Posts Tagged ‘Psychosomatic Illness’

Psychosomatic Medicine and Contemporary Psychoanalysis

Psychosomatic Medicine and Contemporary Psychoanalysis

Graeme J. Taylor

Madison, CT, International Universities Press, Inc., 1987. 391 pp.

Psychoanalysis is often criticized for not keeping up with advances in modern medicine. In an attempt to expand one area for development, Graeme Taylor has shown how contemporary thought in psychoanalysis can provide a new disease model for psychosomatic illness. Taylor’s review is meticulously researched and presented and provides a logical and relevant basis for further work. Most notable is his clear presentation of a psychobiological perspective, integrating behavioral and neurobiological research with object relations theory.

Taylor begins with a historical review of psychoanalytic approaches to psychosomatic illness, suggesting that the latter grew out of the former. Early studies tried to discern a personality type which correlated with classic psychosomatic illnesses, such as asthma and hypertension. Franz Alexander regarded conflict and dependency as correlates of illness. In the 1950-s and 60s, disillusionment with psychoanalytic approaches led to studies which looked at stress and bereavement in generating a susceptibility to illness. Work along the lines of Hans Seyle’s general adaptation syndrome largely replaced psychoanalytic research during this period. To counter this perception, Taylor refocuses discussion on the more recent notion of “alexithymia,” a clinically derived concept which he defines as “a specific disturbance in affective and symbolic functions which renders [the] communicative style sterile and colorless.” According to Taylor, this term has reintroduced discussion of the role of psychoanalytic therapy for psychosomatic illness. In his opening chapters, Taylor clearly presents the successes and failures of each of these developments along with numerous illuminating cases.

In Parts II and III, Taylor discusses current research in object relations theory and neurobiology, respectively. The mother-infant relationship, which he describes as a regulatory factor in the child’s homeostasis, is shown to be highly relevant for research purposes. Animal studies have linked separation from the mother to variations in heart rate, sleep, growth, and thermoregulation. Recent attempts to create bridges of thought between neurobiology and psychoanalysis are discussed with respect to dream theory, and here the author seems to stray. He provides an extensive review of neurobiological studies on sleep and dreaming and ties in early psychoanalytic theory, but he does not pursue the issues sufficiently. Little is said about how sleep research — which has become the most popular area of mind-brain discussion — can bridge enormous epistemological dilemmas between psychoanalysis and neurobiology. Moreover, how is this research relevant to psychosomatic illness? Taylor’s point here is elusive and leaves too much extrapolation to the reader.

Gathering together a rich history of research and theorizing on psychosomatic illness, Taylor approaches the last chapters stressing the potential contribution of object relations theory. As stated above, an understanding of the mother-infant bond, taken here as the most original interpersonal relationship, is crucial for studying predispositions to illness. A truly biopsychosocial approach to psychosomatic illness can only gain from such an understanding, and psychoanalysis is one logical tool of study. Although the author’s overall work is successful in defining a role here for psychoanalysis, he falls short — despite a gallant effort — in establishing a clearly “new” model for disease. He has merely pointed in one direction and provided numerous signposts.

The groundwork for any psychobiological or biopsychosocial model is difficult to construct, because there are endless considerations from each direction. Despite this fact, Taylor has done a masterful job in bringing together many diverse threads of research, thought, and theory. Consequently, he has defined a unique and viable role for psychoanalysis in the study of psychosomatic medicine.