Mostly in the Mind

Half the people who call on doctors are sick in mind as well as in body. To describe their trouble, doctors now use the word psychosomatic (from the Greek psyche, mind, and soma, body). Last week a top-rank woman practitioner of psychosomatic medicine, Dr. Flanders Dunbar of Columbia University's College of Physicians and Surgeons, published a fascinating book on the subject (Mind and Body; Random House; $3.50).

Psychosomatic patients do not just imagine their ailments, Dr. Dunbar points out; they may be seriously or fatally ill of real diseases. An upset mind, she says, can actually bring on or aggravate heart disease, diabetes, stomach ulcers, asthma, tuberculosis.* Some Dunbar observations:

"Sir William Osler, probably the greatest medical teacher who ever lived, once warned his profession that the fate of the tubercular depended more on what they had in their heads than on what was in their chests. ... A germ or a peculiar condition of body cells is [not] the sum and substance of disease."

Lovesick Ladies. The Victorian novelists, Dr. Dunbar thinks, were pretty "realistic" after all: "Their prim and prissy heroines succumbed in droves to an epidemic of ladylike behavior. Disappointed in love or deprived by the malignity of fate of some adored object, they went into gentle declines and perished with immense propriety. ... A great many victims of tuberculosis today are doing the same. . . . They are those baffling cases for whose ailments no thoroughly sound explanation can be given in terms of their lungs alone."

The history books, Dr. Dunbar hints, are full of examples of psychosomatic illness. British Prime Minister William Gladstone developed a "diplomatic cold" whenever he faced a difficult or distasteful debate. Elizabeth Barrett, browbeaten daughter of a tyrannical father, was a bedridden invalid for 20 years--and was cured almost overnight when, at the age of 40, she met and married Robert Browning. In the Ode to a Nightingale, observes Dr. Dunbar, John Keats wrote a perfect, succinct description of a psychosomatic patient: "I have been half in love with easeful Death."

Unhappy Children. Like most psychiatrists, Dr. Dunbar looks for the roots of psychosomatic illness in an unhappy childhood: "There is such a thing as emotional contagion. The youngest infant can be infected with fear or anger or disgust or horror even more easily than with the measles." Infected with such fears, he grows up unusually susceptible to disease and accidents (forms of escape or self-punishment).

Some 80% of all accidents, Dr. Dunbar believes, have a neurotic basis. Many of them show a common pattern: a timely fracture that extricates the victim from a crisis.

Diseases, too, fall into characteristic psychosomatic patterns for Dr. Dunbar. Diabetics are generally spoiled and jealous as children, and develop deep-seated sexual conflicts. Heart patients are often tense, hard-working and ambitious. People with asthma and other allergy diseases tend to have suppressed sex desires.

In treating psychosomatic patients, says Dr. Dunbar, the problem is to "lighten [the patient's] self-imposed sentence."

* Psychosomatic medicine superficially resembles, but is not to be confused with, Christian Science's mental healing. Christian Science's Founder Mary Baker Eddy, unlike the psychosomatists, held that illness is unreal, and disappears when the mind, stripped of error and evil, discovers God's reality.

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