Psychosomatic Illness: A Problem in Communication

The transcripts of recorded clinical psychiatric interviews with 20 patients (8 women and 12 men) suffering from psychosomatic illness were studied to ascertain the nature of their mental content and their capacity to experience affect. In 16 of the 20 patients there was evidence of a form of mentation that appears to have escaped the explicit attention of all but a few investigators: 1) These patients manifested either a total unawareness of feelings or an almost complete incapacity to put into words what they were experiencing. 2) The associations of the majority of the patients were characterized by a) a nearly total absence of fantasy or other material related to their inner, private mental life of thoughts, attitudes and feelings, and b) a recounting, often in almost infinite detail, of circumstances and events in their environment, including their own actions. Their thoughts, that is, were stimulus-bound rather than drive-directed.