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Department of Immunology, Auckland City Hospital
Department of Psychotherapy, Auckland University of Technology Auckland, New Zealand School of Medical Sciences The University of Auckland Private Bag 92019 Auckland, New Zealand Clinic of Medical Psychology Department of Psychiatry and Psychotherapy Innsbruck Medical University |
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Over the last century there have been many reports of physical diseases that appear to be a somatic representation of an individual patient’s personal meanings or ‘story.’ In some, the somatic representation appears to be highly symbolic (Abrahamson, 1948; Alexander, 1950, 1960; Broom, 1997, 2000, 2002, 2007; Chiozza, 1998a, 1998b; Deutsch, 1959; Gottlieb, 2003; Griffith and Griffith, 1994; Groddeck, 1928; Hay, 1982; McDougall, 1989). Interest in
these phenomena peaked during the 1940-70 period (Gottlieb, 2003), particularly around the work of Franz Alexander (Alexander, 1950, 1960), which focused on a limited number of supposedly psychosomatic diseases, such as duodenal ulcer (Mirsky, 1958) and asthma (Knapp et al., 1970). In line with extant psychoanalytic theory, these diseases were characterised as somatic representations of core conflict states and psychological defensive
repertoires generic to each disease state. But interest in this work receded because of: the excessive reductionism involved (Blumenfield and Strain, 2006); the increasing identification of physical mechanisms for these conditions; more recent modelling of psychosomatic disorders in terms of trauma, dissociation, developmental blocks, and neural activation by passing cortical pathways and consciousness (Gottlieb, 2003); a general cultural movement
away from positivist notions of meaning to post-modern narrative-making; and the enduring general and medical acceptance of dualistic concepts of mind and body relationships. The result is that ideas of symbolic diseases have little traction in either modern medicine or psychoneuroimmunology (Broom, 2007). But, the reports cannot simply be dismissed, and they have important implications for understanding the relations of all disease with the
symbolic realm.