The structure of psychosomatic symptoms

1. According to our findings, a psychosomatic structure is not an alternative to neurosis. The syndrome of alexithymia appears to be, in our cases, a transitional phase, the dynamics of which can be understood and treated by psychotherapy. In the course of psychotherapeutic treatment, alexithymia always disappears. 2. However, a special psychotherapeutic technique is advisable, one different from that applied in classical neurosis. 3. For this reason the term psychosomatic structure can be used as a way of expressing a variation of neurosis. 4. Modern concepts of psychosomatic disease describe pathological personalities that are different from the classic pseudoneurotic type because of their narcissistic and pregenital structures. These structures can be concealed underneath a facade of genital and psychoneurotic defense. 5. The old relationship between psychosomatosis and psychosis can be better understood on the basis of our findings, which reveal a borderline structure and splitting mechanisms in many psychosomatic patients. 6. Psychosomatic pathology can be better understood today by relating it to the structure of the psychosomatic family. 7. It appears that if, on the one hand, psychosomatic diseases of a more hysterical picture are frequent among preindustrial cultures and in low-income classes, on the other hand psychosomatic syndromes of a narcissistic and borderline type are characteristic for our civilization.     

Reorganization of tactile perception following the simulated amputation of one finger.

The tactile counterpart of diplopia has recently been described: tactile diplopia or diplesthesia. The human fingers show a rather precise organization of the cutaneous areas eliciting diplesthesia. In particular, these areas are very extensive between nonadjacent fingers (second and fourth, second and fifth, and third and fifth), suggesting that the illusory doubling depends on the lack of reciprocal interaction between cutaneous zones during manipulation. In the present study, four subjects agreed to explore and manipulate objects only through nonadjacent fingers for a period of up to six months. The amputation of the third finger was simulated by excluding it from active exploration by means of a bandage. After six months, the diplesthetic areas of the nonadjacent fingers decreased in size or completely disappeared. It is suggested that this reorganization of tactile perception is due to the increase in temporal correlation of the sensory inputs between nonadjacent fingers.     

Spatial organization of the diplesthetic and nondiplesthetic areas of the fingers

Cutaneous points on different fingers were brought into contact with each other to ascertain whether one stimulus was perceived to be single or double. The perceptual responses were mapped on the five fingertip pads. The results show that there is an extensive cutaneous area on each fingertip pad which elicits one-stimulus perceptions when a single stimulus is applied between each finger and the thumb. This area decreases when the stimulus is applied to adjacent fingers (2-3, 3-4, 4-5), and even more so when it is applied to nonadjacent fingers (2-4, 2-5, 3-5). In fact, in adjacent and nonadjacent fingers the cutaneous surface eliciting a doubling of the single stimulus (diplesthesia) is very extensive. The spatial arrangement of the cutaneous areas eliciting single perceptions appears to be invariant in the proximo-distal plane. Instead, the shift from one kind of perception to another occurs in the medio-lateral plane. It is suggested that this perceptual organization could reflect a neural organization.