In the day to day life occasions are many where a person meets stressful or traumatic life situation to which he may not be able to cope completely.
A social adjustment scale devised by Holmes and Rate lists 43 life events associated with different degrees of dis-organisation and stress in a person’s life, like death of spouse, children, divorce or marital separation, death of a close family member, loss of property, job, disease etc.
As findings of recent studies indicate, individuals who face these general stresses optimistically and boldly are less susceptible to develop a psychosomatic disorder, even if they develop such a disorder, the recovery becomes quick and easy. Besides the general stresses of life, certain specific personalities and conflicts are associated with Psychosomatic disorder.
Chronic and profound emotional tension brings significant changes in the human physiology and this ultimately leads to the development of various psychosomatic disorders. In this connection, the interacting roles of biological, socio-cultural and psychological variables in making an individual prone to psychosomatic disorders and maintaining them have been sensed.
As reported by Coleman (1981) the development of psychosomatic disorders by and large appears to involve the following sequence of events:
(a) Arousal of negative emotions in response to stress situations — the degree of arousal depending not only on the nature of the stress situation, but also upon the persons perception of the situation and his stress tolerance.
(b) The failure of these emotions to be dealt with adequately, either through appropriate expression or through a changed frame of reference or improved competence with the result that the emotional arousal continues on a chronic basis.
(c) Response stereotype — when the damaging effects of chronic arousal become concentrated on a specific organ.
Biological Variables:
The biological variables influencing psychosomatic disorders include genetic factors, differences in automatic reactivity, somatic weakness and alterations in corticovisceral control mechanism.
Genetic Factor:
Asthma, ulcers, migraine and hypertension in greater frequencies have been reported in the close relatives of the patients. Studies by Sines (1959) and Harvald and Hauge (1959) on animals indicate to some degree a specific genetic factor in ulcer susceptibility and bronchial asthma respectively.
Criticisms of the genetic explanation of psychosomatic disorder argue that recent studies on automatic nervous system show that psychophysiological disorder in a given family may result from common experience and imitation learning. However, in-spite of these criticisms it will not be wise to wipe out the genetic factor from the aetiology of the psychophysiological disorder.
Physical Factor:
Physical factor play an important role in the psychosomatic disorders as mental stress and anxieties etc. express themselves through physical organs. Coronary heart disease (CHD) is caused due to the damage of one of the coronary or heart arteries, high levels of saturated cholesterol and calories, high blood pressure, diabetes, mellitus; smoking, overeating and physical inactivity.
In peptic ulcer the excess gastric secretion (especially pepsin) destroys stomach lining tissue. Similarly, in colties the mucous lining of the colon is dissolved and may be eliminated in the stools. In asthma there is a narrowing of the air wave of the trachea, major bronchea and broncheoles. This narrowing of the airways may be caused by increased sensitivity to bacteria.
Differences in Autonomic Reactivity:
Psychophysiological disorders may be the outcome of individual’s primary reaction tendencies to stress. There is significant variation in the primary reaction tendencies in every infant. Different children react to some stress differently by developing specific types of physiological disorders, like fever, indigestion, sleep disturbances etc.
These individual differences in primary reaction tendencies during childhood continue in adult life and most probably account for the differences in susceptibility to psycho physiological disorders and also for the type of disorder one is likely to develop.
Wolff (1950) has in this connection suggested that on this ground people can be classified to stomach reactors, pulse reactors, nose reactors depending on what kinds of physical changes that stress characteristically triggers in them.
A person for example, who reacts to an emotional stress with high blood pressure will be susceptible to hyper tension. On the other hand, one who reacts with excessive secretion of stomach acids will be more likely to develop peptic ulcers.
Somatic Weakness:
From the experimental findings of Rees and White (1964) it is concluded that psychosomatic disorders occur specially in the weak or interior organ of the body which is produced usually due to heredity, illness or trauma.
For example, one who has respiratory infection may develop asthma to stress situations, who has a weak stomach may develop peptic ulcer or other gastro intestinal troubles to emotional stress like worry and anxiety.
Inadequate Cortico Visceral Control Mechanism:
According to Halberstam (1972) Lebedev (1967) when the corticovisceral control mechanism fail in their homeostatic functions, the individual shows exaggerated emotional responses and consequently within the normal time limit he does not regain the physiological equilibrium. This leads to psychophysiological disorder.
Conclusion:
So far as the role of biological factors in psychophysiological disorder is concerned, the maximum emphasis is given on the characteristic autonomic activity of the given individuals, the susceptibility of the effected organs and possible alternations in cortical control mechanisms that usually control autonomic functioning.
Psychosocial Factors:
Psychosocial explanation of psychophysiological disorder includes personality pattern, kinds of stress, interpersonal relationships and learning in the autonomic nervous system.
Personality Factor:
According to Dunbar (1945) as such rigid, highly sensitive to treat, short tempered persons are more susceptible to hypertension. It is also reported that different types of personality make up leads to different kinds of psychosomatic disorders. Kindson (1973) noted hypertensive persons are significantly more insecure, anxious, sensitive and angry than a non- hypertensive control group.
In spite of the importance of personality factor in the development of psychophysiological disorder, it is yet undecided why some individuals with more or less similar personality traits do not develop psychosomatic disorders. The following study of Jenkins supports this view.
Jenkins (1974) administered a questionnaire to 270 men who had no heart attacks and named certain people as Type A who strive diligently to achieve, are very punctual, time conscious, tense, unable to relax and active.
The men who scored high on Type a behaviour had twice as many heart attacks during the 4 year follow up period as against those who scored low. He also found that the majority of these people died of heart attacks while some of them who did not belong to this type had heart attacks.
Some studies have been conducted on the Indian patients with bronchial asthma by Rama Chandran and Thiruvengadam (1974) by the help of Eysenck’s pesonality inventory. They found that most of them were ambiverts leading towards extraversion and neuroticism.
In another study using the M.P.I. (Maudsley Personality Inventory) of Eysenck, Sridar (1975) studied different groups with peptic ulcers, hypertensions, irritable bowel syndrome and bronchial asthma and compared these groups with patients suffering from neuroses and physical illness.
His findings indicated that peptic ulcer, IBS and bronchial asthma patients were introverted and neurotic patients suffering from hypertension to be high only in neuroticism. In a study 3 groups of patients suffering from bronchial asthma, peptic ulcers and ischemic heart disease were compared with the control group by Shanmugam (1981).
He found that all the three groups were extroverted than the matched group free from disease. He further found that cardiac group was more extroverted than the bronchial asthma and peptic ulcer groups and all the psychophysiological groups were more neurotic than the control group. Finally within the three psychosomatic groups, the asthmatic group was more neurotic than the rest two groups.
In addition to the personality factors, the relationship between an individual’s attitude towards stressful situations and the coping pattern he develops has been emphasised by Graham (1962) in the development of psychosomatic disorder. He found the following attitude and coping pattern to be typical.
Ulcers:
The patient feels deprived of what is due to him and wants to get what is owed or promised and to get even.
Eczema:
The person feels that he is being frustrated, but he is helpless to do anything about it except take it out on himself.
Migraine:
He feels something has to be achieved. Drives self to reach a goal and then feels let down.
Asthma:
The patient feels unloved, rejected, left out in the cold.
Hypertension:
The person feels endangered, threatened with harm has to be ready for anything to be on guard. Though the work of Graham has stimulated a lot of interest in the area, there has not been any further study to support the findings of Graham.
Day-to-day observation also shows that many persons suffering from psychosomatic disorder seem to be restrained in their emotional reactions, rather appear to be unable to express their emotions adequately through verbal means.
They have also not learnt to use appropriate ego defences to channelize their emotions. Repression is the only defence mechanism which they use, but the physiological components of emotion leads to psychosomatic disorders.
Hokanson and Burgess (1962) experimentally induced frustration in some subjects and found that those who were given scope to express their physical and verbal aggression as a reaction to their frustration returned quickly to normal blood pressure and heart rate.
On the other hand, those who were not allowed to express their aggression returned to their normal rate of blood pressure and heart beat slowly, which ultimately creates field for psychosomatic disorder. Though personality factors and attitude cannot-account for the total cause of psychophysiological disorder, it can account partly.
Kinds of Stresses:
Alexander (1950) has made an attempt to relate the causes of psychosomatic disorder from an angle other than the personality pattern. He has hypothesized that each kind of psychophysiologic disorder may be connected to a particular type of stress. Peptic ulcers, for instance, according to him are associated with the frustration of the need for love and protection.
Frustration of these needs would lead to negative emotions like anger and anxiety which would aggravate secretions of stomach acids finally clearing the way for peptic ulcer. But this hypotheses could not receive support from subsequent researches in the area.
On the contrary, it can be assumed that a wide range stress situations can lead to a given type of disorder, and a wide range of disorders can result from a given type of stress.
Interpersonal Relationship:
Marital unhappiness, separation, death of near ones, divorce and other stressful interpersonal relationship may influence physiological functioning. In a study of widowers, Parkes, Benjamin and Fitzgerald (1969) found that during the 6 months period following the death of their wives the subjects showed a death rate of 40 per cent above the expected rate.
More-over, the incidence of cardiac deaths among these widowers was so high that investigator called these findings as the “broken heart syndrome”.
Some studies on asthmatic patients by Lipton et al. (1966), Olds (1970) indicate the relationship between pathogenic family patterns to psychophysiological illness. Mothers of such patients were found to be ambivalent and overprotective towards their children and tended to reject them as well as unduly restrict their activities. People coming from such families are likely to be over dependent and insecure.
As a result they are likely to react to normal problems with emotional stress. But at any rate, it is yet a question unanswered, a riddle, why some of these individuals develop psychophysiological disorders, while other can adjust to stressful situations adequately?
Learning in the Autonomic Nervous System:
Pavlov including several other investigators has shown that autonomic responses can be conditioned and in particular, operant conditioning can also be used in this regard. Turnbull (1962) has effectively shown that by reinforcing certain breathing behaviour the ‘E’ can induce respiratory patterns that are progressively closer to asthmatic breathing.
Thus, it has been hypothesized that psychophysiological disorders may occur through accidental conditioning and reinforcement.
For example, by simply crying the child may not be able to draw his mother’s attention. But when he shows grasping or wheezing reactions, he may immediately draw the attention of his mother, with the repetition of this pattern of behaviour; the infant might learn through conditioning an asthma like response as a technique of getting parental attention and alleviating distress.
Psychosomatic disorders therefore as it appears, bring certain secondary gains, like attention and care, security and sympathy from the desired persons.
Sociocultural Factors:
Although psychophysiological disorder vary in incidence from culture to culture and society to society, in the same culture they do not appear to be affected by them.
Through psychosomatic disorders are rarely found in primitive people, like the abrogines of the Western Australian Desert, among the Navojo Indians of Arizona, U.S.A. and among some primitive groups in South America, primitive societies experiencing rapid social changes were found to develop this disorder.
For example, in Japan since the second World War, he incidence of bronchial asthma and irritable colon have significantly increased among the young while hypertension and heart attacks have increased markedly among adults.
Similarly in U.S.A. arthritic was most frequently found in the lower S.E.S. people whereas ulcers and heart problems were most commonly found among executives. But the recent findings do not support strongly these views.
The review by Senay and Redtick (1968) indicated that psychosomatic disorders were not related to social class or other major sociocultural variables. Secondly, stress and emotional tension have become common occurrences in every home and in different strata of society irrespective of culture or creed. So the role of S.E.S. in the causation of psychosomatic disorders may not be very much emphasised.
Treatment:
Before taking steps of treatment of the psychophysiological disorders it is essential to determine two important points i.e., the nature and severity of the organic pathology and the part played by the psychosocial and organic variables in total cause pattern.
For instance, in causation of hypertension, the role of dietary factors is of prime importance in the current psychosocial variables. Except for psychophysiological disorders involving severe organic pathology, treatment of psychophysiological disorder is similar to the other types of neuroses.
Biological Measures:
Apart from the medical treatment for psychosomatic disorders, like bleeding ulcers or coronary heart disease biological treatment centres around the use of mild tranquilizers for reducing emotional tension. These drugs help in alleviating emotional tension and other distressing symptoms which may provide the patient with a breathing spell during which he can regroup his coping power.
Drugs are also presented to control high blood pressure — dietary precautions are advised in peptic ulcer, migraine headache and hypertension. Acupuncture is also used for alleviating backache, tension and migraine headache and the pain of rheumatoid arthritis.
In neuroses, electro sleep-cerebral electrotherapy has produced mixed results in psychophysiological disorder. Morita therapy which involves deprivation of external stimuli according to Murase and Johnson (1974) has been found to be effective with a number of psychophysiological and neurotic disorders.
Psychosocial Measures:
Family therapy has proved some effect in the treatment of children suffering from bronchial asthma and other psychophysiological disorders. Cognitive psychotherapies with an aim to help the person to understand his problems and achieve more successful coping techniques, have been quite effective. However, behaviour therapy and bio-feed back have proved to be most successful psychosocial measures.
Behaviour Therapy:
It is based on the assumption that since autonomic responses can be learned they can also be unlearned through extinction and differential reinforcement According to Wolpe these techniques have been specially useful in the treatment of asthma, peptic ulcer, neurodermatitis, migraine and other psychophysiological disorders through desensitization procedures.
Recently quite a number of behaviour therapists have with considerable success used the suggestion and training in relaxation to treat varied type of psychosomatic disorders. To quote a few, Hinkle (1972) got effective results in treating tension headaches.
Philip, Wilde and Day (1972) successfully treated asthmatic attacks. A number of cases of successful treatment of childhood asthma by conditioning technique has been cited by Lukeman (1975). Kahn, Staerk and Bank (1973) treated 20 asthmatic children through counter conditioning.
Bio-Feed Back:
Information’s about the autonomic functions like heart rate and brain waves in the form of signals like sound or light is provided by the bio-feed back technique. These signals enable the individual to have control over heart rate, brain wave and other autonomic functions.
Currency, bio-feed back technique has been used widely for the control of several psychophysiological disorders like headache, hypertension, backaches, epilepsy, muscular spasms, sexual impotency, teeth grinding, asthma and irregular heartbeats.
However, mixed findings have been obtained regarding the actual magnitude and duration of the effects of such treatment procedure. For example, asthma cases were alleviated only in mild cases but not in severe cases. On the other hand, Budzynski (1974) pointed out that 81 per cent of his patients suffering from migraine headaches were cured to a significant extent by bio-feed back training.
With the development of more effective and sophisticated bio-feed back techniques, probably it would be possible to control a lot of autonomic functions like heart rate, blood pressure, stomach acid secretion and be able to prevent many psychophysiological disorders of his own.
But nevertheless, the conducive attitude of the person and his capacity to deal with the coping technique will facilitate the effectiveness of bio-feed back technique in dealing with certain specific stresses in his life situation.
Conclusion:
Tension, stress and anxiety can have tangible effects on human bodies. Many people who are turning to self relaxation techniques as such yoga and transcendental meditation seem to be pressurized by the burden of stress and anxiety.
In the current stress provoking and emotion loaded society it is quite difficult to control the stress and anxiety. Consequently, psychosomatic disorders are increasing rapidly day-by-day. Under these circumstances treatment of psychophysiological disorders seems to be imperative.
The various treatment methods discussed above should be applied as and when necessary keeping in view the nature of the disease and condition of the patient.