Resumen de The Resentment in the Psychosomatic Pathology
The concept of resentment has been explored extensively in the fields of philosophy, social sciences and psychology. Less critical attention has been paid to it from the point of view of historical medicine.
Resentment is understood as the repeated experiencing and re-living of hostile emotional response reactions against someone else; it is a re-experiencing of the emotion itself which gradually pervades the core of the personality and becomes a generalized experience of suppressed wrath, hostility and hatred largely independent of the activity of the ego that inspires numerous specific hostile intentions. In addition, resentment has a social factor; it is connected with the comparisons which we make between one and another (Masterson, 1979).
This presentation examines the role of resentment in the School of psychosomatic medicine, as developed in United States between 1930 and 1960. The physicians of this school attempted to combine the organicphysiological aspects of illness and the theories of Freud. The psychosomatic approach meant a re-thinking of the mind-body dichotomy, it launched the psychological mechanism as the cause of illness and underlined the role emotions play in somatic illnesses.
We shall refer to Franz Alexander (1891-1964), Helen Flandes Dunbar (1902-1959), Irving D. Harris, etc. Even though their approaches and methodology were different, they were connected through Psychosomatic Medicine, the official peer-reviewed journal of American Psychosomatic Society, (established in 1939 and still being published). Over the years we are interested in, 1930 to1960, we find that resentment is a recurring issue which appears in many articles in the journal. Most of these articles we will consider deal with cases and patient tales which show the etiopathogenic theories and therapeutic aspects of the doctor-patient relationship.
Specifically, the presentation aims to study how resentment was defined from the medical perspective. We will study the introduction of resentment into the psychogenesis of the symptoms, and in the pathologies and diseases with which this emotion was associated. Finally, we will study the repercussions of resentment in the 2 therapeutic approach suggested by the American school, as resentment leads to a pathologicalization of the doctor-patient relationship which is fundamental in psychosomatic treatment.
According to theories of psychosomatic medicine, the physical changes that usually accompany emotions are transitory, but they do produce physical alterations, which can lead to functional disturbances, particularly when the influence of emotions is enduring.
We know, for instance, of cases of so-called "conversion hysteria" within psychoanalysis. The condition appears when a person tries to restrain long-term and repressed emotions (Alexander, 1939), as in the case of resentment.
At least initially, the American Psychosomatic School noted that each emotion was related specifically to an organic disorder or disease (Alexander, 1950). The debate was soon broadened to include the influence of the emotions on other ailments which were defined as functional, due to the absence of an organic basis for their form. Thus began the debate on the relationship between resentment and other negatively-considered emotions, and the origin of certain organic or functional disorders. Some physicians, for example Irving D Harris, claimed that resentment would appear in both types of ailment, but above all in gastric disorders. Others associated this emotion with discomforts such as headache, back-ache or joint pain, which at the time were all considered "functional disorders".
We shall also see that, in medicine, consideration of resentment was linked to greater consideration of the subjective aspects of the health and illness of the patient and those connected with "a maximization of the welfare attainable through available technology".
The psychosomatic therapeutic proposal of the American psychosomatic school stressed the healing nature of the doctor-patient relationship. According to Alexander, it was psychosomatic medicine that allowed the art of medicine to be considered scientific medicine. From that moment on -he stated- "the influence of the doctorpatient bond could no longer be considered a mere addendum to the treatment, an artistic or personal touch, but rather the main basic therapeutic factor" (1939). The therapy, in the case of a process caused by resentment is based on what might be called the principle of "corrective emotional experience" (Alexander, 1946, 112). Helen Dunbar says something similar: "The physician's responsibility is to correct intraorganic dysfunction, but often this is possible only when he becomes the catalytic agent in restoring the patient's capacity for integration in But the doctor-patient relationship, itself, can be an object of resentment, since this emotion is defined by its interpersonal character. Resentment expresses the repetition of a hostile emotional response from either the doctor or the patient. H. Dunbar believes that when the doctor is no longer capable of communicating properly with the patient, s/he becomes a "pathogenic agent", as s/he causes anxiety and fear and thus aggravates the state of the patient.This particular relationship is therefore part of the pathology of the physician-patient relationship which includes resentment together with deception and seduction. (Freeling, 1982).
The studies connect the pathologization of the doctor-patient relationship with processes of chronic suffering or attention. Moreover, the authors differentiate between the ways in which resentment appears depending on the type of disorder or ailment. Thus, for example, the study on the Doctor-Patient Relationship carried out by means of Projective Techniques by M Thaler, H Weiner and Morton F. Reiser (1957) states that in disorders such as arterial hypertension or gastric ulcers the patients use the doctor's inability to cure them as a platform for resentment and provocation. But they also state that there are differences between these two groups of patients.
In the former, the origin of this resentment is real, while in the peptic ulcer group it is based on fantasy. In both cases, these conflicts are dependency related (as is the doctor-patient relationship) and give rise to hostile impulses that lead to the development of defence mechanisms in the formation and establishment of relationships.
In short, from a social and ethical-philosophical perspective, it has been said that some emotions such as guilt, resentment, shame and anger may have a special role in the establishment of a range of "response-dependent" values and norms that that lie at the core of moral life. Here we will show that one of the repercussions of the psychosomatic period was the significance attained by the emotional factor in medicine, which led to emphasis on the importance of communication or the consideration of social-environmental factors, and contributed to the reshaping of the relationships between doctors and patients.
