Disposition disease
Deployment disease is a 1963 by Thure von Uexküll -positioned psychosomatic disease concept in chronic persistent functional syndromes . It represents a further development of earlier concepts of organ neurosis ( Otto Fenichel 1945) and vegetative neurosis ( Franz Alexander 1950).
Naming and methodology
The term readiness sickness resulted from the methodical-systematic delimitation and comparison of mental disorders, which are regarded as necessary, and which cannot be counted among the classic conversion processes. The conversion model fails to explain dispositional diseases. In the case of these disorders, the pathogenetic significance of originally physiological, but all too long-lasting reactions in the way of provision appears decisive. This was decisive for the naming of the supply diseases, even if these occasionally occurred in combination with conversion processes. The term expression diseases was chosen as a corresponding term for the disorders that are permanently triggered only by conversion mechanisms .
The differentiation of the methodology, which is also aimed for, includes, in addition to the analysis of the motivation that is essential for the expressive diseases and the already mentioned provision as a pathophysiological basis, also the consideration of moods as a condition for chronic disorders.
theory
Object and ego libido
The concept of the separation between expressive and dispositional diseases is based on Freud's idea, which was shaped by drive theory , that a distinction must be made between an object libido and an ego libido. Freud imagined the libido as psychic energy that the individual sends out to objects. He spoke of narcissism when this libido was withdrawn from objects and withdrawn onto the individual himself. There is, so to speak, a positive energetic interaction between the objects and the self . Freud illustrated this beneficial effect in the picture of the protoplasmic animal.
- “In this way we form the idea of an original libido cathexis of the ego, which is later transferred to the objects, but which, basically, remains and relates to the object cathexes like the body of a protoplasmic animal to the pseudopodia it sends out . ... The emanations of the libido, the object cathexes that can be sent out and withdrawn again, became noticeable to us all. We also see roughly a contrast between the ego and object libido. The more one consumes, the more impoverished the other. As the highest stage of development, to which it brings the latter, the state of being in love, of us how an abandonment of one's personality against seems object occupation is and its opposite in the imagination (or self-perception) of the paranoid end of the world is [comment. through the narcissistic withdrawal of energy]. "
For the assessment of long-term psychological forces, the development of effective motives that can or cannot be implemented in actions with regard to the instinctual objects is decisive. If these cannot be implemented, the energies provided, but not consumed or sublimated, may have a pathogenic effect.
fear
Another theoretical construct for understanding chronic expression and disposition disorders is the conception of fear as a crucial emotional and affective quality. It usually contributes to the development of motifs. When fear is directed towards an external object, meaningful actions can reduce it. This is done by means of suitable motifs. This is how fear is transformed into fear . However, if this reduction of fear does not succeed due to a lack of suitable motive- controlled attitudes , further fear is triggered and further mental energies are mobilized (anxiety attack). Again, this is done without the possibility of reducing tension. The so-called "free floating fear" arises. In addition, it also causes the object occupation to be abandoned, as already described in Chap. Object and ego libido was represented. The conflict no longer exists here, as in the case of expressive diseases, between the ego and the social environment or super-ego , but between the ego and the id as the bearer of automatically and vegetatively running biological functions and readiness. One is therefore especially afraid of dangers that lie within oneself. In his description of the anxiety neurosis , Freud contrasted this type of disorder with the type of conversion hysteria. Freud can therefore be regarded as the protagonist of the distinction between the concepts of expressive and supply disorders, even if he has always shown himself to be very cautious about the treatment of somatic disorders and never treated organ disorders himself. This, however, is the precondition for decisive health risks from chronically persistent internal malfunctions. A chronically high blood pressure z. B. as a result of essential hypertension can lead to a stroke or heart attack after years of hardening of the arteries .
Pathophysiological concept
Preparations of any kind, like other physiological reactions, are to be imagined as principally antagonistic. The ergotropic and trophotropic attitudes may be mentioned here as examples of such opposing readiness reactions. This is to say that an excessively prolonged duration of certain originally physiological attitudes must ultimately have a detrimental effect. An increased duration of the sympatheticotonia must therefore z. B. manifest as insomnia .
Differentiation between expression and readiness sickness
- In the case of expressive illnesses, the motives distorted by a social conflict no longer lead to a specific way of acting, but only to a “fragment of action”. Affective energies that are partially repulsed can cause acute physical disorders . Such physical symptoms represent an averbal social appeal and thus often lead to a primary gain in illness . The at least partially preserved affective connection between one's own fear or mood, emotionality and psychosocial inhibitions is referred to as the affect correlate . The conflict is therefore to be regarded as at least partially conscious. - According to F. Alexander, the affected organs have striated muscles .
- In the case of readiness diseases, pronounced motivations either do not exist or no longer exist, since they are either not developed, are neutralized by counter- motivations - as in the case of functional syndromes - or are switched off or almost completely suppressed from consciousness by chronically acting defense mechanisms . The psychic can therefore no longer pass into the physical, since it has become unconscious . There are therefore no “fragments of action”. The physical symptoms that are not always or only partially noticed lead to a secondary gain in illness. This means that there is no longer any calming of moods that urge action. They just unconsciously keep providing new energies. The lost connection between fear and body symptoms is called the affect equivalent . - According to F. Alexander, the affected organs have smooth muscles .
Symptoms
The symptoms of the supply diseases cannot be explained with the help of the conversion model. The patient's own motivation, which is usually easily comprehensible in the case of conversion disorders or expressive diseases, is rather pushed into the background in the case of readiness diseases. It is primarily a matter of vegetative symptoms. A change in symptoms is often observed, which can be interpreted as an affect equivalent.
Examples
According to the description of F. Alexander (1891–1964), examples of supply diseases are bronchial asthma , essential hypertension , gastric ulcer , duodenal ulcer , ulcerative colitis , atopic eczema and hyperthyroidism (" holy seven ").
Systematics
With regard to the disease value of provisions , a distinction must be made between temporary, situation-related attitudes in the event of extreme stress, such as exams, stage fright, etc., and permanent attitudes such as the expressive and preparedness illnesses. The risk due to an expression sickness is generally lower than that of a willingness sickness. With the increasing depth of the repression, as is to be assumed in the case of illnesses of readiness, the subjective insight into the pathological events disappears and the risk of physical complications increases. The concept of supply diseases is now regarded as an important factor among others in the earlier classical psychosomatoses (“holy seven”).
literature
- Rainer Otte: Thure von Uexküll. From psychosomatic medicine to integrated medicine. Vandenhoeck & Ruprecht, Göttingen 2001. (online)
Web links
- Rüdiger Breit, Karin Zimmer, Rainer Zwisler: Psychosomatik 1994.
Individual evidence
- ↑ a b c d e f Thure von Uexküll: Basic questions of psychosomatic medicine. Rowohlt Taschenbuch, Reinbek bei Hamburg 1963, (a) to tax authority “Ready-to-use disease”, pp. 194 f., 197 f., 200 f., 203 ff., 233 ff .; (b) on Stw. “Angst” pages 116 ff., 121, 147, 194, 200 ff., 204, 223; (c) re. “Control of Provisioning” on page 170; (d) Re. “Secondary gain from illness”, page 197; (e) re. “Symptom change” on page 205; (f) Re. “Systematics of the disease value” page 200, 203 ff.
- ↑ a b Thure von Uexküll u. a. (Ed.): Psychosomatic Medicine. 3. Edition. Urban & Schwarzenberg, Munich 1986, ISBN 3-541-08843-5 , p. 227.
- ^ Sigmund Freud : On the introduction of narcissism (1914): Ges. W. Volume X, p. 141.
- ↑ J. Schunk: Emotional factors in the pathogenesis of essential hypertension . In: Zschr. Klin. Med. (1953); 152, pp. 251-280.
- ^ Sigmund Freud: Collected works . Volume I, p. 63 (conversion hysteria), p. 317 ff. (Clinical symptomatology of anxiety neurosis), p. 339 (inner conflict in anxiety neurosis).
- ↑ a b c d Sven Olaf Hoffmann , G. Hochapfel: Theory of Neuroses, Psychotherapeutic and Psychosomatic Medicine. 6th edition. Compact textbook. Schattauer, Stuttgart 2003, ISBN 3-7945-1960-4 ; (a) re. “Striated muscles”, page 304, (b) re. “Smooth muscles”, page 304; (c) to stw. “holy seven” page 304; (d) to Stw. "today's meaning" page 304 f.
- ↑ Alexander Mitscherlich : Notes on the chronification of psychosomatic events. In: Psyche. XV, l (1961).