Psychosomatic Medicine 21:218-227 (1959)
© 1959 American Psychosomatic Society

The Ego and the Psychosomatic State

Report of Two Cases

¹ Psychiatry, University of Illinois College of Medicine, and Clinic Associate, Chicago Institute for Psychoanalysis

From observations of the transference neuroses of two patients, data has been obtained from two frames of reference, one dealing with psychic integration and the other with somatic dysfunction. As a consequence it has been possible to make a temporal correlation between the state of ego integration and the appearance or remission of a somatic symptom.

Migraine, hypertension, and peptic ulcer were seen to be associated with a well defended state of psychic equilibrium, whereas asthma occurred when the ego seemed to have lost its unity and organization.

Rather than viewing the specific drives and conflicts attendant to them, or the symptoms in terms of their defensive or tension discharge potentials, psychoeconomic shifts were correlated with ego integration. Since different ego states can be associated with somatic symptoms there must be a complex relationship between a variety of factors rather than any single dynamic pattern.

In this paper, the object relationship of the transference neurosis and the stability of the ego defenses were considered as variables, relevant to the state of integration that determined the level (primitive or mature) at which the ego would function. From this material it is evident that tension was, at times, handled by primitive ego systems when other parts of the ego were defensively adjusted to reality.

The single affect consistently present was that of anger. However, since this study does not purport to investigate specific drives, it must be stressed that anger is not being considered on an instinctual basis. Angry tension is considered a sign of a disturbed homeostasis reflected in both psychic and visceral systems. Its origin certainly includes the frustrations and vicissitudes of early development.

Disequilibrium was reflected in the particular ego system handling the anger, in terms of behavioral aberrations and level of control, or in a somatic dysfunction. I believe the data are consistent with the thesis that frustration from failure of higher ego systems to achieve instinctual gratification in relation to objects, led to the development of libidinal and aggressive tensions that disrupted the integration of the lower, visceral, ego systems and contributed to the somatic syndrome. It is apparent that many factors rather than any single specific one, could contribute to this result.

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