Psychosomatic Medicine 2:468-486 (1940)
© 1940 American Psychosomatic Society

An Analyzed Case of Essential Hypertension

¹ Detroit, Michigan

A case of essential hypertension has been analyzed and reported. In addition to hypertension, the patient suffered from seminal pollutions, ejaculatio praecox, anxiety, a cardiac neurosis accompanied with precordial distress, tachycardia and extra systoles. The analysis was terminated after the patient had remained symptom-free and well for over two months.

This conflict situation showed the classic picture recently described by Saul, published in the American Journal of Psychiatry, Vol. 95, May, 1939, No. 6, namely: a masochistic submissive and an orally dependent attitude towards a dominating mother, leading to a masochistic submissive attitude to a rigid superego and, homosexually, a deep attachment to the parent of the same sex. Further, there developed a chronic, unsuccessful, unsatisfied rebellion and hostility in protest against this submission. The rebellion and hostility were conscious, or near to consciousness, but yet not expressed directly because of fear of loss of love. The masochistic homosexual submissiveness was not conscious and bitter hostility opposed making it conscious in the analysis. Another prominent feature was excessive fear of heterosexuality, which was to some extent indulged, despite the anxiety. The crucial point for the hypertension seemed to be the hostile rebellion against the masochistic submissiveness with consequent anxiety.

This male patient was also masculine-looking, used sexual promiscuity and alcoholism as outlets and showed the chronic rebelliousness particularly in relation to his superior in his work situation.

The evidence in this case, then, suggests that this patient's hypertension may be connected with long-continued repressed hostility and rage, with the consequent production of constant conflict which the individual can neither escape nor solve. This would be in accord with findings reported by others. Therefore, in the condition of essential hypertension too, as Virchow has aptly stated in his dictum: "We must treat not only the disease, but also treat the patient." Such treatment necessarily involves an evaluation of the patient's personality and emotional development, seen in historical perspective.

Note:

Presented before The Detroit Society of Neurology and Psychiatry. September 28, 1939.