(01/22/1891, Bucharest - 03/8/1964, Palm Springs, USA) - psychoanalyst.
Biography. At first he carried out work on studying the physiology of the brain with F. Tang. Then he underwent educational analysis with E. Simmel. In 1932 he emigrated to the USA. From 1932 to 1956 - head of the Psychoanalytic Institute in Chicago. Since 1952, professor of psychiatry at the University of Illinois. Since 1956 - director of the psychiatric clinic at Mont Sinai Hospital in Los Angeles. One of the founders of the journal "Psychosomatic Medicine".
Research. He studied the problems of the psychoanalytic theory of neuroses, explaining their occurrence as a violation of self-control and criminal psychology. One of the pioneers of psychosomatic medicine. Deduced the main psychosomatic diseases from typical human conflicts. Showed that prolonged emotional stress is associated with the development of diseases such as stomach ulcers, hypertension, asthma, colitis, arthritis.
Essays. Psychoanalyse und Gesamtpersonlichkeit. 1928;
Der Verbrecher und seine Richter. 1929;
Roots of Crime. 1935;
Our Age of Unreason. 1942;
Psychosomatic Medicine. 1950;
The History of Psychiatry. 1966;
Psychosomatic Specificity. 1966
ALEXANDER FRANTZ
01/22/1891, Bucharest - 03/8/1964, Palm Springs, USA) - American psychoanalyst of Romanian origin. In 1932 he emigrated to the USA. From 1932 to 1956 - head of the Psychoanalytic Institute in Chicago. Since 1952 - Professor of Psychiatry at the University of Illinois. Since 1956, he has been director of the psychiatric clinic at Mont Sinai Hospital in Los Angeles. One of the founders of the journal Psychosomatic Medicine. He studied the problems of the psychoanalytic theory of neuroses, explaining their occurrence as a violation of self-control and criminal psychology. He was the first to deal with the problems of psychosomatic medicine. He saw the main causes of psychosomatic diseases in typical human conflicts. He showed that prolonged emotional stress causes the development of diseases such as stomach ulcers, hypertension, asthma, colitis, and arthritis.
Name: Psychosomatic medicine. Principles and practical application.
Franz Alexander, Mogilevsky S.
The year of publishing: 2002
Size: 1.29 MB
Format: doc
Language: Russian
The presented book by Franz Alexander in translation “Psychosomatic Medicine. Principles and Practical Application” consists of two basic parts, the first of which examines the general principles of the issue covered, presents the development and principles of various areas of psychiatric science at the present stage, the second part characterizes emotional factors in various diseases of somatic nature.
Name: Post-traumatic unconsciousness
Aleksandrova E.V., Tenedieva V.D., Potopaov A.A.
The year of publishing: 2015
Size: 43.57 MB
Format: pdf
Language: Russian
Description: In the book “Post-traumatic unconscious states”, ed., Aleksandrova E.V. et al., the fundamental and clinical aspects of this medical problem are considered. Anatomy issues are covered... Download the book for free
Name: Psychiatry. National leadership. 2nd edition
Aleksandrovsky Yu.A., Neznanov N.G.
The year of publishing: 2018
Size: 13.42 MB
Format: pdf
Language: Russian
Description: Textbook "Psychiatry. National Guide" edited by Yu.A. Aleksandrovsky et al., is the second expanded and revised edition, which is well known to practicing professional doctors... Download the book for free
Name: Psychosomatic spectrum disorders. Pathogenesis, diagnosis, treatment
Storozhakov G.I., Shamrey V.K.
The year of publishing: 2014
Size: 1.38 MB
Format: pdf
Language: Russian
Description: The practical guide "Psychosomatic spectrum disorders. Pathogenesis, diagnosis, treatment" edited by Storozhakova G.I., et al., discusses the anatomical and physiological foundations of psycho... Download the book for free
Name: Psychiatry. Scientific and practical reference book
Tiganov A.S.
The year of publishing: 2016
Size: 50.5 MB
Format: pdf
Language: Russian
Description: The reference guide "Psychiatry. A scientific and practical reference book" edited by Tiganova A.S., examines the entire spectrum of psychiatric pathology, which is a practical guide for practitioners... Download the book for free
Name: Clinical guidelines for mental disorders. 3rd edition.
Barlow D., Eidemiller E.G.
The year of publishing: 2008
Size: 9.17 MB
Format: pdf
Language: Russian
Description: The book "Clinical Guide to Mental Disorders" as a modern clinical guide to psychiatry examines the practical issues of the discipline, which reflects panic disorder and... Download the book for free
Name: Handbook of Psychiatry.
Zharikov N.M., Khritinin D.F., Lebedev M.A.
The year of publishing: 2014
Size: 1.06 MB
Format: pdf
Language: Russian
Description: Theoretical and practical issues of psychiatry in the reference book "Handbook of Psychiatry" give the most complete picture of this section of medical science. The reference book discusses the diagnosis of... Download the book for free
Name: Borderline neuropsychiatric disorders in children.
Fesenko Yu.A.
The year of publishing: 2010
Size: 5.88 MB
Format: pdf
Language: Russian
Description: The presented book, “Borderline Neuropsychiatric Disorders in Children,” examines a rather pressing problem in child psychiatry - borderline disorders. The publication describes diagnostic... Download the book for free
Name: General psychopathology
Marilov V.V.
The year of publishing: 2002
Size: 4.06 MB
Format: djvu
Language: Russian
Description: The book “General Psychopathology”, edited by V.V. Marilov, examines general issues in the study of psychiatric disorders. Pathological states of perception, thinking disorders are presented...
Alexander F. Psychosomatic medicine. Principles and practical application . /Trans. from English S. Mogilevsky. - M.: Publishing house EKSMO-Press, 2002. - 352 p. (Series “Psychology Without Borders”).
Franz Alexander (1891-1964) was one of the leading American psychoanalysts of his time. In the late 40s - early 50s. he developed and systematized the ideas of psychosomatics. Thanks to his work on the emotional causes of hypertension and stomach ulcers, he became one of the founders of psychosomatic medicine.
In his main book, the author summarizes the results of seventeen years of work devoted to the study of the influence of psychological factors on body functions, on the occurrence, course and outcome of somatic diseases.
Based on data from psychiatry, medicine, Gestalt psychology, psychoanalysis, the author talks about the relationship between emotions and diseases of the cardiovascular system, digestive system, metabolic disorders, sexual disorders, etc., revealing his understanding of the body as an integrated system.
For psychiatrists, psychologists, doctors, students of all these specialties.
TABLE OF CONTENTS
PREFACE. . GRATITUDE.
Part One GENERAL PRINCIPLES
Chapter 1 INTRODUCTION.. ......... .....: ......
Chapter 2
THE ROLE OF MODERN PSYCHIATRY IN THE DEVELOPMENT OF MEDICINE....................................
Chapter 3
THE INFLUENCE OF PSYCHOANALYSIS ON THE DEVELOPMENT OF MEDICINE Chapter 4
INFLUENCE OF GESTALT PSYCHOLOGY, NEUROLOGY AND ENDOCRINOLOGY...................................
Chapter 5
CONVERSION HYSTERIA, VEGETATIVE NEUROSIS. AND PSYCHOGENIC ORGANIC DISORDERS
Chapter 6
DEVELOPMENT OF ETIOLOGICAL THOUGHT. .............
Chapter 7
METHODOLOGICAL CONSIDERATIONS RELATED TO THE PSYCHOSOMATIC APPROACH........
Chapter 8
FUNDAMENTAL PRINCIPLES OF THE PSYCHOSOMATIC APPROACH..................................................... 51
1. PSYCHOGENESIS.................................................... 51
2. PHYSIOLOGICAL FUNCTIONS AFFECTED
PSYCHOLOGICAL IMPACTS. ............. 53
3. THE PROBLEM OF SPECIFICITY OF EMOTIONAL
FACTORS IN SOMATIC DISORDERS..... 69
4. PERSONALITY TYPE AND DISEASE.................................... 72
5. RELATIONSHIP OF NERVOUS AND HORMONAL
MECHANISMS................................................... 78
Part two
EMOTIONAL FACTORS IN VARIOUS DISEASES
INTRODUCTION................................... 87
Chapter 9 EMOTIONAL FACTORS IN GASTROINTESTINAL DISEASES
DISORDERS
1. NUTRITION DISORDERS. APPETITE DISORDERS
2. SWALLOWING DISORDERS..................
3. DISORDERS OF DIGESTIVE FUNCTIONS. . .
4. DISORDERS OF EXCRETORY FUNCTIONS........
Chapter 10 EMOTIONAL FACTORS IN BREATHING DISORDERS.
Chapter 11
EMOTIONAL FACTORS IN CARDIOVASCULAR DISORDERS. ................................... 164
1. CARDIAC DISORDERS
(TACHYCARDIA AND ARRHYTHMIA) ........................... 164
2. HYPERTENSION DISEASE. ....................... 166
3. VASODEPRESSOR SYNOPE. .................... 179
4. PSYCHOGENIC HEADACHES AND MIGRAINES. ......... 181
Chapter 12 EMOTIONAL FACTORS IN SKIN DISEASES 192
Chapter 13
EMOTIONAL FACTORS IN METABOLIC DISORDERS AND ENDOCRINE DISORDERS. .......< 199.
1.THYROTOXICOSIS. ................................... 199
2. FATIGUE ............................................... 219
3. DIABETES MELLITUS. ........................... . . 230
Chapter 14
EMOTIONAL FACTORS IN LESIONS OF JOINTS AND SKELETAL MUSCLES................................................... 239
1. RHEUMATOID ARTHRITIS. ........................... 239
2. PROPENSITY TO ACCIDENTS.................................. 250
Chapter 15 FUNCTIONS OF THE GENITAL ORGANS AND THEIR DISORDERS
(TERESA BENEDEK) .................................... 260
1. MALE SEXUAL FUNCTIONS................................. 272
2. FEMALE SEXUAL FUNCTIONS................................. 274
3. PSYCHOSEXUAL DYSFUNCTIONS. ................ 290
Chapter 16
PSYCHOTHERAPY........... 321
BIBLIOGRAPHY......................... 333
Franz Alexander's "Psychosomatic Medicine" bears the imprint of the personality of its author - a professional in both psychoanalysis and medicine. In 1919, having already received his medical education, he became one of the first students at the Berlin Psychoanalytic Institute. His first book, Psychoanalyse der Gesamtpersoenlichkeit (1927), which developed the theory of the superego, was praised by Freud. In 1932, he helped found the Chicago Psychoanalytic Institute and became its first director. A charismatic leader, he attracted many European psychoanalysts to Chicago, including Karen Horney, who was appointed assistant director of the Institute. Sharing most of Freud's positions, Alexander, however, was critical of the theory of libido and showed great independence in developing his own concepts, and also supported the unorthodox ideas of other psychoanalysts. In general, his position is characterized as intermediate between orthodox Freudianism and neo-Freudianism. In the history of psychoanalysis, Alexander stands out for his special respect for the scientific approach and precise methods, and that is why the Chicago Psychoanalytic Institute, which he continuously directed until 1956, was the center of numerous scientific studies on the role of emotional disorders in a variety of diseases. Although the psychosomatic direction began to take shape in medicine long before Alexander, it was his work that played a decisive role in recognizing emotional stress as a significant factor in the emergence and development of somatic diseases.
The formation of psychosomatics in the 30s of the twentieth century as an independent scientific discipline was not a simple consequence of the invasion of psychoanalysis into somatic medicine in the process of expanding its sphere of influence, just as it penetrated, for example, into cultural studies. The emergence of psychosomatic medicine was predetermined, firstly, by the growing dissatisfaction with the mechanistic approach, considering a person as a simple sum of cells and organs, and secondly, by the convergence of two concepts that have existed throughout the history of medicine - holistic and psychogenic. Alexander's book summarized the experience of the rapid development of psychosomatics in the first half of the twentieth century, and the most interesting thing about it, undoubtedly, is the concentrated presentation of the methodology of a new approach to understanding and treating diseases.
The basis of this methodology, which runs throughout the book, is the equal and “coordinated use of somatic, that is, physiological, anatomical, pharmacological, surgical and dietary, methods and concepts on the one hand, and psychological methods and concepts on the other,” in which Alexander sees the essence of the psychosomatic approach. If now the area of competence of psychosomatic medicine is most often limited to the influence of psychological factors on the occurrence and development of non-mental diseases, that is, the line coming from the psychogenic concept, then Alexander was a proponent of a broader approach coming from the holistic concept. According to this approach, the mental and somatic in a person are inextricably linked with each other, and understanding the causes of diseases is impossible without a joint analysis of these two levels. Although the holistic approach is not currently rejected outright, it often escapes the attention of both researchers and clinicians - probably due to the difficulty of following its methodology, which requires not only a good knowledge of both the psyche and somatics, but also an understanding of them interconnected functioning. The latter is difficult to formalize, necessary in scientific research and clinical practice, and easily escapes the scope of scientific analysis, especially in the context of the ongoing differentiation and specialization of branches of medicine. In this regard, the significance of Alexander's book, in which holistic psychosomatic methodology is not only formulated and substantiated, but also illustrated with numerous examples of its specific application, has perhaps only increased in our days.
Alexander's predecessors and contemporaries described many different kinds of correlations between the emotional sphere and somatic pathology. The most deeply developed theory in this area was Flanders Dunbar's theory of specific personality types. This researcher showed that the psychological portrait ("personal profile"), for example, of patients suffering from coronary heart disease and patients prone to frequent fractures and other injuries, is fundamentally different. However, as in any other field of scientific knowledge, statistical correlation provides only initial material for studying the mechanisms of the phenomenon. Alexander, who has great respect for Dunbar and often cites her work, draws the reader's attention to the fact that the correlation between character and susceptibility to disease does not necessarily reveal the real chain of causation. In particular, between character and predisposition to a certain disease there may be an intermediate link - a specific lifestyle to which people with a certain character are prone: for example, if for some reason they are inclined to professions with a high level of responsibility, the direct cause of the disease may be occupational stress, and not the character traits themselves. Moreover, psychoanalytic research can reveal the same emotional conflict under the guise of apparently completely different personality types, and it is this conflict, from Alexander’s point of view, that will determine the disease to which the individual is most prone: for example, “the characteristic emotional pattern of an asthmatic can be identified in individuals with completely opposite personality types, who protect themselves from the fear of separation using various emotional mechanisms." Thus, thanks to his reliance on the psychoanalytic method, Alexander does not stop at discussing statistical correlations between external indicators of mental and somatic functioning, which have very limited value in relation to the main task - treating the patient, and goes much further, trying - although not always successfully - to identify deep-seated mechanisms of pathology.
The theoretical foundation of this manual is mainly the theory of psychosomatic specificity, or specific conflicts - the most famous concept of Alexander. According to it, the type of somatic illness is determined by the type of unconscious emotional conflict. Alexander proceeds from the fact that “each emotional situation corresponds to a specific syndrome of physical changes, psychosomatic reactions, such as laughter, crying, blushing, changes in heart rate, breathing, etc.”, and, moreover, “emotional effects can stimulate or suppress the functioning of any organ." Psychoanalytic research reveals unconscious emotional tension that persists for a long time in many people. It can be assumed that in such cases, changes in the functioning of physiological systems will persist for a long time, leading to disruption of their normal functioning and ultimately provoking the development of the disease. Moreover, since various physiological changes are observed in different mental states, the result of various long-lasting unconscious emotional states will be different pathological processes: high blood pressure - a consequence of suppressed anger, dysfunction of the gastrointestinal tract - a consequence of frustration of dependent tendencies, etc. Striving to be an objective researcher, Alexander recognized that the key provisions of his theory required additional verification and justification. Unfortunately, the theory of specific conflicts has not received clear experimental confirmation, including in numerous studies of the institute headed by Alexander specifically dedicated to this. However, it was not refuted. It continues to be considered one of the leading psychosomatic theories.
A feature of Alexander's approach was the emphasis on unconscious emotional tension, which, from a psychoanalytic point of view, is more pathogenic because it cannot find a way out in conscious actions. In this way, his approach differs from non-psychoanalytic ones, including those that prevailed in Soviet, and even those that prevail in modern Russian medicine, in which the influence of only conscious mental processes that are accessible to direct observation and description is analyzed. On another level, the opposite of Alexander's approach is a non-specific concept. According to it, the emergence and development of pathology is caused by prolonged conditions of stress, however, the specific form of pathological changes does not depend on the type of stress, but on which organs or systems in a given individual are more vulnerable. Criticizing the specific concept, supporters of the nonspecific concept especially emphasize the lack of complete correlation between the specifics of a psychosomatic disease and the personality of the patient. Apparently, there is no antagonism between all these concepts: some cases may be more consistent with one of them, others - with another. As noted above, the incomplete correspondence between the disease and the external characteristics of the personality is easily explained if unconscious conflicts are taken into account, as Alexander proposed. However, he by no means made a fetish out of psychic influences, recognizing the large role of somatic factors. In particular, he noted that typical emotional constellations characteristic of a certain somatic disease (for example, ulcers) can also be found in a person who does not develop this disease, from which he concluded that the presence or absence of a disease depends not only on emotional , but also from somatic factors that have not yet been sufficiently identified. He turned out to be right - in recent decades, the important role of genetic factors independent of the psyche in determining the individual vulnerability of physiological systems has been convincingly shown.
Most of the space in the book is devoted to the application of the psychosomatic approach and the theory of specific conflicts to specific diseases. Although Alexander, based on a holistic approach, was against identifying a separate group of psychosomatic disorders (in any somatic disease one can find both somatic and mental factors!), the range of diseases he considered almost exactly coincides with what is now generally classified in this group. solid clinical material, including his own observations, data obtained by employees of the Chicago Psychoanalytic Institute, and numerous data from other researchers, he builds a well-thought-out scheme of psychosomatic genesis for each disease. The given case histories perfectly illustrate the ways of using the psychoanalytic method to identify underlying disorders of hidden emotional conflicts and treat these conflicts, and ultimately the disease as a whole.
Excessive optimism and confidence in his approach seemed to have let Alexander down - he often, without sufficient grounds, considered the mechanisms of diseases to be quite well understood, which in fact have been little clarified to this day. Because of this, the chapters devoted to specific diseases look, despite the constant reliance on clinical material, somewhat lightweight and are less convincing than the theoretical part. Thus, the connection between psychogenic constipation and anal-sadistic tendencies, although it will not raise doubts among many psychoanalytically oriented specialists, is unlikely to seem fully proven to others. Alexander's widely known hypothesis about the role of repressed anger in the formation of chronically high blood pressure is generally very convincing, but even it does not have unambiguous experimental confirmation, and many questions related to it are still not clarified. The situation is no better with other psychosomatic hypotheses: although clinical data in favor of one or another of them are periodically reported, it is still too early to draw definitive conclusions. Finally, the effectiveness of psychoanalytic treatment of psychosomatic disorders has apparently been exaggerated: according to modern experts, many psychosomatic patients are simply unable to adequately express their emotions, and therefore classical psychoanalytic techniques often do not improve their condition.
At the same time, we should not lose sight of the fact that these flaws in Alexander’s book are a consequence of the extreme complexity and poor development of the subject. And the understanding of this subject over the past half century, alas, has advanced very little. One reason for this is that most research in the field of psychosomatics unreasonably ignores the methodological principles developed by Alexander. This is manifested either in focusing on only one side, somatic or mental, or in limiting the analysis to the calculation of correlations of somatic and psychological indicators, on the basis of which only the most superficial conclusions about causal relationships are made. Conducting large-scale “correlation” studies is now a task accessible to a wide range of specialists: having data from clinical examinations of patients, you only need to supplement them with “psychology” - connect the psychological “profiles” of the individual, drawn by one of the psychometric tests, and then calculate how they are related to each other with a friend. There are now a great variety of psychometric tests, as well as methods of statistical analysis, and both are easily implemented in computer programs; As a result, the productivity of the researcher, in comparison with the times of Alexander, increases monstrously. However, if the descriptions of the mechanisms of psychosomatic pathology proposed by Alexander were often too speculative, then correlation studies, capturing only individual strokes in the complex picture of psychosomatic interactions, often do not clarify anything at all. The result is extremely little progress in understanding the psychosomatic nature of diseases.
It should be noted that Alexander was clearly wishful thinking, believing that the “laboratory era of medicine,” which was characterized by reducing the goal of medical research to identifying “more and more details of basic physiological and pathological processes,” had already ended. On the contrary, the “tendency he noted to squeeze more and more diseases into the etiological scheme of infection, where the connection between the pathogenic cause and the pathological effect seems relatively simple,” does not seem to be going to weaken at all: more and more new hypotheses that this or that other disease - stomach ulcer, cancer, etc. - caused by some pathogenic microorganism, the scientific and other public meets with genuine interest. One of the reasons for the continued prosperity of the “laboratory approach” is due to the fact that the understanding of human physiology has increased not only quantitatively, but also qualitatively over the past half century. The discovery of many details of physiological mechanisms at the cellular and molecular level served as the basis for new advances in pharmacology, and the huge profits of pharmaceutical concerns, in turn, became a powerful factor supporting physiological research; a vicious circle has developed. This powerful system, which develops according to the principle of positive feedback, largely determines the modern face of “laboratory” medicine.
It is curious that the role of physiological mechanisms has begun to be recognized as leading even in the etiology and pathogenesis of mental illnesses. This was led to enormous progress in uncovering the mechanisms of information transfer between brain cells and associated successes in the pharmacological correction of mental disorders. The need for a broader, systemic understanding of the disease is not denied; on the contrary, sometimes it is even elevated to dogma, but the real orientation of research, medical education, and the organization of medicine contributes very little to this. As a result, many researchers and doctors are actually guided by the principle of reductionism - reducing phenomena of a higher order to lower ones. Instead of considering a healthy and sick organism as a psychosomatic unity, in which both cellular mechanisms and interpersonal relationships in which the individual is included are important - an approach substantiated and developed in detail by Alexander - narrow specialists try to resolve all issues without going beyond their favorite physiological level. At the same time, under the banner of a holistic approach, completely amateurish ideas are most often put forward, ridiculous in theory and ineffective in practice, which have nothing in common with the truly scientific approach of the author of this book. Thus, the advent of the psychosomatic era, contrary to Alexander's expectations, is still delayed.
The reader not connected with medicine and physiology must be warned that many of the “somatic” details of the hypothetical mechanisms of pathogenesis proposed by Alexander are undoubtedly outdated to one degree or another. Even such a seemingly simple phenomenon as ulceration is understood today completely differently than in the time of Alexander, and instead of one disease, about three dozen types of peptic ulcers are now distinguished, differing in the physiological mechanisms of the occurrence and development of the pathological process. A lot has become known about the hormonal regulation of physiological processes, about immune processes (which play, in particular, an important role in arthritis), and progress in understanding the mechanisms of heredity is absolutely colossal - it is worth at least remembering that the carrier of the genetic code was established after the appearance of this books! However, the most valuable thing in the book is not the descriptions of the hypothetical mechanisms of specific diseases, although they contain many subtle observations and completely indisputable conclusions, but the methodology behind them for penetrating into the psychosomatic nature of diseases.