The Coming Age of Psychosomatics. Proceedings of the Twenty-First Annual Conference of the Society for Psychosomatic Research Held at the Royal College of Physicians, St. Andrew's Place, Regent's Park, London, N.W.1, 21st and 22nd November 1977

157 Pages·1979·3.96 MB·English

by  Malcolm Carruthers and Peter Mellett (Eds.)

THE SOCIETY FOR PSYCHOSOMATIC RESEARCH
THE SOCIETY was founded in January 1955. Our aims are (1) to promote the understanding
of psychosomatic relationships by providing a congenial forum for discussion by workers in the
various disciplines of medicine and its allied sciences, and (2) to encourage the presentation of
work nearing completion for critical debate.
Our purpose is to further the interchange of ideas among those with special experience in
the fields of social and clinical medicine, applied psychology, psychiatry, psychoanalysis,
biology, physiology and genetics, in the belief that such interchange will bring about a wider
understanding of the human organism in health and disease. The scope of our enquiries is wide:
it is the whole range of interaction between man, his environment and society, as it relates to the
production of illness.
Officers of the Society
1977-1978
President DR. E.STONEHILL
Vice-President DR. M. J. F. COURTENAY
Hon. Secretary DR. JEANHARRISON
Hon. Treasurer DR. P. WILLIAMS
Council Members DR. MARGARETCHRISTIE
DR. B.LASK
PROF. R.G. PRIEST
DR. P. G. MELi.ETT(ex-officio)
Communications to: Dr. Jean Harrison
Hon. Secretary
Department of Psychological Medicine
St. Bartholomew's Hospital
London EC\A ΊΒΕ, England
THE COMING AGE OF
PSYCHOSOMATICS
Proceedings of the Twenty-first Annual Conference of the
Society for Psychosomatic Research
held at the Royal College of Physicians
St. Andrew's Place, Regent's Park, London, N.W.I
21st and 22nd November 1977
Edited by
MALCOLM CARRUTHERS
The Maudesley Hospital, London
η η ri
PETER MELLETT
Horton Hospital, Surrey
PERGAMON PRESS
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First edition 1979
British Library Cataloguing in Publication Data
Society for Psychosomatic Research, Annual
Conference, 21st, London, 1977
The coming age of psychosomatics.
1. Medicine, Psychosomatic - Congresses
I. Title. II. Carruthers, Malcolm III. Mellen,
Peter
616.08 RC49 79-40438
ISBN 0-08-023736-3
These proceedings were published originally as
volume 22 number 4, Journal of Psychosomatic
Research, 1978 and supplied to subscribers as part of
their subscription.
In order to make this volume available as economically
and as rapidly as possible the author's typescript has
been reproduced in its original form. This method un-
fortunately has its typographical limitations but it is
hoped that they in no way distract the reader.
Printed by A. Wheat on & Co. Ltd., Exeter
ACKNOWLEDGEMENTS
THE PRESIDENT and Council of the Society for Psychosomatic Research wish to thank the
following for their kindness and assistance in connection with this Conference: The Royal
College of Physicians, The British Post-graduate Medical Federation, The Ciba Foundation,
The Horton Hospital Department of Occupational Therapy, CIBA-Geigy Ltd. and Sandoz
Products Ltd.
vi
INTRODUCTION
With its 1977 Annual Conference, the Society for Psychosomatic Research celebrated
a 21st anniversary, a "coming of age" in the old-fashioned sense of the term; it
was natural therefore to consider what the future might hold for research based on
the psychosomatic approach.
As with the previous year's Conference, we adopted a "womb to tomb" chronological
sequence; many present at the last session may have wondered if they had had a
glimpse even beyond those confines.
Having established at the 1976 Conference that it was possible to recall events
going as far back as birth, if not earlier, it appeared logical to examine these
early life events to see what help might be given to those who had slipped through
the preventive net, with which that Conference was particularly concerned. Re-
living painful events, with release of the appropriate affect, as Freud put it,
even if it did not erase the memories, could at least reduce their disturbing
power. Dramatic remissions of psychosomatic symptoms were described with this
treatment. There were alsc considerable implications for the future development
of radical treatment, if the first few breaths of life were seen to be associated
with profound vascular changes or painful affects,so that breathing behaviour
patterns inappropriate to later life were "conditioned" to occur with and there-
fore to be revived by bronchial capillary dilatation (of allergic or infective
origin)or life experiences giving rise to depression, anxiety or ill-expressed
anger.
Minimal brain damage at birth is probably far more frequent than is generally
recognised. The damage from this round in the fight for survival is, however,
usually insufficient to cause obvious neurological defects, though it may well be
that more refined methods of testing, particularly of psycho-motor skills and
linkage and dominance of the cerebral hemispheres, may make us much more aware of
the need to find ways round both old and new brain lesions. These neglected
matters were discuesed in a session, in which the stages were reviewed, whereby
pre-natal and post-natal influences shape the individual's psychosomatic future.
This led inevitably to reshaping of approaches to treatment.
The possibility of relieving pathological states of the psyche and their con-
comitant somatic abnormalities by physical means was next considered. After
many years of neglect, the principle that physical exercise and fitnese can also
contribute to mental well-being is being explored with the rigour that modern
scientific medicine demands. It appeared more difficult to quantify the beneficial
effects of releasing emotion by physical manipulation, though devotees of this
approach will happily testify to its effectiveness.
For those who cannot or will not use physical means of relieving emotional distress,
there is a vast and bewildering array of psycho-pharmacological armour which may
give protection against the slings and arrows of outrageous fortune, past, present
and future. Knowledge of the mechanism of action of these increasingly prescribed
drugs gives fascinating insights into the ways in which disturbances of brain
chemistry can influence both mind and body. It was appropriate that such matters
should be discussed at this Conference.
Similarly more detailed knowledge of the physiological consequences of behavioural
responses is likely considerably to modify our approach to treating somatic
disorders associated with mental disturbance. Probably one of the reasons why
the medical profession in general is paying greater attention to stress-related
vii
viii Introduction
disorders is the efficacy of stress-blocking drugs, particularly the "beta-
blockers" , in treating both the obvious somatic manifestations of anxiety as well
as physical conditions, in which a psychosomatic element has been suggested,
including coronary thrombosis and hypertension.
It will be interesting to see whether non-drug methods for voluntary control of
the "involuntary" nervous system, such as Yoga, "Autogenic" training and biofeed-
back techniques, in which people take an active part in maintaining and restoring
their own health, gain greater favour than the more passive drug orientated
approach, which has predominated in medicine, though not in this Society since
it came into existence 23 years ago. Similarly, there has been great emphasis
on the influence of diet on our physical health, particularly in relation to
cardio-vascular disease, with little concern for the effect diet may have on
mental health. This Conference provided food for thought in this latter
connection.
Even if the preceding sessions had not caused a great deal of philosophical
speculation, looking at the many body rhythms governed by what was once regarded
as the seat of the soul, the pineal gland, should certainly have had this effect.
Hans Selye has described this as being the generation of the "stress seeker".
It was shown that this search may well lead the long distance traveller to
disrupt his pineal calendar and produce a wide variety of potentially damaging
disturbances of delicate body rhythms. The importance of having more knowledge
of the ways in which these disturbances might be minimised was clearly demonstrated.
The final session of the Conference closed the birth-death cycle with a profound,
almost mystical, psychedelic experience, which is impossible to describe adequately
within the limits of these proceedings. It did, however, emphasise the need for
the wise physician to maintain a continuous re-appraisal of the psychosomatic
approach to Man. This pursuit would lead not only to better care for patients,
including the dying, but to awareness of the life of Everyman as potentially full
of struggle, grandeur, appalling suffering to the point seemingly of total defeat
and ecstasy extending beyond the furthest stars.
Malcolm Carruthers
Peter Mellett
London, June 1978.
Journal of Psychosomatic Research, Vol.22, pp. 227-238.0022-3999/78/0801-0227 $02.00/0
©Pergamon Press Ltd. 1978. Printed in Great Britain.
TREATING PSYCHOSOMATIC DISORDERS RELATED TO BIRTH TRAUMA
Frank Lake MB MRCPsych DPM DTM
Clinical Theological Association
Lingdale, Weston Avenue
Nottingham NG7 ^BA
SUMMARY
This paper summarises the experience of the author from 195*+ to 1970 in
facilitating the reliving of peri-natal experience principally using LSD 25 as
abreactive agent.
From I97O-I977 the method has been simplified utilizing the group context,
simulating the peri-natal situation and by the use of deep breathing within
certain limits.
The psychosomatic symptoms which yield to, or may be modified by the reliving of
peri-natal distress are those which occur in relation to certain depressive
syndromes, phobias (especially claustrophobia and agoraphobia) the obsessional
neuroses and certain of the roots of paranoid, schizoid, hysterical, homosexual
and psychopathic personality disorders.
She course of migraine, and, in the experience of some workers, asthma and epilepsy
is modified by peri-natal recall. Atopic dermatitis can remit dramatically.
Peri-natal recall points to the origins of unilateral facial and bodily pains,
1
chronic sinusitis and otitis, and some rarer conditions such as 'foot-tapping
and Gilles de la Tourette's syndrome. Interesting connections between birth
trauma and the rheumatic diatheses should be pursued - as should those between
severe birth compression and subsequent chorea and disseminated lupus erythematosus.
1
Birth •primalling (i.e. reliving peri-natal experience) may have a hypotensive
effect.
Stress at birth affects the alimentary tract; gastric duodenal and intestinal
syndromes can be beneficially modified by connecting up the sensations, emotions
and relationships of the original distress, before, during and after birth.
227
228 Frank Lake
TREATING PSYCHOSOMATIC DISORDERS RELATED TO BIRTH TRAUMA
Frank Lake M.B., M.R.C. Psych., D.P.M., D.T.M.
Lingdale, Weston Avenue, Nottingham. NG7 4BA
My task has been greatly lightened by your allowing me to assume that
you, as members of the Society for Psychosomatic Research, are open
to this somewhat novel concept that perinatal injury ^s a causal
factor in certain psychosomatic disorders. However, I do not want to
presume upon that permission and intend to draw together the kinds of
clinical experience which go to show that birth trauma does, at times,
provide that degree of severe pressure or tension which, acting upon
those parts of the nervous system which are fully functioning and
competent at birth, triggers off the mechanisms of stress.
It seems axiomatic that it is those organs and functions which
are fully functioning and competent at birth which become involved in
responding to and registering the injury. These are, of course the
visceral anabolic functions subserved by the visceral autonomic ner-
vous system, the endocrine glands and their secretions, and some primi-
tive muscular actions and joint functions. The skin as an organ can
come in for some rough handling during birth. Drawing these together,
you will recognise that we are already speaking of those structures
which are most affected by psychosomatic disorders. Genetic factors
and constitution must determine which diathesis is activated by this
life-or-death struggle. Whether the responses evoked are those we
associate with Cannon or Selye, both can be mobilised at this time.
Different perinatal emergencies lead to severe specific stresses of
shorter or longer duration.
This stress reaction generally subsides when the emergency is
over, but if it has been so severe as to demand splitting off from
consciousness and repression, then by definition it remains latent.
In later years, similar pressures and tensions of living are per-
ceived as evoking the return of the trauma, as it was in the begin-
ning. Added to the normal body-mind responses to present trouble,
resonance with the archaic element of birth injury triggers off
identically the same somatic sensations and psychological emotions as
at the beginning. All the specific defensive reactions that were
originally aroused and recorded occur again. But whereas, on the
first time round, the end of the birth process brought about a mea-
sure of demobilisation of those defenses, now, the common enough
perpetuation of life stress means that no demobilisation is ordered.
The mistaken sense that the perinatal injuries and the defensive
reactions to which they gave rise are still relevant and have to be
faced again in the present, guarantees the chronicity of the disorder.
If we find this hard to accept, we can perhaps look on either
side of the psychosomatic phenomena, to the psychological on the one
hand and to the purely neurological on the other.
Treating Psychosomatic Disorders Related to Birth Trauma 229
Otto Rank (1924) described the trauma of birth as the first
experienced anxiety. He saw it as the prime source material for all
the neuroses and character disorders. It was, he claimed, the origi-
nal emotional shock underlying all personality dysfunction. He
affirmed that *we have recognised the neuroses in all their forms as
reproductions of, and reactions to, the birth trauma.' If, as Rank,
Fodor (1949), Winnicott (1958) and many others have reported, diffi-
cult births leave emotional scars, do they also leave physical scars?
Ten years ago, the work of H.F.R. Prechtl (1967) in Groningen in
the Netherlands showed that obstetrical complications carry a high
risk of neurological damage to the surviving infant. Specially
detailed neurological examination of the new-born indicated that
those who scored high on a rating for obstetrical complications
showed that 'besides handicaps due to pre-natal and perinatal brain
damage, minor brain dysfunctions, undramatic from the clinical neuro-
logical point of view, may lead to severe problems in the life of
children and their parents. The available data, Prechtl reports,
'are alarming', particularly the finding that these small neurologi-
cal deficits are not healed. They were still present 2 -4 years
later, in 73% of 150 children in whom they had been found on post-
natal examination. A follow-up at aged 8 'showed a similar picture'.
Since Prechtl is still actually publishing 10 years later he may well
have established whether these definite neurological signs of birth
damage are still unchanged at 18. Later this morning we look forward
to hearing Peter Blythe on Minimal Organic Brain Dysfunction, and the
steps he is taking to deal with it.
You may be aware of the work done by Paul Baken (1975) in
Simon Fraser University in Vancouver, showing that the syndrome of
stammering, dyslexia, and left-handedness relates more closely to a
history of traumatic births, with violent pressure over the left
cranium and the subjacent left hemisphere, and with anoxia during the
delivery, than it does to any genetic factors that could be offered
to account for it. Twice as many left-handed or ambidexterous stu-
dents had stressful births, such as multiple, premature, Caesarean,
breech or prolonged birth, or breathing difficulty, than in the
right-handed group. 'Handed deviation by itself appears to be the
most prevalent and benign result of birth stress,'
Some months ago I had what seems on the face of it to be strik-
ing confirmation of this, and of the effectiveness of reliving the
birth injury in reversing what may well be an ongoing physiological
inhibition of function and not an organic pathology or scarring.
A final year medical student came on one of our three day growth
workshops to work on some emotional problems which need not delay us.
This called for a reliving of an exceedingly traumatic birth during
which severe pressure developed over the left parietal area of the
fetal skull as it was impacted in the bony pelvis. She was able to
make full contact with this immense pain and bore it through to the
end. Six weeks later I had a letter from her written in an unfami-
liar italic handwriting. She reported that shortly after returning
home she had begun to feel a strong desire to use her right hand for
writing. The inhibition which had been strong throughout childhood
and had led to her using the left hand for writing had undoubtedly
lifted. Her own explanation may well be correct, that the original
severe cranial pressure had led to some inhibition of function in the
subjacent left hemispherical cortex. The repressed pain had pro-
longed the effect. De-repression through efficient primal work had
ended that inhibition.
It seems that, on the one hand, the psychological and on the
other hand, the somatic results of birth trauma can be shown to
230 Frank Lake
persist on into later life. The intermediate hypothesis, that this
is also true of the psychosomatic disorders, in which the two are
indissolubly combined, would not seem to be inherently unreasonable.
Perinatal Events Emerge in Psycholytic Therapy
It was when I first began to use LSD 25 in psychotherapy,
23 years ago, that my attention was drawn to the possibility that
birth trauma could be vividly relived. In 1954, Dr. James Valentine
my Superintendent at Scalebor Park Hospital, asked me to work on a
new drug which was said to help alcoholics. We had already formed
an AA group in the hospital after seeing the work of Dr. Max Glatt
at Warlingham. After spending some time with Dr. Ronald Sandison,
who had introduced LSD at Powick, Dr. Valentine freed me from most
other duties and for two years I was looking into the usefulness of
LSD 25 in psychotherapy.
What I was not prepared for was the frequent reports by patients
that they were reliving troublesome births. I understood neurolo-
gists to say that the nervous system of the baby was so undeveloped
that this was out of the question. I relayed my incredulity to my
patients, but they insisted on continuing my education. A number of
cases emerged in which the reliving of specific birth injuries, of
forceps deliveries, the cord round the neck, of a stretched brachial
plexus, of uterine inertia and various other dramatic episodes were
so vivid, so unmistakable in their origin, and afterwards confirmed
by the mother or other reliable informants, that my scepticism
wavered. At that time I had news of an international conference of
psychiatrists working with LSD, reporting the reliving of birth
trauma so frequently that the evidence became overwhelming.
It is my friends among the obstetricians who have been most
impressed by what they have seen, remarking on the accuracy of the
movements of the patient, having deliberately regressed to babyhood,
the rotation and extension exactly to the correct degree, the
sequence of pressure points and the typical timing of the contrac-
tions. If they have hitherto imagined that babies have no feelings
at this time, nor any record of them, this proves to be a very
chastening experience. It is the clients' (not all are patients)
own certainly that this is a recapitulation of their own actual birth
which gives them the courage to relive, with relatively little fear,
a sequence of physical sensations and emotions which have hitherto,
when they presented themselves in conjunction with later life crisis,
terrified them. To have the origin of such lifelong terrors at last
in context robs them of their power to make a person feel that such
an irrational onslaught of vertex headache and much else must be
madness.
The therapeutic effect is proportional to the completeness of
the reliving. These memories extend back into intra-uterine events
throughout the pregnancy, such as threatened miscarriage, attempted
abortion, sudden emotional shocks and griefs and being in the
mother's womb when a land-mine fell upon the house. Frequently
these have been quite inexplicable to the patient until, with remark-
able correspondence as to detail, a mother has, for the first time,
shared with the son or daughter the sad fact of pre-natal happen-
ings which she had hoped never to need to think of again.
But you have not asked me to speak in a general way about the
impressive list of disorders which are related to perinatal events,
such as claustrophobia and many other phobias of life and death,
which affect both mind and body and are, in that sense psychosomatic.
I take it that you wish me to confine my observations to the dis-
orders commonly classed as psychosomatic.