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1/19. Thanatomania in an Asmat community. A report of successful "western" treatment.

    Case report from the Asmat-area, West New Guineaof black magic in a 12-year-old boy, confirmed anthropologically and medically. Successful treatment by western medicine was achieved by removing the emotional pressure exerted by the community on the patient through physical and pharmaceutical isoledical help saving a black magic victim. A follow-up of the medicine and anthropology, permitting a discussion of the medical cultural implication.
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2/19. The power of the visible: the meaning of diagnostic tests in chronic back pain.

    This article explores the meaning of diagnostic tests for people with chronic back pain. Lower back pain is one of the most common health problems in the US. Five to ten percent of the patients who visit a primary care provider for back pain ultimately develop a chronic condition. We draw on interviews with chronic back pain patients in Atlanta, Dallas and Seattle to argue that testing constitutes an important element in the legitimation of pain for these patients. We discuss three aspects that make testing an area of concern for patients: a strong historical connection between visual images and the medicalization of the interior of the body, a set of cultural assumptions that make seeing into the body central to confirming and normalizing patients' symptoms, and the concreteness of diagnostic images themselves. Our interviews show that when physicians cannot locate the problem or express doubt about the possibility of a solution, patients feel that their pain is disconfirmed. Faced with the disjunction between the cultural model of the visible body and the private experience of pain, patients are alienated not only from individual physicians but from an important aspect of the symbolic world of medicine. This paper concludes by suggesting that a fluid, less localized understanding of pain could provide a greater sense of legitimacy for back pain patients.
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3/19. A case study of neurosis secondary to trauma in an eight-year-old girl. Comments on the tendency for psychogenic illness to become chronic.

    This case study deals with an eight-year-old girl who developed persistent abdominal pain and vomiting for which no physiological cause could be discovered. After two months of unsuccessful treatment for her illness, the girl was referred for a psychiatric consultation. During the psychiatric interview, the psychogenic nature of the girl's illness became readily apparent, as did the nature of the conflict which had produced it. The tendency is strong for psychogenic illness, such as this, to become chronic without psychiatric treatment. Many physicians are reluctant to apply clinically basic psychiatric techniques to the treatment of physical illness. A suggestion is made that closer collaboration between psychiatry and other medical specialties could be of great value in preventive medicine.
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4/19. Stress and distress in clinical practice: a mind-body approach.

    Primary care physicians are often taxed by patient complaints that do not seem to have a clear etiology, nor do the patients improve despite good medications and expensive procedures. Current studies show that stress or distress may have a significant effect on the onset, the course, and the management of many, if not all, diseases. Understanding patient's underlying stress physiology and coping mechanisms may enable physicians to better understand various clinical disorders and treat their manifested symptoms. Evidence is reviewed by which stress may exacerbate or cause illness and by which behavioral medicine interventions can improve clinical outcomes.
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5/19. psychosomatic medicine: the divergent legacies of Freud and Janet.

    A series of differing explanations of a puzzling case of psychosomatic illness introduces some reflections on a century's history of psychoanalytic interest in the mind-body problem. Freud and Janet explained the physical symptoms of hysteria using radically different models of the mind. Since then Janet's model, banished early on, has returned to haunt the castle of psychoanalysis. The enduring influence of Janet's model on subsequent thought in this field, especially that of Marty and de M'Uzan, Sifneos, LeDoux, and others, is traced, as is the influence of Freud's model on Groddeck, Alexander, McDougall, Fonagy, and others. It is argued that although these models are vastly different at one level of abstraction, at a higher level they share an important set of assumptions.
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6/19. Self-reports, spouse ratings, and psychophysiological assessment in a behavioral medicine program: an application of the five-factor model.

    This article describes the integration of the five-factor model into assessment procedures used with 109 patients in an outpatient behavioral medicine program. The population, program, assessment techniques, and general findings are explored. A case history involving a psychophysiological disorder is utilized to demonstrate the utility of a taxonomy of personality traits. The NEO-PI, a five-factor instrument, is integrated with other assessment techniques to assist in diagnosis, rapport building with the patient, tailoring treatment techniques and goals to the individual's intrapersonal and interpersonal dynamics, and predicting relative success and compliance with noninvasive self-regulation procedures and psychotherapy.
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7/19. behavioral medicine in the general hospital.

    The application of behavioral procedures to the treatment of medical disorder has greatly expanded the techniques available to the psychiatrist practicing in the general hospital. While there are diverse behavioral strategies that have proven quite useful, the bases for these are limited and readily implemented in the hospital setting. In this paper, the behavioral methods of assessment and various strategies of treatment of medical, psychophysiological, and "psychosomatic" disorders are overviewed.
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8/19. Psychosomatic illness concept and psychotherapy among the Akan of ghana.

    The example of the Akan in ghana shows that western medicine has no psychotherapeutic alternative to offer the so-called "developing countries". The traditional healing methods existing in such countries must be preserved and researched in order to maintain them at least at their present standard (9). This task, as well as that of developing these methods over the coming decades to keep pace with the cultural development process, is one that devolves upon the young scientists and doctors of such countries. This in turn requires further study of socialization values and norms, the potential resultant conflicts, the psychotherapeutic conflict-solving processes designed to obviate them and the forces at work in such psychotherapy.
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9/19. An explication of 'wind illness' in northern thailand.

    'wind illness' is a very common complaint among the Northern Thai, yet is rarely recognized by Thai physicians trained in biomedicine. persons most susceptible to 'wind illness' are adult women who have ever borne a child. Consequently, data were obtained from 415 everparous women, 43% of whom reported ever having had 'wind illness' and 57%. never having had it. In addition, 20 individuals who had ever had the syndrome were followed for case study, and 13 indigenous healers who traditionally treat clients suffering 'wind illness' were interviewed. Their perceptions of the etiology, symptomatology and treatment of 'wind illness' are reported in Part I. Part II is an attempt to define 'wind illness' in terms of biomedicine and as a consequence of fertility. Part III synthesized the emic and etic accounts with explanations for the perdurance of 'wind illness' despite the advances of biomedicine and the recent fertility decline in Northern thailand.
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10/19. The dream specimen in psychosomatic medicine in the light of clinical observations.

    The author attempts to demonstrate a relationship between dreams and symptom formation in the psychosomatic patient. The egos of many patients predisposed to psychosomatic illness have shown a deformation of a defensive nature because of early impingement of the protective shield (a maternal function) which caused a precocious development of a false-self in Winnicott's sense. In a series of dreams the failure of one or more dream functions became evident. Such failures are often found in patients with psychosomatic symptoms and depend on the severity of illness and preillness factors such as personality, body image and type of object relationships. The dream functions identified were the traumatolytic, the wish-fulfilling, the symbolizing and the integrating ones. The author further speculates on the relationship between the physical symptom, the failure of a particular dream function, the physiological correlates of the manifest versus the latent content of the dream, the breakdown of the process of symbolization and the activation of an archaic body image representation.
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