Symptom change

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Symptom change or symptom change means change in psychopathological symptoms or syndromes (syndrome shift ) in an objectively descriptive sense. This change in the temporal course of a symptom pattern is a fundamental characteristic of psychological complaints and therefore also gives rise to basic theories in terms of possible causes. It is therefore a question of the basic concepts of psychiatry and psychosomatic medicine and has also been a research concept since around 1950. So far it has led to numerous other terms in medicine. Symptom change describes a frequent and very specific observation of the course of illness : With the current development or emergence of a physical symptom , an already existing mental symptom improves and, conversely, after an improvement of a physical symptom, a mental one occurs (again).

Explanatory concepts

The descriptive, purely empirical-scientific dimension of symptom change enables various possible interpretations.

Conversion model

This concept goes back to the concept of conversion developed by Sigmund Freud (1856–1939) to explain the triggering of mental and physical illnesses and states that initially simple and seemingly harmless affects can add up over time when repeated over time, similar to amounts of energy, and finally that Crossing the threshold of individual adaptation . This is the prerequisite for the development of psychological symptoms. The triggering of a physical symptom presupposes that the “arousal sum” of these affects is “converted” into the physical ( Latin conversio = conversion). Freud distinguished between a total and a partial conversion, depending on whether the traumatizing affects are fully or partially converted into the physical.

(1) External psychophysics
(2) Internal psychophysics
(3) Neurophysiology , perceptual
physiology Possible approaches to psychological forces according to Gustav Theodor Fechner (1801–1887)

Freud's concept of the sums of excitation is based on his psychodynamic ideas and the vectorial summation of affects as psychic forces similar to that of amounts of forces as physical quantities . Analogous spatial ideas, namely of the inner soul space, were logically and compulsorily connected. Freud's concept of topics was taken up by Kurt Lewin and the further development of vector psychology . Thure von Uexküll developed the concept of the integration space , see the following section Topological Interpretation . Freud's distinction between complete (total) and incomplete (partial) conversion suggests that he also made a dynamic distinction between physical and mental symptoms. Following on from this, Alexander Mitscherlich came up with the concept of two-phase displacement . It says that with increasing suppression of conflict-prone motives, the subjectively perceived fear decreases, but the objectively perceptible physical symptoms increase. The shift in the conflictual discussion within the psychophysical topic over time is understandable due to the model concept of psychophysical correlation . With the distinction between total and partial conversion, Freud followed Gustav Theodor Fechner's distinction between external and internal psychophysics, see Fig. 1. Freud's conversion model still provides a reason for system-theoretical and nosological debates, e.g. B. the distinction between neuroses and psychoses. Indeed, it is a fact that phenomena of symptom change are observed more frequently in neuroses than in psychoses.

In connection with the term change in symptoms, it can be stated that Freud believed that certain symptoms of illness can be traced back to changeable affects, which in turn are to be understood as reactions to certain traumatic experiences.

Whether it is possible, on the basis of the Freudian conversion model, to exhaustively explain the connection between psychological experience on the one hand and physical processes such as stimuli and neural processes on the other, remains questionable, see also the quality problem of consciousness dealt with by the philosophy of mind .

Topological interpretation

The separation of physical and mental symptoms demands that both the conditions and the consequences of the conversion of psychological “sums of excitement” into the physical, as described by Freud, are observed. To understand the phenomena of symptom change, Thure von Uexküll proposed his model of the integration space. He pointed out that the "anatomical picture of the human body with its tissues, organs and organ systems ... undergoes a change when it is incorporated into the more comprehensive picture of the integration space". This picture serves as the “basis for our orientation”. The fixed spatial structure is receding and "changing functional units" are made available. These changing functional units, in turn, serve the everyday tasks of adaptation already mentioned in the section on conversion model .

Shift theory

The theory of layers has been taken up by various authors. This is where biological and dynamic aspects come together. a. are important in shock treatment and somatotherapy . A distinction is usually made between a basic vital (physical) and a higher mental layer. A scale of gradual transitions from the functional syndromes to the expressive illnesses to the provision ailments should also be considered in the illness systematics.

Practical examples of symptom change

  • Since Jean-Martin Charcot, the prime example of the mutability of symptoms has been hysteria with its temporary "colorfulness" and opaque variety of disorders ( Belle indifférence des hystériques; La hystérie imite les maladies)
  • The occurrence of asthma attacks or epileptic seizures is relieved by the occurrence of psychosis . After the psychosis has subsided, the corresponding physical symptoms reappear. In the case of epilepsy, this phenomenon has been studied under the heading of alternative psychosis.
  • It is a proven fact that psychiatric illnesses change according to social and cultural environment. This finding is the result of comparative psychiatry .
  • It is known that organic brain or other physical diseases u. U lead to weakening or interruption of psychological symptoms, see also shock therapy .

Conclusions regarding the medical systematics

Change in symptoms is by no means exclusively attributable to hysteria. That is why Thure von Uexküll did not speak of hysteria here, but of expressive illness. The authors Hoffman and Hochapfel happily chose this term. Even Karl Jaspers has a psychology of expression described. Furthermore, the concept of functional syndromes should be mentioned as a diagnostic group in which the change in symptoms plays a major role. The supply diseases are a group of disorders, the physical complications of which often lead to irreversible damage or death.

Well-known example of symptom change

Franz Kafka (1883–1924) is known as a writer for his self-observations and self-analyzes . In his letter to his father , he discusses his lung disease. In letters to Milena Jesenská from April 1920, Kafka wrote:

“It was so that the brain could no longer bear the worry and pain that was imposed on it. It said, 'I'm giving up; but if there is still someone here who cares about the preservation of the whole, then he may take some of my burden off me and it will go on for a while. ' Then the lungs reported that they didn't have much to lose. The negotiations between the brain and the lungs may have been terrible. "

and especially about his hemorrhage caused by tuberculosis ...

“... also frightened, of course, went to the window, leaned out, went to the washstand, walked around the room, sat me on the bed - blood all the time. I was not at all unhappy, because I gradually knew, for a certain reason, that after 3 or 4 years of almost sleeplessness, provided that the bleeding stopped, I would sleep for the first time. It also stopped (hasn't come back since) and I slept the rest of the night. "

Even Max Brod reports in his diary

“Measures because of Kafka's illness. He depicts her as psychological, as it were, rescue from marriage. He calls it: his ultimate defeat! But he has slept well since then. Tormented soul. "

Individual evidence

  1. ↑ a b c d e f g h i Thure von Uexküll : Basic questions of psychosomatic medicine. Rowohlt Taschenbuch, Reinbek near Hamburg 1963; (a) to district “Change in two different directions”: p. 48; (b) Re. “Two-phase displacement”: p. 204; (c) Re. “Comparative frequency of psychosomatic symptoms in neuroses and psychoses”: p. 47; (d) to district “Integrationsraum” p. 234 f .; (e) on stw. "Adaptation" page 235 f .; (f) on Stw. “Layer theory and systematics” p. 205 f .; (g) Re. “Psychosomatic interactions also in psychoses” p. 48; (h) re. “Expression disease” p. 203; (i) Re. “Provisioning suffering” p. 206.
  2. ↑ Sigmund Freud : The defense neuropsychoses . [1894] In: GW , Volume I. Fischer, p. 63
  3. ↑ Dynamics (1). In: Uwe Henrik Peters : Dictionary of Psychiatry and Medical Psychology . 3. Edition. Urban & Schwarzenberg, Munich 1984, p. 141 f.
  4. ↑ Further sources: body diagram and the associated distinction between perception and imagination of one's own body.
  5. ↑ a b Sven Olaf Hoffmann , G. Hochapfel: Theory of Neuroses, Psychotherapeutic and Psychosomatic Medicine. [1999]. 6th edition. Compact textbook, Schattauer, Stuttgart 2003, ISBN 3-7945-1960-4 ; (a) on hysteria: pages 221, 230; (b) page 202.
  6. ^ Walter Christian: Clinical electroencephalography. Textbook and old glass . 2nd Edition. Georg Thieme, Stuttgart 1977, ISBN 3-13-440202-5 ; P. 174.
  7. ↑ Klaus Dörner , Ursula Plog: To err is human or textbook of psychiatry / psychotherapy. 7th edition. Psychiatrie-Verlag, Rehburg-Loccum 1983, ISBN 3-88414-001-9 ; Page 377 f.
  8. ↑ Karl Jaspers : General Psychopathology . 9th edition. Springer, Berlin 1973, ISBN 3-540-03340-8 , pages 130, 153, 190, 214 ff., 231, 259 f., 630
  9. ^ Franz Kafka : Letter to the father . Reclam Universal Library No. 9674, Stuttgart 1995, ISBN 3-15-009674-X , page, lines 43, 28 and 46, 14, cf. also the comments on this and on page 93 of the edition with excerpts from Kafka's letters, which are cited here after the footnote. On the concept of self-analysis, see the epilogue to this edition, page 104