Psychosomatic Medicine 20:475-483 (1958)
© 1958 American Psychosomatic Society

Ego Mechanisms in Three Pulmonary Tuberculosis Patients

A Contribution to the Study of the Psychosomatic Process

¹ 25 East Washington St. Chicago 2, Ill.

The thesis of this paper is that certain changes in ego operations constitute a part of the chain of events whereby the loss of an object relationship is followed by a somatic illness. This is based on the observation of time correlations between integrating and distintegrating emotional forces, and remission and exacerbation of respiratory illness.

An hypothesis is advanced regarding the mechanism of connection between the state of ego integration and the physical illness. It is postulated that:

A. Susceptibility to respiratory illness in these patients is increased when there is what we consider psychologically to be ego depletion. Resistance to the physical illness is correlated with replenishment of ego energy from the narcissistic reservoir.

B. Two mechanisms whereby psychological integrative mechanisms may contribute to this energy depletion and restoration are advanced. These are:

1. In the first two patients the loss of a supportive relationship led to lowered selfesteem, hopelessness, and a distraught state, considered to be evidences of ego depletion, and also to breakdown of behavioral controls. The latter added to the ego depletion, and the process then became circular.

2. In the third patient the loss of a supportive relationship led to lowered selfesteem, hopelessness, feeling of lack of motivation or purpose for working, and lack of energy to work, considered to be evidences of ego depletion. Despite this depleted state, the patient continued the expenditure of great effort and became ill.