Psychosomatic Medicine 7:234-240 (1945)
© 1945 American Psychosomatic Society

Eighth Service Command Postgraduate Medical Education

Neuropsychiatric Case Report

A typical case or psychogenic headache in an otherwise healthy soldier is reported. Presenting symptoms and history contain characteristic psychic and somatic components. From the transference relationship and the material presented, the symptom-complex was recognized as due to an unresolved emotional conflict. The soldier's family history and personality developmentrevealed this to be ambivalence toward his father, toward whom he was unconsciously driven to express hostility. This was accomplished through a compromise symptom-formation. Somatic symptoms diminished intensity as the emotional content of the soldier's problem was made clear to him.

The soldier's growing awareness of the underlying motivation aroused resistance in the form of flight for relief on the somatic level. The acceptance of surgery exemplified the typical wishful need to find the consciously acceptable support that a somatic disease offers. It can be surmised that the soldier's rejection to the psychiatrist in seeking surgical relief and then return to the psychiatrist was an acting out the basic ambivalence he felt toward his father. The return to the psychiatrist, while in part due to the need to seek relief, was motivated by the unconscious need to discharge the guilt feelings growing out of the expressed hostility. This was again observed as the soldier's resistance took the form of an intense need to return home to relieve the ill father of the business responsibilities. In so doing, he no longer felt the the inner threat that he would be in some way responsible if the father were to die and thus his ego was strengthened in repressing the unconscious hostility. The displacement of the conflicting emotions from the somatic complaints into this resistance clearly indicates that the underlying force produces the somatic complaints as defensive compromise. The form of resistance also was serve the purpose of obtaining secondary gain by separation from the service. The evident neurotic motivation of the somatic symptoms and the secondary gain made it necessary to refuse consideration for either a furlough or a discharge, if therapeutic assistance were to be given the soldier.

The threat to the already critical home situation given by the brother's accident did not alter the fundamental neurotic pattern. However, it admirably lent itself for further rationalization of this defense. The reality situation, nevertheless, demanded consideration on its own merits, and in this sense the soldier was shown that his request to return home would be evaluated in terms of the real economic situation at home. When he was shown the lack of medical basis for discharge together with the disapproval of his request for a dependency discharge, there appeared to result sufficient gratifying relief for his guilt, so that he was able to project onto the Army the responsibility for his failure to relieve his father. He appeared to have thus made a readjustment wherein the conflict became more quiescent and he suffered less from somatic symptoms and anxiety. The therapeutic processmade it possible for the soldier to relieve a sufficient degree of the emotional disturbances arising from his conflict to be able to make a healthier adjustment, which allowed him to function as an efficient soldier.

The soldier's problem, which on first glance would appear to be of somatic origin, was actually found to have emotional forces as its cause. Psychotherapy made it possible for the soldier to recover from his acute maladjustment and to continue to function on a constructive military level. This was found to be practical within the limitations inherent in the Army framework.

Note:
This meeting, held in Detroit on October 25, 1944, was planned for obstetricians and pediatricians for the purpose of re-appraising present-day practices in the care of newborn infants.