Psychosomatic Medicine 18:150-158 (1956)
© 1956 American Psychosomatic Society

Process in Psychosomatic Disorders

¹ Departments of Medicine and Psychiatry, University of Rochester School of Medicine and Dentistry, Strong Memorial Hospital, and Rochester Municipal Hospital, Rochester, N. Y.

I have presented some ideas for consideration in viewing the human organism; ideas which have developed from observation of somatic and psychological manifestations in patients with lymphomas and leukemias. These patients were studied in a general hospital influenced by the more comprehensive concepts of human biology fostered by John Romano.15 These ideas have proven of use in better understanding process in psychosomatic disorders. They are presented with the assumption that they may be useful to the reader, but with awareness that their utility even for myself may be only transient.

The human organism is viewed as a number of systems or levels of organization such as the cell, the interstitial tissues, the gastrointestinal tract, or the mental apparatus, among many others. The total organism functions without disease as long as each system, in part autonomous, maintains its specific function and appropriate boundary interaction. Manifestations of pathology or dysfunction in any system represents dysfunction in that particular system and cannot be assumed to represent or mean dysfunction in another system.

While organ systems may be interrelated and profitably classified in a diversity of ways, any particular classification is not pursued here. It is only suggested that consideration of an umbilical level of organization or stage of growth is of value in comprehension of certain psychosomatic phenomena.

The apertural characteristic, at times described as an attribute of one system or another, is emphasized as a property of all organ systems.

Such conceptions require consideration of boundaries and what is called the environment. It is pointed out that the environment to the organism and the outside world to the observer are not synonymous. During development there is change in the peripheral environment to the organism even though there may be no change in the outside world to the observer. The boundary of interaction of each level of organization constitutes the environment of that level of organization and each such boundary of interaction has been at a stage of growth, the external environment to the whole organism. This means that a boundary, an environment, and a level of organization may be morphologically the same but varying with time, function, and frame of reference. It is further suggested that an attribute of the human organism is the ability to change its environment; that is, to focus on the environments available. These are multiple and may be classified as internal environments, intermediate environments, external environments, and characterized respectively as physiological, psychological, and social.

In the "understanding of man in process with environment" appreciation of the dynamic attributes of the organism, man, is no more or no less necessary than appreciation of the lability of his environment. This brings us back to where we began, to L. J. Henderson who expressed somewhat the same ideas over 40 years ago in The Fitness of the Environment and who was perhaps the first to view biological phenomena with the currently popular transactional approach.