Dr. Peter Bernad

     One can not classify these patients' as sychosomatic²⁴ as there is no apparent pathological syndrome. Also, except in specific situations where a history of hypochondriac or hysteria has been conclusively established, it is impossible to categorize this type of patient as a hypochondriac or hysteric. 

     Not only has there been little research into the characteristics of this phenomenon but also since there is no established disease state associated, there has been little interest within the medical profession for such investigations. 

     The value of evaluating the dynamic character structure of these patients is multidimensional. Practically, if specific generalizations can be established which are particular to these individuals they may serve an important function in medical diagnosis (especially if uniform measurement is possible). Furthermore, if specific attitudes can be attributed to these individuals as a group certain relationships between 'somatic fixation' and attitude structure may become clear. It may be found that 'somatic fixation' is a category of behavior which falls into the 
framework of a larger personality type 
indicating specific attitudes such as 
'authoritarianism'. 

*  Mr. Berger is a second year medical student at University of Ottawa.  

** Mr. Bernad is a second year medical student at McGill University.  
 
 

     References to such a relationship from the literature on the authoritarian personality is scarce. In The Authoritarian Personality,¹ from interview ratings of Dynamic Character Structure in relation to scores on the Ethnic Prejudice Questionnaire (EPQ) items 56d, 56e, and 56f, the possibility of high scorers putting the main emphasis on somatic symptoms (although there is an admitted absence of clear cut results due to the high number of Neutrals) as a trend in the direction of 'projection on to the body' has been opened. Low scorers with somatic symptoms tended to state problems in terms of faulty adjustment and emotional difficulties; high scorers showed a preoccupation with body processes and anxiety about the integrity of bodily and nervous functioning, which, carrying the being crazy connotation has been related to the fear of admitting the existence of psychological problems. While patients as a whole vary in both the amount and severity of somatic symptoms and in theft subjective importance, more high (H) than low (L) scorers tended to put the main emphasis on somatic symptoms in the story of their complaints.¹ 

     This experiment was designed to eliminate the large number of Neutrals found in previous investigations and to establish whether the relationship between 'somatic fixation' and 'authoritarianism' is a valid one.  

SUBJECTS 
      All subjects included in the data were patients who has visited the emergency department at St. Mary's Hospital in Montreal for diagnosis and treatment of a somatic complaint. Ss were only included if willing to participate.  
 

PROCEDURE  
      Initially, all potential Ss were divided into two groups. Group I included patients requiring treatment and or showing a positive correlation between somatic complaint and clinical diagnosis. Group II included patients not requiring any specific treatment and or showing a negative correlation between somatic complaint and clinical diagnosis.  

      In order to eliminate the large number of Neutral scorers which have been found in previous research1 rigid criteria were designated and adhered to in the placing of potential Ss into either group. The clinical diagnosis of the intern and its correlation to the patients somatic complaint (either positive or negative was the first essential part of the grouping process. Only definitive diagnoses were acceptable, none involving cases of a serious nature. {No Ss were admitted to the hospital for treatment; all treatment was administered in the emergency department). All Ss with any known history of psycho or organopathology were not used. The diagnosis, in all cases a product of clinical examination and laboratory results (blood & urine) was accompanied by a patients evaluation sheet on which the intern was asked to describe the patients general level of anxiety as well as to include any significant remarks uttered during the interview. Ss were only included if they seemed to have attained a level of education sufficient enough to understand the experimental questions and instructions.  

     Because of the difficulties (not sufficient time) in obtaining both male and female Ss of various ages who fulfilled the grouping requirements in large numbers, only females between 30 and 45 years of age were included in the present experiment.  
  
       After receiving written instructions Ss were administered the F-test from 45^a1.  Testing was only accomplished in each case 
after individual diagnosis and group classification, and when necessary, only after treatment. 

Group II included the experimental Ss's. 

F-tests scores for both experimental (N-11) and control (N-13) groups were determined. The item rating system is shown in Table I. The mean F scores for experimental and control Ss are shown in Tables II & III respectively. 
 
 
 
 

      Significant general observations not included here, are included in the discussion. 
 
 

DISCUSSION  
    The immediate conclusions from the data collected are the following: (1) There appears to be a positive correlation between 'somatic fixation' and 'authoritarianism'. Ss showing positive 'somatic fixation' produced significantly higher F-Test scores than did Ss showing negative 'somatic fixation'. The mean F-Test score of the experimental Ss was significantly higher than the F-Test neutral point score of 4.0.1. (2) The large number of neutrals (individual scores not significantly different from the neutral point) obtained in past experiments¹ may be eliminated by strict preselection sampling methods as were used in the present work. 

      Apparently there exists a class of individuals, members of which show what has been termed 'somatic fixation'; producing significantly higher F-Test scores than control Ss, whose somatic complaints are positively correlated with clinical diagnosis. 

   One must not neglect the possibility that those individuals showing 'somatic fixation' may be potential hypochondriacs. A hypochondriacal symptom represents an increased focusing of attention on actual somatic functioning^l4,21. Underlying the somatic preoccupation is usually a long standing psychic discomfort for which where has been no relief. In contrast to a conversion reaction (hysteria) the individual with a hypochondriacal reaction can talk freely of his emotional difficulties; however, he does not link up his somatic preoccupation with these problems. They are kept separate (isolated). With this in mind it is significant that in previous research low scorers on the EPQ tended to state problems in terms of faulty adjustment or emotional difficulties rather than relating to the physical dimension¹.      

The focusing of attention onto bodily activity leads to a full time preoccupation with the details of one or another aspect of somatic control. The functioning of the gastro-intestinal, respiratory, cardiovascular, visual, auditory, and reproductive systems are favorite sources of such complaints as spasm, burning, photo phobia, hyperansis, hypersecretion, pulsations, ^14,21 etc. In the course of the present experiment it was noted that the interns who had examined the patients agreed unanimously that experimental Ss consistently, to a noticeable extent in the course of relating their somatic complaint to the intern, complained of "something being wrong with nearly every system". The control Ss appeared to be consistently more specific in their complaints. Experimental Ss were consistently described as being "concerned with selves", "worried looking", "high strung", "in: high anxiety state", "most often overly nervous". 

      Frequently the somatic preoccupation will have its onset at the time of somatic illness and the preoccupation will linger on, el. cough, after the flu, changes in urinary or bowel habits after immobilization, pain or aching following trauma. Since the symptom gives the patient control not only over himself but also his previous psychic discomfort it is usually difficult to remove. 

      The symptom may be reinforced inadvertently by the physician's examination and tests undertaken to find something "organically" wrong and by generous trials of drugs for somatic relief. Actual somatic complications may occur as a result of the indications and manipulations used. 

      Indeed, relationships between anxiety, hysteria,^l0 or hypochondrial concern and high scores on the E-Scale have previously been suggested¹. This fits in well with results which have shown individuals with a high level of free anxiety to show a high or consistent agreement with authoritarian attitudes^4,7. Also this relates to the intern interview observations mentioned above. 

Applied social psychology may play a rool in clinical judgment¹⁶. Categories or diagnosis leave a great deal to the subjective judgment of each physician^2,5. It is often unclear whether a case should be classed as psycho pathological; as a simple neurosis, or whether one of the symptoms stands out sufficiently to warrant diagnosis such as hysteria or hypochondriasis, It may be a question of which are predominant symptoms ^2,120. 

      There is an essential unit of psychological processes involved in clinical and social judgement¹⁶. Informational analysis has a great potential value in such judgment which involves the identification of stimuli²³. The major variables of the judgment task involve the dimensional attributes of input, output, judge, and situation variables.  A clinician must make judgments which involve

      The conclusions of the present research are limited for several reasons. Firstly, the scarcity of data restricts the statistical reliability of the conclusions, For example, because of the small number of Ss individual items on the F-test were not correlated. The current Es carried out the research without aid or support from hospital medical staff other than interns within the emergency room. This restricted access to Ss. It would have been preferable to obtain results from a population of subjects, which included members of both 
sexes and a large spectrum of ages.  Unfortunately, time or facilities were not available for the interviewing of Ss or for following up on Ss. The classification of the Ss into groups was only as accurate as the clinical diagnosis and observations of the intern. The Es could not guarantee the interns' efficiency of accuracy and in all cases merely took this for granted. 

      For further investigation the present Es suggest the use of projective interviews, and follow ups of patients. Interceding attitude variables such as 'anomie', as well as other factors including SES, anxiety, level, and developmental history should be comprehensively investigated and correlated to 'authoritarianism' and 'somatic fixation'. Common psychological dimensions have been found to underlay 'anomie', 'authoritarianism', prejudice, and SES¹⁷. Both 'anomie' and 'authoritarianism' may be reactions to a perception of inadequacy ~n social adaptation¹⁸ and which may be expressed in one output dimension as a tendency for 'somatic fixation'.

       Although there appears to be a positive correlation between 'authoritarianism' and 'somatic fixation' the dimensions of the relationship have not yet been isolated. The correlation itself is significant. It illustrates the essential role of social psychology and specifically attitude psychology in psychosomatic medicine. Also it may suggest that there may exist a physical or somatic reinforcement for a particular set of attitudes among large groups of individuals. A more intensive investigation along the lines used and suggested by this experiment and indicating the interplay of many related factors might serve to make this relationship more clear. 
 
 
 
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