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Psychosomatic Concepts in Atopic Dermatitis—a Critique

ADOLPH ROSTENBERG, Jr., M.D.
[+] Author Affiliations

Submitted for publication Jan. 29, 1959.

Based on a talk given at the 17th annual meeting of the American Academy of Dermatology and Syphilology, Chicago, December, 1958.


Chicago

From the Department of Dermatology, University of Illinois.


Arch Dermatol. 1959;79(6):692-699. doi:10.1001/archderm.1959.01560180066017
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The term "psychosomatic" is a relatively new one, but the concept of "psychosomatic disease" is of ancient lineage. Plato, in his dialogue, "Charmides," has Socrates say, "The great error of our day in the treatment of the human body is that physicians separate the soul from the body." Socrates was right. A man is a man, and he reacts neither psychologically nor somatically but as an integrated unit. Thus, strictly speaking, all diseases are psychosomatic. Such a view, while conceptually correct, is not the most practical; but, unfortunately, neither the term "psychosomatic" nor the boundary of the concept of a "psychosomatic disease" have been precisely defined. Few would be impressed with the relationship of the psyche to the rash of measles; yet many would wish to explore the interconnections of the psyche and the development of neurotic excoriations.

While it seems preposterous to discuss the psyche and

REFERENCES

It might be pointed out that the usual relation of the sine qua non factor to the over-all symptomatology is an intransitive one, i. e. its presence is necessary but is not sufficient.
The term "anterospective" was given to me by Dr. Mark Lepper.
Gottesman, A. H., and Menninger, K.:  The Dermatologist and the Psychiatrist , Arch. Dermat. & Syph. 59:367-373 ( (April) ) 1949;.
Grinker, R. R.: Psychosomatic Research , New York, W. W. Norton & Company, 1953;,
Mendelson, M.: Psychosom. Med. 18:363 ( (Oct.) ) 1956;.
Sontag, L. W.:  The Purpose and Fate of a Skin Disorder , Psychosom. Med. 7:306-310 ( (Sept.) ) 1943;.
Allendy, R.:  A Case of Eczema , Psychoanalyt. Rev. 19:152-163 ( (April) ) 1932;,
Bartemeier, L. H.: Psychoanalyt. Quart. 7:216-231 ( (April) ) 1938;.
Greenhill, M., and Finesinger, J. E.:  Neurotic Symptoms and Emotional Factors in Atopic Dermatitis , Arch. Dermat. & Syph. 46:187-200 ( (Aug.) ) 1942;.
Lynch, F. W.; Hinckley, R. G., and Cowan, D. W.:  Psychosomatic Studies in Dermatology: B. Psychobiologic Studies of Patients with Atopic Eczema (Disseminated Neurodermatitis) , Arch. Dermat. & Syph. 51:251-260 ( (April) ) 1945;.
Walsh, M. N., and Kierland, R. R.:  Psychotherapy in the Treatment of Neurodermatitis , Proc. Staff Meet. Mayo Clin. 22:578-584 ( (Dec. 10) ) 1947;.
Allerhand, M. E.; Gough, H. G., and Grais, M. L.:  Personality Factors in Neurodermatitis , Psychosom. Med. 12:386-390 ( (Nov.) -Dec.) 1950;.
Cormia, F. E.:  The Role of Psychosomatic Factors in Dermatoses , Connecticut M. J. 14:1051 ( (Dec.) ) 1950;.
Kepecs, J. G.; Rabin, A., and Robin, M.:  Atopic Dermatitis: A Clinical Psychiatric Study , Psychosom. Med. 13:1-9 ( (Jan.) -Feb.) 1951;.
Wittkower, E., and Edgell, P. G.:  Eczema , A. M. A. Arch. Dermat. & Syph. 63:207-219 ( (Feb.) ) 1951;.
McLaughlin, J. T.; Shoemaker, R. J., and Guy, W. B.:  Personality Factors in Adult Atopic Eczema , A. M. A. Arch. Dermat. & Syph. 68:506-516 ( (Nov.) ) 1953;.
Fiske, C. E., and Obermayer, M. E.:  Personality and Emotional Factors in Chronic Disseminated Neurodermatitis , A. M. A. Arch. Dermat. & Spyh. 70:261-267 ( (Sept.) ) 1954;.
Cleveland, S. E., and Fisher, S.:  Psychological Factors in the Neurodermatoses , Psychosom. Med. 18:209-220 ( (May) -June) 1956;.
White, J. M.; Jones, A. M., and Ingham, J. G.:  A Rorschach Study of the Neurodermatoses , J. Psychosom. Res. 1:84-93 ( (Feb.) ) 1956;.
Macalpine, I.:  Psychosomatic Symptom Formation , Lancet 1:278 ( (Feb. 9) ) 1952;.
Spitz, R. A.:  The Psychogenic Diseases in Infancy , Psychoanalyt. Study of Child 6:255, 1951;.
Rosenthal, M. J.:  Psychosomatic Study of Infantile Eczema: I. Mother-Child Relationship , Pediatrics 10:581-591 ( (Nov.) ) 1952;.
Williams, D. H.:  Management of Atopic Dermatitis in Children: Control of the Maternal Rejection Factor , A. M. A. Arch. Dermat. & Syph. 63:545-560 ( (May) ) 1951;.
Marmor, J.; Ashley, M.; Tabachnick, N.; Storkan, M., and McDonald, F.:  The Mother-Child Relationship in the Genesis of Neurodermatitis , A. M. A. Arch. Dermat. 74:599-605 ( (Dec.) ) 1956;.
Alexander, F., and Ross, H. (ed.): Dynamic Psychiatry , Chicago, University of Chicago Press, 1952;, p. 374.
Alexander, F.: Psychosomatic Medicine , New York, W. W. Norton & Company, Inc., 1950;, pp. 68-70.
Bandler, B.:  Some Conceptual Tendencies in the Psychosomatic Movement , Am. J. Psychiat. 115:36-43 ( (July) ) 1958;.
Szasz, T. S.:  Oral Mechanisms in Constipation and Diarrhea , Internat. J. Psycho-Analysis 32:196, 1951;,
Alexander, F., and Ross, H.: Dynamic Psychiatry , Chicago, University of Chicago Press, 1952;, p. 381.
Rostenberg, A., Jr.:  Atopic Dermatitis: A Discussion of Certain Theories Concerning its Pathogenesis , Am. Pract. & Digest Treat. 6:1094-1101 ( (July) ) 1955;.

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It might be pointed out that the usual relation of the sine qua non factor to the over-all symptomatology is an intransitive one, i. e. its presence is necessary but is not sufficient.
The term "anterospective" was given to me by Dr. Mark Lepper.
Gottesman, A. H., and Menninger, K.:  The Dermatologist and the Psychiatrist , Arch. Dermat. & Syph. 59:367-373 ( (April) ) 1949;.
Grinker, R. R.: Psychosomatic Research , New York, W. W. Norton & Company, 1953;,
Mendelson, M.: Psychosom. Med. 18:363 ( (Oct.) ) 1956;.
Sontag, L. W.:  The Purpose and Fate of a Skin Disorder , Psychosom. Med. 7:306-310 ( (Sept.) ) 1943;.
Allendy, R.:  A Case of Eczema , Psychoanalyt. Rev. 19:152-163 ( (April) ) 1932;,
Bartemeier, L. H.: Psychoanalyt. Quart. 7:216-231 ( (April) ) 1938;.
Greenhill, M., and Finesinger, J. E.:  Neurotic Symptoms and Emotional Factors in Atopic Dermatitis , Arch. Dermat. & Syph. 46:187-200 ( (Aug.) ) 1942;.
Lynch, F. W.; Hinckley, R. G., and Cowan, D. W.:  Psychosomatic Studies in Dermatology: B. Psychobiologic Studies of Patients with Atopic Eczema (Disseminated Neurodermatitis) , Arch. Dermat. & Syph. 51:251-260 ( (April) ) 1945;.
Walsh, M. N., and Kierland, R. R.:  Psychotherapy in the Treatment of Neurodermatitis , Proc. Staff Meet. Mayo Clin. 22:578-584 ( (Dec. 10) ) 1947;.
Allerhand, M. E.; Gough, H. G., and Grais, M. L.:  Personality Factors in Neurodermatitis , Psychosom. Med. 12:386-390 ( (Nov.) -Dec.) 1950;.
Cormia, F. E.:  The Role of Psychosomatic Factors in Dermatoses , Connecticut M. J. 14:1051 ( (Dec.) ) 1950;.
Kepecs, J. G.; Rabin, A., and Robin, M.:  Atopic Dermatitis: A Clinical Psychiatric Study , Psychosom. Med. 13:1-9 ( (Jan.) -Feb.) 1951;.
Wittkower, E., and Edgell, P. G.:  Eczema , A. M. A. Arch. Dermat. & Syph. 63:207-219 ( (Feb.) ) 1951;.
McLaughlin, J. T.; Shoemaker, R. J., and Guy, W. B.:  Personality Factors in Adult Atopic Eczema , A. M. A. Arch. Dermat. & Syph. 68:506-516 ( (Nov.) ) 1953;.
Fiske, C. E., and Obermayer, M. E.:  Personality and Emotional Factors in Chronic Disseminated Neurodermatitis , A. M. A. Arch. Dermat. & Spyh. 70:261-267 ( (Sept.) ) 1954;.
Cleveland, S. E., and Fisher, S.:  Psychological Factors in the Neurodermatoses , Psychosom. Med. 18:209-220 ( (May) -June) 1956;.
White, J. M.; Jones, A. M., and Ingham, J. G.:  A Rorschach Study of the Neurodermatoses , J. Psychosom. Res. 1:84-93 ( (Feb.) ) 1956;.
Macalpine, I.:  Psychosomatic Symptom Formation , Lancet 1:278 ( (Feb. 9) ) 1952;.
Spitz, R. A.:  The Psychogenic Diseases in Infancy , Psychoanalyt. Study of Child 6:255, 1951;.
Rosenthal, M. J.:  Psychosomatic Study of Infantile Eczema: I. Mother-Child Relationship , Pediatrics 10:581-591 ( (Nov.) ) 1952;.
Williams, D. H.:  Management of Atopic Dermatitis in Children: Control of the Maternal Rejection Factor , A. M. A. Arch. Dermat. & Syph. 63:545-560 ( (May) ) 1951;.
Marmor, J.; Ashley, M.; Tabachnick, N.; Storkan, M., and McDonald, F.:  The Mother-Child Relationship in the Genesis of Neurodermatitis , A. M. A. Arch. Dermat. 74:599-605 ( (Dec.) ) 1956;.
Alexander, F., and Ross, H. (ed.): Dynamic Psychiatry , Chicago, University of Chicago Press, 1952;, p. 374.
Alexander, F.: Psychosomatic Medicine , New York, W. W. Norton & Company, Inc., 1950;, pp. 68-70.
Bandler, B.:  Some Conceptual Tendencies in the Psychosomatic Movement , Am. J. Psychiat. 115:36-43 ( (July) ) 1958;.
Szasz, T. S.:  Oral Mechanisms in Constipation and Diarrhea , Internat. J. Psycho-Analysis 32:196, 1951;,
Alexander, F., and Ross, H.: Dynamic Psychiatry , Chicago, University of Chicago Press, 1952;, p. 381.
Rostenberg, A., Jr.:  Atopic Dermatitis: A Discussion of Certain Theories Concerning its Pathogenesis , Am. Pract. & Digest Treat. 6:1094-1101 ( (July) ) 1955;.

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