Psychosomatics and Eating Disorders

The Newsletter of the Psychosomatic Discussion Group

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The Newsletter Interview:

A Conversation with C. Philip Wilson, M.D., Interviewer: Deborah Shaw Link, M.D.

LINK: I think of you, Phil, as the dean of the psychoanalytic psychosomatic community. For the first issue of the Newsletter we'll have time and space to explore your ideas ahout the analytic treatment of psychosomatic illnesses. Sum up first, tell me about your work.

Wilson: My work includes chairing two psychosomatic workshops. The first is the Psychosomatic Discussion Group of the Psychoanalytic Association of New York, that was started by Melitta Sperling in 1960. The second is the Psychosomatic Discussion Group of the American Psychoanalytic Association that I initiated in 1983. In these long-term projects there has been a unique opportunity to study and discuss the analyses of patients with a wide range of psychosomatic symptoms. A rich cross fertilization has resulted from the deliberations of some sixty psychoanalysts from throughout the United States. We have published our findings in three books that provide a blueprint for the analytic treatment of these patients.[Fear of Being Fat; Psychosomatic Symptoms: Psychodynamic Treatment of the Underlying Personality Disorder; Psychodynamic Technique in the Treatment of the Eating Disorders -Ed.]

LINK: And your own intellectual development? Tell me about yourself.

Wilson: Originally I was in internal medicine. After Columbia I went into the Navy. As a Navy doctor I had a chance to study the incidence of disease in 300 healthy 18 and 19 year olds in the crew. The ship was an attack transport. We were in Japan and then went to China and were out for a year. The minute we left San Francisco, the sick bay was full of men with diarrhea, constipation, headaches etc. However, a year later when we came into Hawaii, that sickbay was empty - nobody was ill. When I came home to finish residency training I treated my first seriously ill chronic psychosomatic patients.

LINK: This was by now in psychiatry?

Wilson: No. I was chief medical resident at the Naval Hospital in Oakland. We had prisoners of war returned from the Japanese prison camps. We could not get them to leave the hospital. They had chronic colitis, headaches, and skin diseases. Later, in my psychosomatic training and research I realized that these symptoms had developed in the prison camps, where they had been starved and very brutally treated by the Japanese. The connection to the prison camp came together for me later in my analytic training at Columbia where I worked with George Daniels who did pioneer work with ulcerative colitis. He started a psychosomatic research clinic at Presbyterian where he had students do psychotherapy and analytic treatment of ulcerative colitis patients under supervision. They got quite impressive results.

LINK: How did he keep them out of the hands of the surgeons?

Wilson: These were not so seriously ill patients. I worked in consultation liaison with him and with Aaron Karush, also at Presbyterian Hospital. At that time I was able to see the difficulties of steroid treatment. Some patients did have to have surgery. But it was an important research project which has not been replicated. I was at Columbia University Psychoanalytic Training Center from 1948 to 1952 where there was great enthusiasm for psychosomatic research.

LINK: So even in the analytic world this kind of work and interest wasn't considered to be on the "edge"?

Wilson: No. It was considered a central focus. For a year I sat in on the taping of an analysis of a man who had Raynaud's disease. He was hooked up to a plethismograph to measure the arterial pulse. An attempt was made to correlate that with the emotional content of dreams in the analysis.

LINK: You "sat in"? How?

Wilson: As an observer of the analysis. But I realized after some while that the apparatus and the observer and the situation interfered with the analysis. But it was interesting. Then I wrote my first psychosomatic paper with Nathaniel Ross on bronchial asthma that was published in 1949 in an asthma textbook by Witkower, an authority at the time.

LINK: Tell me what Melitta Sperling was like.

Wilson: When I first met her, she was in her fifties; extremely outspoken, red haired thoughtful, and brilliant. She was, in looking back, subject to tremendous opposition because of her sex. I remember a patient of hers whose psychosomatic symptom had been resolved in work with Sperling but who came to me later for follow-up. She described an incident about Sperling. One day, Dr. Crohn, the gastroenterologist whose name is attached to Crohn's Disease called her. She said to him "Dr. Crohn, you don't know anything about what you're doing. This patient needs psychoanalysis, not just medication!" And thig was to the big authority. The pioneers were very outspoken, assertive people. They certainly didn't make friends. She had trained at the New York Psychoanalytic Institute and was, as was her husband Otto, a training and supervising analyst at Downstate.

LINK: Not at New York?

Wilson: No. She was put in charge of a child psychiatric clinic in Long Island City, where she had carte blanche to treat cases there with the backing of the medical people. She was the first person who treated children with ulcerativc colitis. I remember her giving a paper on her analysis of a child of three with ulcerative colitis and also of the mother. She did that in order to get at the relation between the mother and child. She felt that the unresolved anal conflicts of the mother were really etiologic in the colitis symptoms of the child and that the mother had to be treated at the same time.

LINK: At the same time by her?

Wilson: Yes, by her. I remembcr the classical analysts lambasted her, saying she couldn't be objective. She said, to the contrary, that you have to see the child and the mother to get at the unconscious conflicts. She argued that they were applying the standards of analysis of adults to the analysis of children. She was criticized totally which didn't stop her in the slightest. She published many papers in the psychiatric, psychoanalytic and the child psychiatric literature here and in foreign journals. Her focus was particularly on the psychopathology of the parents. In some of her cases she would not be able to approach the child, who had, for example, ulcerative colitis, unless she analyzed the mother for a period first in order to get at how the mother was treating the child.

LINK: So in effect, Sperling saw the body of the child as the organ of expressiun of the conflicts of the mother?

Wilson: Yes.

LINK: Particularly the mother?

Wilson: She did emphasize that when we say "mother" it could be the father or other caretakers who present as the pathological parenting figures. Her papers reported the resolution of symptoms in a large number of cases with ulcerative colitis. That also enraged the medical world, that she would report forthrightly on ulcerative colitis as if it was a psychiatric disease and that psychoanalysis was the treatment. Many said, "Maybe it's cured and maybe it's not." Her boldness infuriated them.

LINK: Phil, 1 know that you and your colleagues have many patients who have had a complete or relatively complete remission of their symptoms but that you, like the Sperlings, have encountered criticism and doubting by many in the analytic establishment.

Wilson: That is true, but an increasing number of respected analytic authorities support and contribute to our work. My colleagues and I have been asked to present papers at major psychiatric and psychoanalytic centers throughout the country.

LINK: What about follow-up after analysis?

Wilson: We don't say that the disease may not recur. With ulcerative colitis the patient should go in for colonoscopy and workup every six months because of the risk of colon cancer.

LINK: But even so as in a case I know about that you analyzed, the patient's symptoms are no longer ruinining his life.

Wilson: They need the medical workup but their whole life has been changed in terms of adaptation, marriage, having children, work, etc. And the same is true for asthma. I've had cases I've followed for twenty years where the symptoms are either minimal or are completely resolved. The patients know what is behind the symptom. They're able to abort it themselves as it comes up. For instance, with ulcerative colitis, many of these patients will express the conflict as gas, farting in situations where they would have bled before.

LINK: Embarrassing perhaps, but not lifethreatening.

Wilson: They can either analyze it themselves or return to talk with their analysts.

LINK: What are the resistances of some analysts that stop their analyzing patients with psychosomatic symptoms?

Wilson: A major resistance involves their analytic training.

LINK: And their own analyses?

Wilson: Their own analyses largely dealt with oedipal problems. They'll say that preoedipal problems were dealt with but in many training analyses they have not been resolved. In addition, psychosomatic cascs are not accepted for training cases. I tried to get certain cases accepted at the Downstate, but they were not. The technique of analysis of the majority of patients with psychosomatic disease involves first dealing with preoedipal material and leaving oedipal material alone.

LINK: Even though it is right there?

Wilson: The oedipal material can be florid. As an example, in the early fifties I had an anorexic and I didn't know how to treat her so I got the best supervisor I could from the New York Psychoanalytic. He helped me with my transference and countertransference. I had such anxiety. But I remember the patient had a dream about a baby in a baby carriage. He had me interpret, oedipally, that she wanted to have a baby by me and by other people. That was a complete mistake at that time. She wanted to be the baby - a preoedipal wish. The difficulty is that you have to select out the preoedipal material, which means keeping away from the oedipal material. Only later could I interpret her wish to be a mother.

LINK: Might another professional resistance be the difficulty in dealing vlith the primitiveness of oral rage? It's hard to tolerate, hard to handle.

Wilson: Actually, just when the psychosomatic symptoms start to clear, the most primitive anxiety, suicidal symptoms, and acting out can emerge in the analysis, as can transference psychoses. The task of dealing with all that takes experience and supervision. The analysis of oral rage is a central issue related to my research on stone as the earliest ontogenetic and philogenetic symbol, which masks oral-incorporative, sadomasochistic and cannibalistic conflicts.

LINK: Share with me how you sustain your own person with the weight of the very demanding oral and anal pathology you've dealt with continually. How do you keep yourself ready to meet these patient's demands decade by decade and keep them alive?

Wilson: Having sublimations you really enjoy is extremely important. I enjoy athletics- tennis and golf - and also enjoy art and have taken various courses in art in New York City. I also enjoy the museums of New York. As an ancillary interest I've been studying the meaning of stone symbolism in the work of a number of artists. I also enjoy literature very deeply. When I was at Yale the English department was very Freudian. I majored in English and was asked to go on for graduate work there. I had read a lot of Freud in college and as a junior wrote a paper on blood images in Macbeth. I don't have the paper any more though I wish I did for it was one of the stimuli that got me into the field of psychosomatics.

LINK: You've spoken many times about going to the theater..

Wilson: Our pleasure in living in this city is that we go to the theater frequently. My wife, Christine, was a singer and actress in the golden years of musical comedy. I also spend my time writing, working on the psychosomatic books and on other topics. I find that the field is endlessly interesting. The work is as rich and new to me as when I started out, I keep learning more and more. These patients provide that.

LINK: They are lucky to have you as are the members of your discussion groups who monthly, yearly, draw on your energy and enthusiasm and integrity as a source of inspiration. Thank you, Phil.-

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