This PowerPoint presentation developed in 2010 to be presented at a number of professional development lectures and workshops. It is also being used in a modified form at the Jansen Newman Institute's Master of Counselling and Applied Psychotherapy program (PSY616 - Working with Psychosomatic Signs and symptoms).

1. Learning for Sustainable Living
Psychosomatic and
Environmental Medicine
Example: Cancer
Werner Sattmann-Frese PhD

2. Werner Sattmann-Frese (PhD)
• Werner is a psychotherapist and social
ecologist working as a Senior Lecturer and
Program Manager at the Jansen Newman
Institute / Think Education in Sydney (
www.jni.edu.au). He is also developing a
learning program on sustainable living at
www.lfsl.info.
• You can contact him at slse.bigpond.net.au

3. Definition of Psychosomatic Medicine
• Blakiston's Medical Dictionary gives the
following definition of psycho-somatics:
“Psychosomatics is the branch of
medicine dealing with psychic and
physical components as a unit, and the
interrelationship between them”
(Blakiston's Medical Dictionary, p. 67).

4. The origin of the term
• The term psychosomatic medicine was
coined by the German physician and
psychiatrist Johann Christian August
Heinroth in 1818. It was then used for some
years in a moralistic and ethical sense but
quickly disappeared because of the growing
influence of the developing natural sciences.

5. Revival of the term
• The term was revived again by Sigmund
Freud in connection with his successful
psychoanalysis of Miss von R.

6. Case of Elisabeth von R.
• Fraeulein (Miss) Elisabeth von R." is the pseudonym
Freud gave to Ilona Weiss, a young woman of
Hungarian origin, whose case is described in the
Studies on Hysteria (1895d) and whom he treated in
the fall of 1892 and July 1893. The third daughter in a
well-to-do Hungarian family, Elisabeth von R. was
twenty-four years old when Freud treated her in the
autumn of 1892 for pains in her legs and difficulties
with walking, problems she had been experiencing
for two years.
• http://www.answers.com/topic/elisabeth-von-r-case-
of.

7. Case of Elisabeth von R.
• An improvement occurred when she herself
provided the source of her hysterical
conversion: Her pains began at the spot on her
thigh where, every morning, her father placed
his inflamed leg so she could change his
bandages.
• From then on "her painful legs began to 'join in
the conversation' during our analyses" (1895d,
p. 141).

8. Case of Elisabeth von R.
• Freud writes, "I sometimes followed the
spontaneous fluctuations in her condition; and I
sometimes followed my own estimate of the
situation when I considered that I had not
completely exhausted some portion of the story
of her illness" (1895d, p. 149).

9. Three Key Views on Illness
• Psychological and emotional processes are
causative factors of somatic illness (Freud
and others).
• The somato-psychosomatic circle
(Overbeck).
• Illness is an expression of our lack of all-
consciousness and challenges us to become
conscious of ourselves and to find back to
our spiritual roots (Dethlefsen).

10. What about the natural environment?
• Emotional and physical llness (dis-
ease) has to be viewed from many
different perspectives and related to
many contexts!

11. Issues affecting the health and well-being of human
and other living beings

12. Many factors contributing to illness relate
to the ‘perils of progress’.
o These include:
• Noise
• Pesticides
• Formaldehydes
• Food irradiation
• Nanoparticles
• Cadmium and aluminum in food
• Microwaves, electric, and electromagnetic fields
• Artificial light
• Pollution of water

13. Issues affecting the health and well-being of the
web of life

14. Signs and Symptoms
• A symptom denotes a subjective state or
a subjective experience, whereas a sign
denotes an ‘objectifyable’ pathological
manifestation of an illness, that is
something that can be measured and
identified by an external observer.

15. Help versus healing
• Conventional medicine calls a
therapeutic intervention a success
when the symptom disappears.
• Psychosomatic medicine insists that
healing is about making symptoms
redundant by using symptoms as
guides to a deep understanding of a
person’s lack of wholeness and
wellness.

16. Symptoms as communication
• Wesiack and Uexkuell point out that a
person who communicates by means of
symptoms is doing this without the
conscious intention to inform the receiver
of the his or her inner state. Symptoms are
forms of unconscious communication in
contrast to the spoken word with which a
person consciously tries to convey a
feeling or an idea (Uexkuell, 1990, p. 36).

17. Symptoms may be regarded as the physical
signs of an organismic expression without the
associated feeling attached
• Alexander writes: “Every emotional state has its
own physiological syndrome. Increased blood
pressure and accelerated heart action are a
constituent part of rage and fear. Increased
stomach secretion may be a regressive
response to an emergency. Attacks of asthma
are correlated with an unconscious suppressed
impulse to cry for the mother’s help” (Alexander,
1950, p. 68).

18. Deep down we know …
• Dethlefsen suggests that: “Every sick person
feels deep down that his [sic] illness must have
something to do with the way he [she] is. He
experiences a certain sense of guilt, for he
knows that his illness signifies more than just a
malfunctioning of his body. But this approach is
immediately stifled by the doctor with the
assurance that the whole thing is “nothing
but...” (Dethlefsen, The Challenge of Fate, p.
108).

19. Aspects of conflict
• Conflict: Opposition between apparently or
actually incompatible forces. Internal or
psychological conflict may be between
instinctual impulses, (e.g., libidinal and
aggressive, see also instinct) or between
structures (e.g., ego and id).

20. Aspects of Conflict (2)
Sydney Morning Herald 15/11/2006

21. The primary and secondary gains of
illness
Primary and secondary gains correspond to
the direct or indirect advantages that
individuals gain from their illness. The
primary gain is a constitutive element of the
illness that is present in the very motive of
the illness. The secondary gain is an
addition to the primary gain and comes into
play at a later stage. It consolidates the
disorder.

22. Primary and secondary gains of Illness
Primary gain subdivides into two parallel
aspects. In the internal part, illness remains the
most economic solution in cases of conflict, and
this is the "flight into illness." The external part is
linked to profitable arrangements occasioned in
the individual's relational life.
http://www.answers.com/topic/gain-primary-and-
secondary

23. Wiesbaden Kurpark
Fancy a cure (secondary gain) at Wiesbaden resort?

24. Franzensquelle - Franzensbad
http://de.wikipedia.org/
wiki/Franzensbad

25. Primary and secondary gains of illness
The secondary gain assists the ego in its
effort to incorporate the symptom into the life
with a sick role. It procures a satisfaction that
is narcissistic or linked to self-preservation.
Harrison, Love your disease, it is keeping
you healthy

26. Tertiary gain of illness
• Tertiary Gain was first proposed by Dansak in 1973 as an
important factor in modulating and motivating illness behavior.
Tertiary gain is defined as a gain sought or attained from a
patient’s illness by someone other than the patient. Often the
caregiver may benefit from the doctor-patient relationship by:
fulfilling altruistic needs, representing the “little man” against
Goliath (big corporation/ government), withdrawing from
confronting the patient with the truth, establishing oneself as a
patient advocate, avoiding intellectual honesty, and attacking
professional detractors.
• Dansak, DA On the tertiary gain of illness. Compr Psychiatry.
1973 Nov-Dec;14(6):523-34. No abstract available. PMID:
4764353 [PubMed - indexed for MEDLINE]

27. Question: Who is gaining from selling this?

28. Answer:
• Pfizer, the largest pharmaceutical
company in the world.
• In case you want to know what this
chemical structure represents:
Sildenafil- also known as Viagra.

29. Signs and Symptoms Toolbox (1)
A person’s self may:
• choose a certain organ to manifest
• create an inflammation
• create pain
• develop a tumor
• create a swelling by accumulating body fluids
• increase the body temperature
• block or exaggerate nervous impulses
• transform one form of tissue into another

30. Possible signs and symptoms (2)
• prevent parts of the bodymind from growing
• open the bodymind to the invasion of foreign
organisms
• create chronic muscle contractions
• create alternative metabolic pathways
• starve the periphery of the body of nutrients
• reduce or exaggerate the functionality of the
senses
• cry out for love or push people away through
skin lesions, etc.

31. These signs and symptoms may point at:
• conflicts with love and commitment
• limitations of energy and emotional and
physical exhaustion
• conflicts with social and emotional
boundaries
• conflicts with the expression of anger and
rage
• conflicts with independence and dependence,
and
• difficulty in handling guilt.

32. They may also point at:
• difficulty in expressing needs for nurturing
and body contact
• difficulty in expressing sexual needs and
excitement
• conflicts with the awareness and expression
of fear, and
• difficulty in grieving the loss of another
person or a loss of function associated with
ageing or a disability.

33. Alexithymia (1)
• Alexithymia literally means being
without words for feelings. It is a term
coined by Peter Sifneos in 1973 to
describe a state of deficiency in
understanding, processing, or
describing feelings and emotions.

34. Alexithymia (2)
• Alexithymia is defined by:
• 1.difficulty identifying feelings and distinguishing
between feelings and the bodily sensations of
emotional arousal
• 2.difficulty describing feelings to other people
• 3.constricted imaginal processes, as evidenced by
a paucity of fantasies
• 4.a stimulus-bound, externally oriented cognitive
style
• (http://en.wikipedia.org/ wiki/Alexithymia).

35. Causes of cancer (1)
• There are about 200 different types of cancer
affecting all the different body tissues. What affects
one body tissue may not affect another. For example,
tobacco smoke that you breathe in may help to cause
lung cancer. Overexposing your skin to the sun could
give you a melanoma on your leg. But the sun won't
give you lung cancer and smoking won't give you
melanoma.
• http://www.cancerhelp.org.uk/help/default.asp?
page=119#multi_fact

36. Causes of cancer (2)
• Carcinogens: A 'carcinogen' is something that can help to
cause cancer. Tobacco smoke is a powerful carcinogen.
• Age: Most types of cancer become more common as we
get older. This is because the changes that cause a cell to
become cancerous in the first place take a long time to
develop.
• Genetic make up There have to be a number of
genetic mutations within a cell before it becomes
cancerous. Sometimes we are born with one of these
mutations already.
• http://www.cancerhelp.org.uk/help/default.asp?
page=119#multi_fact

37. Causes of cancer (3)
• The immune system: People who have problems with
their immune systems are more likely to get some forms of
cancer. This group includes people who
– Have had organ transplants and take drugs to
suppress their immune systems to stop organ rejection
– Have AIDS
– Are born with rare medical syndromes which affect
their immunity
http://www.cancerhelp.org.uk/help/default.asp?
page=119#multi_fact

38. Causes of cancer (4)
• Diet: Cancer experts estimate that changes to our diet
could prevent about one in three cancer deaths in the UK.
In the western world, many of us eat too many animal fats
and not enough fresh fruit and vegetables. This type of
diet is known to increase your risk of cancer.
• Day to day environment: By this we mean what is
around you each day that may help to cause cancer. This
could include
– Tobacco smoke
– The sun
– Natural and man made radiation
– Work place hazards
– Asbestos
• http://www.cancerhelp.org.uk/help/default.asp?
page=119#multi_fact

39. Causes of cancer (5)
• A form of pollution still neglected by most environmentalists is
electromagnetic pollution, also called ‘electrosmog’. According
to the researchers cited on websites such as
www.wissenschaft-unzensiert.de, www.funksmog.org;
www.oekosmog. de, the technology associated with mobile
phones has been identified as capable of leading to:
– increases in the risk of brain cancers
– biological damage to the brain through heating effects
– symptoms such as headaches, earaches, bad sleep, fatigue,
blurring of vision, short-term memory loss, numbing and
tingling
– so-called ‘hot spots’ in the brain that can contribute to the
emergence of Alzheimer’s disease
– bouts of epilepsy and facial rashes and swelling.

40. Psychosomatic views of cancer (1)
The studies of Bahnson (1964) and his colleagues (1979)
support the hypothesis that cancer patients rely heavily on
denial and repression. Bahnson found that cancer
patients, unlike persons in three control groups,
remembered their parents as noninvolved, cold and not
participatory in their early emotional lives. They concluded
that the rigid defensiveness and lack of self-
communication in cancer patients may be related to early
family patterns. From: The Psychiatric Response of
Personality and Immunity to Cancer - Elsa Colby-Morley,
Ed.D.,Ph.D.1(http://www.orthomolecular.org/library/jom/19
82/pdf/1982-v11n03-p185.pdf

41. Psychosomatic views of cancer (2)
• Bahne-Bahnson (1982) also proposes that
people suffering from cancer are
experiencing, in a psychosomatic way, old
emotional deficits around nurturing. He
argues that people suffering from cancer take
over the role of the nurturer, whereby the
tumor symbolises the inner child that is
struggling with the effects of deprivation.
Sadly, in this symbolic scenario the growing
inner ‘baby’ is destroying its mother.

42. Loss of Identity
• A typical feature of cancer cells is their
loss of identity and sense of socially
responsible behaviour in the human
body. Rather than identifying with the
organ of which it has become a part
during the organism’s ontogeny, cancer
cells grow for the sake of growing.

43. Anarchy in the organism
• This fact has led Henschel and Vester (1977)
to regard cancer as a disorganised way of
living, whereas Dethlefsen and Dahlke (1990)
describe cancer as a state of anarchy in the
organism. The latter authors regard cancer
cells as anarchists who have stopped playing
to the rules of the organism, but follow their
own ‘motives’. Why would they do that?

44. Earth Cancer
• Weigel (1995, p. xii) writes:
– An invasive and unrestrained malignant cell is to human
cancer what an invasive and unrestrained human being is
to earth cancer. Both represent an aberrant version of
their original constitution; both are permitted to thrive
because of a systemic imbalance; both are deadly to the
health of the organism. In the same vein, the
anthropologist Hern (1990) draws our attention to the
growth of London from 1800 to 1955 as an expanding,
invasive and malignant tumor, whereas Roszak (2001)
describes the spread of urban conglomeration as ‘Gaia’s
City Pox’.

45. What is needed to protect our health and
wellbeing?
• A commitment to maintaining physical and emotional
wellness
• An engaging in appropriate lifestyle choices
• Education on environmental health hazards
• Conflict identification and resolution skills
• An holistic understanding of the world
• Social change and a willingness to work with the
causes of exploitation
• A focus on social, spiritual, and emotional growth and
progress.

46. Bibliography (1)
• Alexander, F 1950, Psychosomatic Medicine: Its Principles
and Applications, Norton, New York.
• Blakiston’s, (1980) Pocket Medical Dictionary, McGraw-Hill,
New York.
• Csikszentmihalyi, M 1992, Flow: The Psychology of
Happiness, Rider, Sydney.
• Bahne-Bahnson, C 1982, ‘Psychosomatic Issues in Cancer’,
in RL Gallon (ed.) The Psychosomatic Approach to Illness,
Elsevier North Holland, New York
• Dethlefsen, T 1984, The Challenge of Fate, Coventure,
London.
• Dethlefsen, T & Dahlke, R 1990, The Healing Power of
Illness, Element, Brisbane, QLD, Australia.

47. Bibliography (2)
• Henschel, G & Vester, F 1977, Krebs – fehlgesteuertes
Leben, Deutscher Taschenbuch Verlag, Munich,
Germany.
• Hern, WM 1990, ‘Why Are There So Many of Us?
Description and Diagnosis of a Planetary Ecopathological
Process’, Population and Environment, vol. 12, no 1, pp.
9-39.
• Overbeck, G 1984, Krankheit als Anpassung, Suhrkamp
Verlag, Frankfurt/Main, Germany.
• Roszak, T 2001, The Voice of the Earth: An Exploration of
Ecopsychology, Phanes Press, York Beach, ME, USA.

48. Bibliography (3)
• Von Uexkuell, T 1963, Grundfragen der
psychosomatischen Medizin, Rowohlt Taschenbuch
Verlag, Reinbek, Germany.
• Von Uexkuell, T Adler, R, Herrmann, JM, Köhle, K
Schonecke, OW Wesiack, W (eds.) 1979,
Psychosomatische Medizin, Urban & Schwarzenberg,
Munich, Germany.
• Weigel, VB 1995, Earth Cancer, Praeger, Westport,
CT, USA.