Learning for Sustainable Living

Psychosomatic and Environmental Medicine

Example: Cancer

Werner Sattmann-Frese PhD

Werner Sattmann-Frese (PhD)

• Werner is a psychotherapist and social ecologist working as a Senior Lecturer and Program Manager at the Jansen Newman Institute / Think Education in Sydney (www.jni.edu.au). He is also developing a learning program on sustainable living at www.lfsl.info.

• You can contact him at slse.bigpond.net.au

Definition of Psychosomatic Medicine

• Blakiston's Medical Dictionary gives the following definition of psycho-somatics: “Psychosomatics is the branch of medicine dealing with psychic and physical components as a unit, and the interrelationship between them” (Blakiston's Medical Dictionary, p. 67).

The origin of the term

• The term psychosomatic medicine was coined by the German physician and psychiatrist Johann Christian August Heinroth in 1818. It was then used for some years in a moralistic and ethical sense but quickly disappeared because of the growing influence of the developing natural sciences.

Revival of the term

• The term was revived again by Sigmund Freud in connection with his successful psychoanalysis of Miss von R.

Case of Elisabeth von R.

• Fraeulein (Miss) Elisabeth von R." is the pseudonym Freud gave to Ilona Weiss, a young woman of Hungarian origin, whose case is described in the Studies on Hysteria (1895d) and whom he treated in the fall of 1892 and July 1893. The third daughter in a well-to-do Hungarian family, Elisabeth von R. was twenty-four years old when Freud treated her in the autumn of 1892 for pains in her legs and difficulties with walking, problems she had been experiencing for two years.

• http://www.answers.com/topic/elisabeth-von-r-case-of.

Case of Elisabeth von R.

• An improvement occurred when she herself provided the source of her hysterical conversion: Her pains began at the spot on her thigh where, every morning, her father placed his inflamed leg so she could change his bandages.

• From then on "her painful legs began to 'join in the conversation' during our analyses" (1895d, p. 141).

Case of Elisabeth von R.

• Freud writes, "I sometimes followed the spontaneous fluctuations in her condition; and I sometimes followed my own estimate of the situation when I considered that I had not completely exhausted some portion of the story of her illness" (1895d, p. 149).

Three Key Views on Illness

• Psychological and emotional processes are causative factors of somatic illness (Freud and others).

• The somato-psychosomatic circle (Overbeck).

• Illness is an expression of our lack of all-consciousness and challenges us to become conscious of ourselves and to find back to our spiritual roots (Dethlefsen).

What about the natural environment?

• Emotional and physical llness (dis-ease) has to be viewed from many different perspectives and related to many contexts!

Issues affecting the health and well-being of human and other living beings

Many factors contributing to illness relate to the ‘perils of progress’.

o These include:• Noise• Pesticides• Formaldehydes• Food irradiation• Nanoparticles• Cadmium and aluminum in food• Microwaves, electric, and electromagnetic fields• Artificial light• Pollution of water

Issues affecting the health and well-being of the web of life

Signs and Symptoms

• A symptom denotes a subjective state or a subjective experience, whereas a sign denotes an ‘objectifyable’ pathological manifestation of an illness, that is something that can be measured and identified by an external observer.

Help versus healing

• Conventional medicine calls a therapeutic intervention a success when the symptom disappears.

• Psychosomatic medicine insists that healing is about making symptoms redundant by using symptoms as guides to a deep understanding of a person’s lack of wholeness and wellness.

Symptoms as communication

• Wesiack and Uexkuell point out that a person who communicates by means of symptoms is doing this without the conscious intention to inform the receiver of the his or her inner state. Symptoms are forms of unconscious communication in contrast to the spoken word with which a person consciously tries to convey a feeling or an idea (Uexkuell, 1990, p. 36).

Symptoms may be regarded as the physical signs of an organismic expression without the associated feeling attached

• Alexander writes: “Every emotional state has its own physiological syndrome. Increased blood pressure and accelerated heart action are a constituent part of rage and fear. Increased stomach secretion may be a regressive response to an emergency. Attacks of asthma are correlated with an unconscious suppressed impulse to cry for the mother’s help” (Alexander, 1950, p. 68).

Deep down we know …

• Dethlefsen suggests that: “Every sick person feels deep down that his [sic] illness must have something to do with the way he [she] is. He experiences a certain sense of guilt, for he knows that his illness signifies more than just a malfunctioning of his body. But this approach is immediately stifled by the doctor with the assurance that the whole thing is “nothing but...” (Dethlefsen, The Challenge of Fate, p. 108).

Aspects of conflict

• Conflict: Opposition between apparently or actually incompatible forces. Internal or psychological conflict may be between instinctual impulses, (e.g., libidinal and aggressive, see also instinct) or between structures (e.g., ego and id).

Aspects of Conflict (2)Sydney Morning Herald 15/11/2006

The primary and secondary gains of illness

Primary and secondary gains correspond to the direct or indirect advantages that individuals gain from their illness. The primary gain is a constitutive element of the illness that is present in the very motive of the illness. The secondary gain is an addition to the primary gain and comes into play at a later stage. It consolidates the disorder.

Primary and secondary gains of Illness

Primary gain subdivides into two parallel aspects. In the internal part, illness remains the most economic solution in cases of conflict, and this is the "flight into illness." The external part is linked to profitable arrangements occasioned in the individual's relational life. http://www.answers.com/topic/gain-primary-and-secondary

Wiesbaden Kurpark

Fancy a cure (secondary gain) at Wiesbaden resort?

Franzensquelle - Franzensbad

http://de.wikipedia.org/wiki/Franzensbad

Primary and secondary gains of illness

The secondary gain assists the ego in its effort to incorporate the symptom into the life with a sick role. It procures a satisfaction that is narcissistic or linked to self-preservation.

Harrison, Love your disease, it is keeping you healthy

Tertiary gain of illness

• Tertiary Gain was first proposed by Dansak in 1973 as an important factor in modulating and motivating illness behavior. Tertiary gain is defined as a gain sought or attained from a patient’s illness by someone other than the patient. Often the caregiver may benefit from the doctor-patient relationship by: fulfilling altruistic needs, representing the “little man” against Goliath (big corporation/ government), withdrawing from confronting the patient with the truth, establishing oneself as a patient advocate, avoiding intellectual honesty, and attacking professional detractors.

• Dansak, DA On the tertiary gain of illness. Compr Psychiatry. 1973 Nov-Dec;14(6):523-34. No abstract available. PMID: 4764353 [PubMed - indexed for MEDLINE]

Question: Who is gaining from selling this?

Answer:

• Pfizer, the largest pharmaceutical company in the world.

• In case you want to know what this chemical structure represents: Sildenafil- also known as Viagra.

Signs and Symptoms Toolbox (1)

A person’s self may:• choose a certain organ to manifest• create an inflammation• create pain• develop a tumor• create a swelling by accumulating body fluids• increase the body temperature• block or exaggerate nervous impulses• transform one form of tissue into another

Possible signs and symptoms (2)

• prevent parts of the bodymind from growing• open the bodymind to the invasion of foreign

organisms• create chronic muscle contractions• create alternative metabolic pathways• starve the periphery of the body of nutrients• reduce or exaggerate the functionality of the

senses• cry out for love or push people away through

skin lesions, etc.

These signs and symptoms may point at:

• conflicts with love and commitment• limitations of energy and emotional and

physical exhaustion• conflicts with social and emotional

boundaries• conflicts with the expression of anger and

rage• conflicts with independence and

dependence, and• difficulty in handling guilt.

They may also point at:

• difficulty in expressing needs for nurturing and body contact

• difficulty in expressing sexual needs and excitement

• conflicts with the awareness and expression of fear, and

• difficulty in grieving the loss of another person or a loss of function associated with ageing or a disability.

Alexithymia (1)

• Alexithymia literally means being without words for feelings. It is a term coined by Peter Sifneos in 1973 to describe a state of deficiency in understanding, processing, or describing feelings and emotions.

Alexithymia (2)

• Alexithymia is defined by:

• 1.difficulty identifying feelings and distinguishing between feelings and the bodily sensations of emotional arousal

• 2.difficulty describing feelings to other people

• 3.constricted imaginal processes, as evidenced by a paucity of fantasies

• 4.a stimulus-bound, externally oriented cognitive style

• (http://en.wikipedia.org/ wiki/Alexithymia).

Causes of cancer (1)

• There are about 200 different types of cancer affecting all the different body tissues. What affects one body tissue may not affect another. For example, tobacco smoke that you breathe in may help to cause lung cancer. Overexposing your skin to the sun could give you a melanoma on your leg. But the sun won't give you lung cancer and smoking won't give you melanoma.

• http://www.cancerhelp.org.uk/help/default.asp?page=119#multi_fact

Causes of cancer (2)

• Carcinogens: A 'carcinogen' is something that can help to cause cancer. Tobacco smoke is a powerful carcinogen.

• Age: Most types of cancer become more common as we get older. This is because the changes that cause a cell to become cancerous in the first place take a long time to develop.

• Genetic make up There have to be a number of genetic mutations within a cell before it becomes cancerous. Sometimes we are born with one of these mutations already. 

• http://www.cancerhelp.org.uk/help/default.asp?page=119#multi_fact  

Causes of cancer (3)

• The immune system: People who have problems with their immune systems are more likely to get some forms of cancer. This group includes people who

– Have had organ transplants and take drugs to suppress their immune systems to stop organ rejection

– Have AIDS– Are born with rare medical syndromes which affect

their immunity http://www.cancerhelp.org.uk/help/default.asp?page=119#multi_fact

Causes of cancer (4)• Diet: Cancer experts estimate that changes to our diet could

prevent about one in three cancer deaths in the UK.  In the western world, many of us eat too many animal fats and not enough fresh fruit and vegetables.  This type of diet is known to increase your risk of cancer. 

• Day to day environment: By this we mean what is around you each day that may help to cause cancer. This could include – Tobacco smoke– The sun– Natural and man made radiation– Work place hazards– Asbestos

• http://www.cancerhelp.org.uk/help/default.asp?page=119#multi_fact

Causes of cancer (5)• A form of pollution still neglected by most environmentalists is

electromagnetic pollution, also called ‘electrosmog’. According to the researchers cited on websites such as www.wissenschaft-unzensiert.de, www.funksmog.org; www.oekosmog. de, the technology associated with mobile phones has been identified as capable of leading to:– increases in the risk of brain cancers– biological damage to the brain through heating effects– symptoms such as headaches, earaches, bad sleep, fatigue,

blurring of vision, short-term memory loss, numbing and tingling

– so-called ‘hot spots’ in the brain that can contribute to the emergence of Alzheimer’s disease

– bouts of epilepsy and facial rashes and swelling.

Psychosomatic views of cancer (1)

The studies of Bahnson (1964) and his colleagues (1979) support the hypothesis that cancer patients rely heavily on denial and repression. Bahnson found that cancer patients, unlike persons in three control groups, remembered their parents as noninvolved, cold and not participatory in their early emotional lives. They concluded that the rigid defensiveness and lack of self-communication in cancer patients may be related to early family patterns. From: The Psychiatric Response of Personality and Immunity to Cancer - Elsa Colby-Morley, Ed.D.,Ph.D.1(http://www.orthomolecular.org/library/jom/1982/pdf/1982-v11n03-p185.pdf

Psychosomatic views of cancer (2)

• Bahne-Bahnson (1982) also proposes that people suffering from cancer are experiencing, in a psychosomatic way, old emotional deficits around nurturing. He argues that people suffering from cancer take over the role of the nurturer, whereby the tumor symbolises the inner child that is struggling with the effects of deprivation. Sadly, in this symbolic scenario the growing inner ‘baby’ is destroying its mother.

Loss of Identity

• A typical feature of cancer cells is their loss of identity and sense of socially responsible behaviour in the human body. Rather than identifying with the organ of which it has become a part during the organism’s ontogeny, cancer cells grow for the sake of growing.

Anarchy in the organism

• This fact has led Henschel and Vester (1977) to regard cancer as a disorganised way of living, whereas Dethlefsen and Dahlke (1990) describe cancer as a state of anarchy in the organism. The latter authors regard cancer cells as anarchists who have stopped playing to the rules of the organism, but follow their own ‘motives’. Why would they do that?

Earth Cancer

• Weigel (1995, p. xii) writes:

– An invasive and unrestrained malignant cell is to human cancer what an invasive and unrestrained human being is to earth cancer. Both represent an aberrant version of their original constitution; both are permitted to thrive because of a systemic imbalance; both are deadly to the health of the organism. In the same vein, the anthropologist Hern (1990) draws our attention to the growth of London from 1800 to 1955 as an expanding, invasive and malignant tumor, whereas Roszak (2001) describes the spread of urban conglomeration as ‘Gaia’s City Pox’.

What is needed to protect our health and wellbeing?

• A commitment to maintaining physical and emotional wellness

• An engaging in appropriate lifestyle choices• Education on environmental health hazards• Conflict identification and resolution skills• An holistic understanding of the world• Social change and a willingness to work with

the causes of exploitation• A focus on social, spiritual, and emotional

growth and progress.

Bibliography (1)

• Alexander, F 1950, Psychosomatic Medicine: Its Principles and Applications, Norton, New York.

• Blakiston’s, (1980) Pocket Medical Dictionary, McGraw-Hill, New York.

• Csikszentmihalyi, M 1992, Flow: The Psychology of Happiness, Rider, Sydney.

• Bahne-Bahnson, C 1982, ‘Psychosomatic Issues in Cancer’, in RL Gallon  (ed.) The Psychosomatic Approach to Illness, Elsevier North Holland, New York

• Dethlefsen, T 1984, The Challenge of Fate, Coventure, London.

• Dethlefsen, T & Dahlke, R 1990, The Healing Power of Illness, Element, Brisbane, QLD, Australia.

Bibliography (2)

• Henschel, G & Vester, F 1977, Krebs – fehlgesteuertes Leben, Deutscher Taschenbuch Verlag, Munich, Germany.

• Hern, WM 1990, ‘Why Are There So Many of Us? Description and Diagnosis of a Planetary Ecopathological Process’, Population and Environment, vol. 12, no 1, pp. 9-39.

• Overbeck, G 1984, Krankheit als Anpassung, Suhrkamp Verlag, Frankfurt/Main, Germany.

• Roszak, T 2001, The Voice of the Earth: An Exploration of Ecopsychology, Phanes Press, York Beach, ME, USA.

Bibliography (3)

• Von Uexkuell, T 1963, Grundfragen der psychosomatischen Medizin, Rowohlt Taschenbuch Verlag, Reinbek, Germany.

• Von Uexkuell, T Adler, R, Herrmann, JM, Köhle, K Schonecke, OW Wesiack, W  (eds.) 1979, Psychosomatische Medizin, Urban & Schwarzenberg, Munich, Germany.

• Weigel, VB 1995, Earth Cancer, Praeger, Westport, CT, USA.