Kinsella, Ralph A.

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The Linacre QuarterlyVolume 14 | Number 4 Article 310-1-1947Behavior and SymptomsRalph A. KinsellaFollow this and additional works at: https://epublications.marquette.edu/lnqPart of the Ethics and Political Philosophy Commons, and the Medicine and Health SciencesCommonsRecommended CitationKinsella, Ralph A. (1947) "Behavior and Symptoms," The Linacre Quarterly: Vol. 14 : No. 4 , Article 3.Available at: https://epublications.marquette.edu/lnq/vol14/iss4/34 THE LINACRE QUARTERLY is heightened when the same advice is given by a psychiatrist on medical grounds and Ly a priest on religious grounds. This positi,·e healthy influence exerted by high-minded psychiatrists is real and eminently worth while, but they confer negative benefits also. They spare the patient the danger of falling into the hands of those practitioners who are hostile to religion. The suggestible, self-centered neurotic is in real danger of having his own faith harmed, when a man with the reputation of an expert scorns religion as an outgrowth of primitive fears, or of ignorant superstitions as a threat to mental health and unworthy of our enlightened scientific age. When the patient is assured with a great show of learning that religion is a myth, that God is simply the figment of a despondent mind that is struggling to recapture a sense of uterine omnipotence, he may come to regard faifr and its teachings as such lowly things that they have power neither tc encourage nor to stimulate. Thus, he is robbed of his confidence in .­provident God, of his hope in prayer and the sacraments, in a futun· life, and in the other consoling truths of religion which are at the sarnl' time the best preservatives of mental health and one of the most power ful agencies for its restoration. There are two medical specialties in which religious-minded doctor:, arc urgently needed, obstetrics and psychiatry. It is true, there arc many Catholics eminent in both of these fields. Some of the outstanding psychiatrists of the country are exemplary members of the church. There is need for more of them and it is to be earnestly hoped thu t many of our young men from our Catholic medical schools will take up this specialty. Psychiatry has ceased to be regarded as the stepchild of medicine. It not only has become "respectable" but has proved ii s value and need in these days when men and women are battered by the e111otional strains of our complex modern life. To fulfill its functi011s perfectly, it must regard its patients not as sick bodies, but as sick persons with spiritual 11atures and spiritual destinies. It must recognize that a man who is to live a full, contented, healthy life must have moral itlcals and live up to them. And one of the surest protections agaimt devastating conflicts and a most effective means of recovering from them is a trust in a provident God, the aid of religion, and the hope of uncml­i11g happiness. Such a goal can best be achieved by team work between a psychiatrist who knows something about sin and a priest who kno1rs something about psychiatric symptoms. • THE LINACRE QUARTERLY BERA VIOR AND SYMPTOl\1S RALl'H A. KINSELLA, l\I.D. Professor and Director of the Department of Internal Medicine, St. Louis University School of Medicine D OUGHL Y thirty per cent of the people who consult doctors pre­.I"'- sent symptoms that are not based on disease. If the doctor fails to recognize this, all sorts of needless treatment may be used, even to the extent of performing major operations. There are generally two types of people who express their conflicts, discontents, or efforts to escape the unpleasant tasks of life through symptoms which may be attached to almost any anatomical system of the body. One of these types is represented in the individual who wilts under environmental stress. This person reacts with a depressive response. The other type reacts more excitedly. There is no way of separating the types by assigning either one to a particular part of the autonomic nervous system, since both types of people may utilize the sympathetic Md parasympathetic systems. Type one is a patient familiar to all practitioners,  and is rcprescntccl in many hospital admissions, and continue to be frequently misunder­stood, and often badly treated. A study 1 of this type of person grew out of the observations made at numerous record meetings, and showecl that many patients with a variety of chief complaints really represented a common type of behavior. In this study 242 patients were analyzed, and it was found that their chief diagnoses included such states as hypothyroidism, neurocirculatory asthenia, visceroptosis, and the various organ-neuroses, such as gastric neurosis. An analysis of this group showed that no matter what their diagnoses might be, their complain-ts were strikingly similar. Two-thirds of these patients complained of weakness, nervousness, and headache, and about one-third complainccl of palpitation, dizziness, and abdominal pain. The study had for its further purpose the determination of physical features which might serve to identify this type of person. Among these physical features were: (I) Low basal metabolic rate; (2) Low blood pressure; (3) Low gastric acidity; ( 4) Flat sugar tolerance curves. In view of the similarity of some of these reactions, to con<litions in which failure of the adrenal glands is suspected, a number of patic�ts were given potassium tolerance tests, but these were found to be normal. There was no special anatomical type that dominated this group, al­though the hyposthenic habitus was more frequent. There was no evidence of glandular dysfunction in any of these patients. As in the case of type two, there was a definite history of the same type of distur-6 THE LIN:ACltE QUARTERLY baucc in one, and rarely both of the parents, but longevity was the rule,and there was no history of insanity or "nervous breakdown." How thii-.JJcrson was bein(J" handled by the physician he consulted was illustratcl'0 d . by the fact that forty-seven per cent of the group had appen ectom1c, fo1· lon,r-standino· pain in the lower right quadrant, without relief. h h . Type two is represented by a person with a more striking display o.symptoms. ,vhile the pattern of symptoms is found usually in one o·the other parent, the family group furnishes much more frequen '·instances of "nervous breakdown" and insanity. This type of persm•reacts 111orc positively to the various tests that are used as criteria.For example, blood pressure readings are in the higher zones of norma .and hypertensive disease is more frequent in the family group. The suga ·tolerance curve is of the elevated type. Presenting symptoms are mor .:often definite implications, with illustrative gestures, of various orga1 ;in the body, and not the ill-defined "weakness, nervousness, and headache'of type one. Type two more frequently has organ 11curosis, such u.;palpitation, hyperperistalsis, and in fact involvement of any anatomic, lsystem, such as the lungs as in intrinsic asthma; the skin, as in certa:'.·1types of urticaria, and erythema; and the gast ro-intestinal tract. Th employment of the last named system in the projection of sympton shas been extensively studied by ,volff.2 More recently the same auth< rhas reported the study of individuals exhibiting the use of other anatomi­cal departments in the pro.fection of symptoms.TREATMENT. In the handling of these patients who are ,;onumerous among the patients of the average practitioneI", it is importantfirst of all to make sure that no organic disease exists. This is tllcfirst responsibility of the doctor. It is very important not to institu tctreatment for conditions that are not clearly evident after a thoroughexamination. Patients with pains in the arms and legs should not Geaivcn "shots" for arthI"itis when there is no standaI"d evidence of arthri tish ·1 present. Nor should patients be subjected to operations such as tons1 -lcctomy, or the wasliing out of sinuses on account of an imagined "poi­soning of the system." It is equally clear that the moI"e serious formsof surgery such as cholecystectomy, and the removal of appendices andovaries· and the operation of ventro-suspension should never be offeredas a treatment of pain which is an autoprojection by the patient, andwhich is not based on any pathology in the organ it is pI"oposed toremove. Education of the medical profession will probably make someadvancement toward removing the stigma which attaches to some ofthese surgical procedures. The real treatment of the patient lies in the analysis · of the condi­tions on which he bases his behavior. For some of this behavior he isresponsible, and acts effectively in bringing about his own recovery oncethe situation is explained. ,i\Te must naturally exclude those physiologicalTHE LINACRE QUARTERLY 7 responses such as the hypcrsecretion of acid in the stomach under the�tress of excitement an� fr_i�ht fron'. any consideration of responsibility,although even here the rnd1v1dual nught be trained to rccoanize the real value of external situations, and to develop an indiffcr:i 1Ce to theirpresence. Jus� as soldi�rs were frequently brought back into battle byappc_al_s to their sense of duty and honor, so in the private office of thephysician many patients can set their behavior in normal channels thruan appeal to their sense of fairness, and tu their consideration of therights of others.It is not _ncc_cssary_ to bisect the human being and separate him intothat ?art of h11�1 wl11ch constitutes his responsible portion and that cryptic subconsc10us portion which Freud and his adherents like toutiliz� to explain human behavior. The autonomic responses of the huni'anmach_mc are seldom responsible for visits to the doctor in an individualw?o is capable of self-direction. Nor are we concerned in this discussionwith those cases of temporarily or permanently irreversible states ofbehavioI" which fall into the area of psychiatry.The thirty pc1· cent of visitors to the doctor referred to at the bc<Yin-. 5 mug arc free agents, who project symptoms as a result of incorrectand inaccurate_ rcspo11sc to cnviromncntal strai11. The discu·ssion invari­ably leads to the area of philosophy.If medical schools 111ay send their students to birth control clinicsf�r. instruction; if internes may authoritatively discuss the question ofg1vmg an overdose of morphine to a hopelessly sick individual; if teachersof nurses may indicate the permi�sibility of premarital sexual inter­course, it is obvious that some teachers in the field of medicine haveaccepted th: doctrines of some teachers in the field of philosophy. It isequally obv10us that this acceptance deeply affects the behavior of thewell and the care of the sick. If medical tcachin<r is to be i11flucnccd bv . h J ccrtam tenets in social philosophy it follows that we should be sure ofthe validity of these tenets .Herc is a fresh field i11 which to work. For while the devices ofpsychiatry often result in adjustment in the behavior of the individuala�d in a consequent alleviation of SJ'mptoms, in the long run the indi­vidual n'.ust be maintained as a free agent ,i'orthy of that thing calledhuman liberty. l\1oral misbehavior cannot be substituted merely as a�atter of relief without undermining the personal responsibility on whichhbe�·ty rests: These principles familiar in Christian philosophy shouldbe Ill the rnmds of physicians when they confer with patients who havesymptoms without organic disease. There should be a stoppage' of un­�ecessary surgical and medical treatment. ThcI"e should be an increase111 sympathetic direction and in explanations based on a truthful attitqde.1 Kinsella, R. A., Rabinovich, S., and Furlong, J. J. (Trans. Assoc. Amer. Phys 57 1942 p. 110). . ' ' 2 Wolff, H. G. (Trnns. Assoc. Amer. Phys. 57, 1942, p. 115).

Behavior and Symptoms

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Behavior and Symptoms

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