental processes in a certain way. Therefore, it was not unreasonable to hope that with the progress of biochemistry, especially with the development of deep knowledge about the complex interaction of the endocrine glands, the physiological causes of psychoses and psychoneuroses would be understood and this would make it possible to more effective therapy.
With the exception of a significant group of schizophrenic disorders, in which deep personality disintegration occurs without any noticeable organic changes, and also larger group psychoneuroses, psychiatry in the second decade of the century was able to become a full-fledged field of medicine, based, like other main fields of medicine, on pathological anatomy and physiology and using traditional methods of treatment. We will see, however, that the development of psychiatry took a different path. Psychiatry did not accept an exclusively organic point of view
vision. On the contrary, other areas of medicine began to adopt approaches that originally originated within psychiatry. This is the so-called psychosomatic point of view, and it proclaimed new era in medicine: the era of psychosomatics. It is interesting to try to understand how this happened in order to better understand today's trends in the development of medicine.
CHAPTER 3
THE INFLUENCE OF PSYCHOANALYSIS ON THE DEVELOPMENT OF MEDICINE
Despite such isolated successes as the explanation and treatment of progressive paralysis and myxedema by traditional medicine, most psychiatric conditions, schizophrenic psychoses and psychoneuroses, have stubbornly resisted any effort to squeeze them into a generally accepted framework. Many personality disorders, as well as mild emotional disturbances, came to be regarded as “functional” diseases, in contrast to progressive paralysis and senile dementia, which were called “organic” because of the presence of demonstrable structural changes in brain tissue. However, such a terminological distinction could not in any way affect the complicating circumstance, namely, that the disintegration of mental functions in schizophrenia was resistant to any type of therapy, both pharmacological and surgical methods, and at the same time did not lend itself to any explanations in line with traditional installations. Although the rapid progress in the application of laboratory methods to the rest of medicine was so promising that psychiatrists remained hopeful for
a definitive understanding of all psychiatric disorders in terms of anatomy, physiology and biochemistry.
In all centers of medical research, intensive attempts are being made to solve the problem of schizophrenia and other functional brain disorders from the point of view of... Research in histopathology, bacteriology and biochemistry continued until the 90s of the last century, when Sigmund Freud introduced a completely new method of research and therapy. It is generally accepted that the origins of psychoanalysis are the French school and the research of Charcot, Bernheim and Liebeau in the field of hypnosis. In his autobiographical writings, Freud traces the origins of his ideas under the influence of Charcot's experiments at the Salpêtrière and, later, the experiments of Bernheim and Liebeau in Nancy. From a biographical point of view, this picture is impeccable. However, from the point of view of the history of scientific thought, the beginning of the psychodynamic approach to mental illness Freud himself put it.
Just as Galileo was the first to apply the method of scientific reasoning to the phenomenon of the movement of the earth, Freud was the first to apply it to the study of human personality. Personality analysis or motivational psychology as a science begins with Freud. He was the first to consistently apply the postulate of strict determinism of psychological processes and established the basic dynamic principle of psychological causation. After he discovered that human behavior is largely determined by unconscious motivations, and developed a method for transferring unconscious motivations to a conscious level, he was the first to demonstrate the genesis of psychopathology
gical processes. With this new approach, the abnormal phenomena of psychotic and neurotic symptoms, as well as apparently meaningless dreams, can be understood as meaningful products of mental activity. Over time, his original views partially underwent some changes, but the main ideas were mostly confirmed by further observations. The most lasting among Freud's scientific heritage were the method of observing human behavior and the method of reasoning he used for the purpose of psychological understanding of the results of observation.
From a historical perspective, the development of psychoanalysis can be considered one of the first signs of opposition to the one-sided analytical development of medicine in the second half of the 19th century, the highly specific in-depth study of particulars and the neglect of the basic biological fact that the body is a single whole, and the functioning of its parts can only be understood from the point of view systems as a whole. Thanks to the laboratory approach to a living organism, a huge number of more or less interconnected parts of the organism were discovered, which inevitably led to a loss of perspective. The understanding of the organism as a complex mechanism in which each element interacts with another for some specific purpose was either ignored or declared too teleological. Adherents of this approach argued that the body develops due to certain natural causes, but not for any purpose. A machine made by human hands can, of course, be understood on a teleological basis; the human mind created it for a specific purpose. But man was not created by a higher intelligence - this is only a mythological concept, which modern biology has managed to avoid, arguing that the animal body should not be understood teleologically, but on a causal and mechanistic basis.
However, as soon as medicine, willy-nilly, took up the problems of mental illness, such a dogmatic attitude had to be abandoned - at least in this area. When studying personality, it is so obvious that the organism is in highest degree interconnected whole that it is impossible not to pay attention to it. William White put it in very accessible language."
The answer to the question: “What is the function of the stomach?” - is digestion, although it represents only a small part of the activity of the whole organism and only indirectly, which, of course, is important, correlates with its other functions. But if we undertake to answer the question: “What does a person do?”, we answer from the point of view of the whole organism, saying, for example, that he is walking down the street, or doing gymnastics, or going to the theater, or studying medicine, etc. e... If the mind is an expression of a general reaction, as opposed to a particular reaction, then every living organism must be characterized by mental, that is, general, types of reaction... What we imagine as the mind in all its boundless complexity, - this is the highest type of reaction to a living organism, historically having the same age as the most familiar bodily types of reactions to us...
"W i 11 a m W h i t e: The Meaning of Disease. Batimore, Wiiams & Wikins, 1926.
Thus, we can assert that personality expresses the unity of the organism. Just as a machine can only be understood from the point of view of its function and purpose, so a complete understanding of the synthetic unit we call the body is possible only from the point of view of the individual, whose needs are ultimately satisfied by all the parts of the body in their clear interaction.
Psychiatry, as the science of pathological personality,
opened the way for the introduction of a synthetic point of view into medicine. But psychiatry was able to fulfill this function only after the study of personality was taken as a basis, and this was the merit of Sigmund Freud. Psychoanalysis consists of an accurate and detailed study of the development and functions of personality. Despite the fact that the term "psychoanalysis" contains the word "analysis", its historical meaning lies not in an analytical, but in a synthetic approach.
CHAPTER 4
INFLUENCE OF GESTALT PSYCHOLOGY, NEUROLOGY AND ENDOCRINOLOGY
At the same time, of course, psychoanalysis was not only scientific direction, leading towards synthesis. A similar trend could be observed at the turn of the century in all fields of science. In the 19th century, development scientific methods came down to data collection; discovery of new facts has become main goal. But the interpretation and correlation of these facts in the form of synthetic concepts was treated with skepticism, perceiving them as irrational speculation or as a substitution of science for philosophy. In the 1990s, the tendency towards synthesis intensified, apparently as a reaction to an excessive psychoanalytic orientation.
The new trend towards synthesis has spread only to non-medical areas of psychology. There, too, the analytical approach traditional for the 19th century dominated. After Fechner and Weber introduced the experimental method into psychology, || Psychological laboratories began to appear, where the human psyche was dissected to its bones. The psychology of vision, hearing, tactile sense, memory, and will began to develop. But the experimental psychologist never even tried to understand the relationship of all these different mental abilities and their totality in the human personality. The Gestalt psychology of Köhler, Wertheimer and Koffka can be seen precisely as a counteraction to this particularistic analytical orientation. Probably the most important achievement of Gestalt psychologists was the clear formulation of the thesis that the whole is not equivalent to the sum of all its parts and that the system as a whole cannot be understood by studying its individual elements; that is, in fact, the opposite statement is true - the parts can only be fully understood when the meaning of the whole is clear.
Medicine developed in a similar way. Advances in neuroscience have paved the way for a broader understanding of the relationships between different parts of the body. It became evident that all parts of the body were connected, directly or indirectly, with the main center and acted under the control of this central organ. Muscles, as well as internal organs, the latter through the autonomic nervous system, communicate with higher
centers of the nervous system. The unity of the body is clearly expressed in the functioning of the central nervous system, which regulates both internal vegetative processes in the body and external ones related to interaction with the outside world. Central control is represented by the higher centers of the nervous system, psychological aspects which (in a person) we call personality. In fact, it is now obvious that physiological studies of the higher centers of the central nervous system and psychological studies of personality relate to different aspects of the same subject. If physiology approaches the functions of the central nervous system from the point of view of space and time, then psychology deals with them from the point of view of various subjective phenomena, which are a subjective reflection of physiological processes.
Another stimulus for the development of the synthetic direction was the discovery of the endocrine glands, the next step towards understanding the extremely complex interrelations of various vegetative functions of the body. The endocrine system can be considered as a regulatory system, just like the nervous system. If the regulatory influence of the central nervous system is expressed in the conduction of control nerve impulses along peripheral nerve pathways to various parts of the body, then chemical regulation carried out by the endocrine glands occurs by transferring certain chemicals with the bloodstream.
It is now known that the metabolic rate is mainly regulated by the activity of the thyroid gland, that carbohydrate metabolism is regulated by the reciprocal influence of pancreatic secretion
glands, on the one hand, and the hormones of the adrenal gland and the anterior pituitary gland, on the other, and that the main gland regulating the secretion of peripheral endocrine glands is the anterior pituitary gland. ;
Recently, more and more evidence has emerged that most of the functions of the endocrine glands are subordinate to the functions of higher brain centers, that is, in other words, mental life.
These psychological discoveries have enabled us to understand how the mind controls the body and how peripheral bodily functions in turn influence the central functions of the nervous system. The fact that the psyche controls the body is the most essential thing that we know about life processes, despite the fact that medicine and psychology neglect this fact. We observe this constantly, throughout our lives, from morning to evening. Our life as a whole consists of performing voluntary movements aimed at realizing thoughts and desires and satisfying subjective sensations such as thirst or hunger. The body, our ingenious mechanism, performs many complex and precise motor actions under the influence of psychological phenomena such as thoughts and desires. Speech, the most specific of all somatic functions for humans, simply expresses thoughts with the help of a subtle musical instrument, the vocal apparatus. We express all emotions through physiological processes; sadness corresponds to crying; fun - laughter; and shame brings a blush to the cheeks. All emotions are accompanied by physiological changes:
fear - rapid heartbeat; anger - more intense heart work, increased blood
34
pressure and changes in carbohydrate metabolism; despair-dde _ deep breaths and exhalations. All these physiological phenomena appear as a result of complex muscle interactions under the influence of nerve impulses going to the facial muscles and to the diaphragm in the case of laughter; to the lacrimal glands - in case of crying, to the heart - in case of fear and to the adrenal glands and cardiovascular system - in case of anger. Nerve impulses arise in certain emotional situations, which in turn occur when interacting with other people. Accordingly, psychological situations can only be understood from the point of view of psychology as the general reaction of the body to the surrounding world.
CHAPTER 5
CONVERSION HYSTERIA, VEGETATIVE NEUROSIS AND PSYCHOGENIC ORGANIC DISORDERS
The application of the above considerations to certain pathological somatic processes has led to the emergence of a new trend in medicine, namely “psychosomatic medicine”.
The psychosomatic view of medicine implied a new approach to the study of the causes of illness. As has already been noted, the fact that strong emotions affect somatic functions belongs to the sphere of our everyday experience. Each emotional situation corresponds to a specific syndrome of somatic changes, psychosomatic reactions, such as laughter, crying, blushing, changes in pulse, inhalation, etc. However, although these psychomotor processes relate to everyday experiences and do not have harmful effects, medicine until recently, little attention was paid to their detailed study." These somatic changes under the influence of strong experiences are transient in nature. When the emotion stops, the corresponding physiological process (crying or laughter, heartbeat or high blood pressure) is also inhibited, and the body returns to a state of balance.
The study of neurotics from the perspective of psychoanalysis has revealed that under the influence of long-term emotional disorders, chronic somatic disorders can develop. Such somatic changes under the influence of emotions were first observed in hysterics. Freud introduced the concept of “conversion hysteria,” when somatic symptoms develop as a reaction to chronic emotional conflicts. Such changes were noted in the muscles controlled by willpower and in the sensory organs. One of Freud's most important discoveries was that when an emotion cannot be expressed and released through normal channels through voluntary activity, it can become a source of chronic mental and somatic disorders. Whenever emotions are suppressed as a result of mental conflicts, that is, excluded from the field of consciousness and thus deprived of adequate discharge, they become a source of chronic tension, which is the cause of hysterical symptoms.
From a physiological point of view, the hysterical conversion symptom is close in nature to the usual one. One of the few exceptions is Darwin (59).
any voluntary arousal, expressive movement or sensory sensation. In hysteria, however, the motivating psychological impulse is unconscious. When we hit someone or walk somewhere, our arms and legs move under the influence of conscious motivations and goals. The so-called expressive movements: laughter*, crying, facial expressions, gestures - are based on simple physiological processes. However, in the latter case, arousal does not arise under the influence of a conscious goal, but as a result of emotional tension, released in a complex physiological way. In the case of a conversion symptom, such as hysterical paralysis or contracture, the “leap from psyche to somatic” is no different from the jump that occurs with any general motor excitation, such as voluntary movements, laughter or crying. Apart from the fact that the motivational psychological component is unconscious, the only difference is that hysterical conversion symptoms are highly individual, sometimes unique creations of the patient, invented by him to express his partially repressed psychological content. Expressive movements, such as laughter, on the contrary, are standard and universal (Darwin - 59).
There is also a completely different group of psychogenic somatic disorders affecting internal organs. Representatives of early psychoanalysis repeatedly tried to extend the concept of hysterical conversion to all forms of psychogenic somatic disorders, including also disorders related to internal organs. According to this point
In view, high blood pressure or stomach bleeding have a symbolic meaning similar to conversion symptoms. No attention was paid to the fact that the autonomic organs are regulated by the autonomic nervous system, which is not directly related to thought processes. Symbolic expression of psychological content exists only in the sphere of voluntary innervation (speech) or expressive movements (facial expressions, gestures, laughter, crying, etc.). Perhaps blush could also be included in this group. It is unlikely, however, that internal organs such as the liver can carry out the symbolic expression of ideas. But this does not mean that they cannot be influenced by emotional stress spreading through the corticothalamic and autonomic pathways. It has long been established that emotional influence can stimulate or suppress the functioning of any organ. After emotional stress subsides, somatic functions return to normal. When emotional stimulation or suppression of autonomic function becomes chronic and excessive, we explain this as “organic neurosis.” This term includes so-called functional disorders of internal organs, the cause of which is partly nerve impulses arising as a result of emotional processes occurring somewhere in the cortical and subcortical regions of the brain.

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