A Psychosomatic Theory of Thyrotoxicosis

Abstract

X jrUCH accumulated knowledge exists concern-J -V J . » n g the pathophysiology and histology of Graves' disease, and the presence and precipitating role of psychologic factors are well established. The ultimate etiology and, in particular, the nature of the psychologic influences are still unknown.The emotional concomitants of thyrotoxicosis are discussed in detail in the clinical literature, and there are a large number of well-documented observations on the precipitation of the thyrotoxic state by emotional trauma: a phenomenon expressed most succinctly by the term "shock Basedow." Only a few investigators, including Nolan Lewis (33), Agnes Conrad (11), Brown and Gildea (8), Lidz and Whitehorn (34, 35) have studied patients from a psychodynamic point of view. These workers have demonstrated the presence of certain personality features in this disease. Our study consisted of the analysis of material from anamnestic interviews of 23 patients and multiple psychoanalytic interviews of one patient.Our first aim was to determine the psychodynamic constellations in which the characteristic psychologic factors appear. As a result of these studies, it has been possible to propose a psychologic gestalt which includes both our own results and the physiologic and psychologic findings of previous observers. This presents a comprehensive picture which throws light on the development of the disease, upon spontaneous remissions as well as the response to treatment. We propose to demonstrate that the disease symptoms can be understood as the organism's responses to the early experiences of development which are characteristic for these patients. In this response the thyroid gland is only one effector link in a chain of physiologic events. More specifically, the physiologic response can be well understood

The Diagnosis of Thyrotoxicosis

“…refuses to carry out efficiently the dictates of a relatively active mind. A psychosomatic theory of toxicosis has been developed by Ham et al (1951). find that the condition tends to occur in individuals frustrated in early life who make continued efforts towards premature self-sufficiency, and when these fail develop chronic anxiety.…”

Endocrine Treatment in Psychiatry

“…Ham et al (1951) have agreed some others that symptoms of thyrotoxicosis can be understood as the patient's response to early experiences and although the experiences differ in detail they fall into pattern characteristic of the disease. In all the patients they studied there were extreme feelings of insecurity early life, a strong sense of responsibility, but a tendency to suffer in silence; this is in some contrast to the anxious patient, who has no such tendency.…”

Association between Psychoneurosis and Thyroid, Musculoskeletal and Intestinal Disorders in Four Agricultural Collective Settlements in Israel

“…(8)) and thyro toxicosis (Ham, G.C., Alexander, F. and Carmichael, H .T . (9,10); Lidz, T. (11,12)) have been considered as somatic expressions of psychoneurosis, and recently Monat (13) expressed the possibility of hypochondrical and mental manifestations of anxiety and depression as a result of chronic amebiasis.…”