Psychodynamic Perspectives on Sickness and Health

Author:  Duberstein, Paul R. and Joseph M. Masling
Publisher: Washington DC: American Psychological Association, 2000
Reviewed By: Mark J. Hilsenroth, Kelley Callahan and Erin Eudell-Simmons, Fall 2002, 45-46

For all those who attempt to integrate psychodynamic theory and practice with research, few volumes have proven more useful, encouraging, and supportive than the “Empirical Studies of Psychoanalytic Theories” series by Joe Masling and Bob Bornstein. The latest volume by Duberstein and Masling continues this tradition in the area of health psychology. The chapters in this volume discuss psychodynamic principles in relation to stress, illness, cardiovascular functioning, traumatic events, mortality, loss, and bereavement. For any who would question how or why psychodynamically based formulations and research could be useful with regard to problems of health and illness, they need only review the introduction of this book to be educated as to several compelling reasons. In what seems more like a very good review chapter on the history of health related formulations in psychoanalytic theory, Duberstein and Masling review the integration of mind and body, treatment of patients with physical symptoms, barriers within health psychology and psychoanalysis to this integration as well as a synthesis of these paradigms into a contemporary model of a psychodynamic health psychology that provides an excellent foundation for the rest of the book.

The first chapter by Bornstein extends his prior seminal work in the area interpersonal dependency (1993, 1996, 1999) to the field of health psychology. Bornstein first reviews the theoretical basis of interpersonal dependency and examines both the negative and positive pathways this personality trait has on illness. These effects are examined in relation to illness risk, utilization of health services, the initiation of treatment and subsequent compliance with treatment recommendations. Levels of dependency (high or low) were significantly associated with each of these areas and demonstrate the relevance of this psychodynamically-based construct to research in health psychology. The next chapter by O’Neill is focused specifically on the relation of psychodynamic formulations in regard to heart disease. In this chapter he very nicely reviews the literature on the personality characteristics of coronary heart disease and Type A behavior patterns with psychodynamic formulations of hostility and obsessive character. The findings of his empirical review demonstrate key similarities between the characteristics of these health related problems to psychodynamic constructs of unconscious impulse, defense mechanisms and affective modulation/dysregulation. In an examination of dreaming and illness, Kramer provides an extensive and thorough review of these issues with regard to several physical problems including somatic concerns, body image, heart disease, gastrointestinal problems, respiratory disorders, AIDS and rheumatoid arthritis. In addition, this chapter examines the relationship between dreams and emotional state or mood as well as the physiology of the brain during sleep and dreaming. Overall, this chapter is an extensive summary of valuable empirical and clinical research, which supports a number of connections between dream characteristics with medical and psychological illness.

Chapters by Smyth and Greenberg as well as Bonanno and Kaltman each focus on stress reactions experienced by those surviving traumatic events. The first of these chapters reviews the empirical literature on scriptotherapy and several clinical theories regarding the adverse effects of trauma spanning from Janet, Breuer, and Freud, to more modern theorists like Horowitz. The authors then attempt to integrate clinical theory with the current experimental research on the affects of writing about stressful experiences. Their review of this literature is comprehensive, providing an excellent synopsis of what the research has shown thus far, and pointing to necessary and important future directions. The evidence linking writing about stressful events with numerous health benefits for healthy individuals is impressive. Those interested in clinical research will definitely be looking forward to several future research initiatives, described in this chapter as currently underway, that will enable the effectiveness of this approach to be examined with clinical populations. In an interesting juxtaposition to chapter four, chapter five by Bonanno and Kaltman, challenges the notion that one needs to “work through” traumatic memories, and suggests instead that effective treatment helps patients to “work toward” the creation of a personal narrative that places traumatic experience in the context of a broader and enriched life narrative. In providing a clearly written and informative review of recent advances in cognitive neuroscience, the authors describe what is currently known about differences in how traumatic memories are encoded and recalled compared to normal memories. Based on this information they assert that it is not the process of “lifting repression” or “working through” that is beneficial, but instead the process of gaining distance from the event that allows one to gain understanding and assimilate the traumatic memories into a more complex and resilient self. Finally, the authors make suggestions for effective treatment based on the literature reviewed. The review of research, especially related to cognitive neuroscience, is well presented and anyone involved in the treatment and/or research of psychological trauma would do well to be informed by it.

The final two chapters of this volume examine the effects of mortality, death and bereavement on illness. The first, by Arndt, Goldenberg, Greeeberg, Pyszczynski, and Solomon, provides an overview of terror management theory and the subsequent impact of ones sense of mortality on health related issues. These authors also provide an excellent discussion of both the adaptive and maladaptive consequences of defenses regarding these mortality concerns. The Duberstein chapter reviews stress and illness in relation to bereavement and grief exploring how psychodynamic constructs such as early attachment experiences, affective temperament and personality structure interact with bereavement reactions latter in life. He specifically integrates empirical research on stress, depression, and immune system functions, with psychodynamic formulations of bereavement responses.

In sum, this is a fine addition to the “Empirical Studies of Psychoanalytic Theories” series that now expands to include the important area of Health Psychology. The contributors do a very nice job of integrating Psychodynamic theory, constructs and research with extant paradigms and research within Health Psychology. Those interested in any combination of research and practice will gain from the useful summary of issues, empirical review and theory provided in this intersection of Psychodynamic Perspectives on Sickness and Health.

Bornstein, R. (1993). The dependent personality. New York, NY: Guilford Press.
Bornstein, R. F. (1996). Construct validity of the Rorschach Oral Dependency scale: 1967-1995.
Psychological Assessment, 8, 200-205.
Bornstein, R. F. (1999). Criterion validity of objective and projective dependency tests: A meta-analytic assessment of behavioral prediction. Psychological Assessment, 11, 48-57.

Mark J. Hilsenroth is an Associate Professor at the Derner Institute for Advanced Psychological Studies, Adelphi University. Ms. Callahan and Mrs. Eudell-Simmons are advanced graduate students at the Derner Institute for Advanced Psychological Studies, Adelphi University.

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