Psychological processes in somatic disease

Abstract: PSYCHOLOGICAL PROCESSES IN SOMATIC DISEASE Noomi Elander Lindberg Contents The course of disease was investigated in three studies of patients with rheumatoid arthritis (RA). The aim was to explore changes in clinical course during and after psychodynamically oriented psychotherapy, with one session of 60-90 minuteds per week for 3.3 years as a median. The most innportant study of these three is Study II which included 15 RA patients treated with the above type of psychotherapy. A retrospective evaluation of psychic and somatic states at each therapy session and medical examination during a study period of 4 years was made on the basis of detailed therapy notes and medical records, respectively. A method with "life lines" was used to illustrate the course of psychic state and of rheumatic disease. Result. Six patients improved, on the whole continuously, both psychically and somatically throughout the study period and for a long time thereafter. Another five patients improved during the first 1 - 2 years. Later, when emotional links to childhood trauma were opened up these patients regressed and the course of rheumatic disease and psychic state became more varied. In four cases, there was greater variety in both the course of psychic state and the course of rheumatic disease. Nevertheless, after the psychotherapy period all patients had returned to their professional work again. These results were in accordance with those in a previous Study I. In a 20-years' follow-up of an earlier group (Study III) there were indications that favourable results from psychotherapy could be sustained for a very long time. Study IV. In a group of nine female assembly workers the rate of sick leave due to neck/shoulder pains was 14% despite the fact that ergonomic measures had been taken in accordance with the prescriptions of the Labour Inspectorate.The women felt "repressed and trodden upon from above". When the management director was pesuaded radically to improve his attitude towards these women, the sick-leave rate fell below 1 % . Studv V. Psychosomatic connections in 11 patients suffering from amalgam illness were verified by means of in-depth psychodynamic interviews. Two patients who completed the interview with insight therapy noted improvements in their emotional stability. Conclusion. Psychoanalytically oriented treatment of patients with the above somatic diseases and who are willing to cooperate with it, can be a valuable contribution to the therapeutic arsenal.