Psychosomatic Medicine 17:311-321 (1955)
© 1955 American Psychosomatic Society

Observations on the Role of the Mechanism of Depression in Some Patients with Disseminated Lupus Erythematosus

¹ Departments of Medicine and Psychiatry, the Johns Hopkins University, School of Medicine, Baltimore, Md.

In a psychiatric study of 14 patients with disseminated lupus, we have found that the threat of the loss of a significant personal relationship regularly provoked an exacerbation of the complaint of pain and disability. Disseminated lupus results in a restriction on physical activity which is a particularly severe threat to those persons who have made use of activity as a means of relieving anxious and depressed feelings.

The need for hyperactivity is an outgrowth of an early-life reaction to loss in the mother-child relationship in which passive longings are denied and hyperindependence develops. When confronted with life situations which revive this constellation of feelings, we observed a sequence of failing integrative efforts. These lead from a noticeable increase in activity and pressure of work with denial of affective changes, through depressed feelings, restriction of activity and development of symptoms of fatigue and joint pains, to an eruption of overwhelming overt anxiety. At this point, either a childlike demanding state appears or a grossly psychotic pattern emerges.

The effect of disseminated lupus in producing organic cerebral changes contributes to the disruption of ego integrative activity and acts as an additional anxiety-producing agent. The possibility that the tensions generated in the interpersonal conflict situation contribute to the tissue pathology of the disease is suggested as a subject for further investigation.