Psychological stress; psychoanalytic and behavioral studies of surgical patients.

"Only within the past twenty years or so have research workers in the human sciences begun to make systematic observations for the purpose of finding out how people feel, think, and behave at times when they are facing the threat of pain, serious injury, or death. About ten years ago I became acutely aware of the lack of cogent, dependable evidence. There were, of course, many controlled laboratory experiments purporting to deal with stress behavior, but almost all of them dealt with extremely brief exposures to threat stimuli or measured only peripheral aspects of emotional excitement. Such experiments provide behavioral data which are generally quite reliable but of dubious value for extrapolating to the conditions of actual life stress. In contrast to the tangential laboratory investigations were a large number of field studies of major disasters, focusing on the effects of prolonged exposure to powerful stress stimuli. But most of these studies proved to be extremely weak in precisely those respects where the laboratory studies were strong. Since major surgery involves a profound threat to body integrity as well as a variety of severe deprivations, it seemed likely that a great deal could be learned about the processes of normal adjustment to life stresses. From the findings presented in this book, the reader will be able to judge for himself the values and limitations of carrying out research with surgical patients. With the cooperation of the surgery staff in a general hospital, I was able to obtain pertinent data for a series of 30 intensive surgical case studies. In each of these cases, several regularities were noted concerning the sequence of stress responses, the most important of which involved a striking relationship between the degree of fear manifested before the operation and the degree of stress tolerance manifested after the operation. In order to test the apparent relationship and to obtain further correlational data bearing on the influence of preoperative information about the impending stressful events, a second study was conducted with a much larger group of subjects. Next, I participated in a psychoanalytic research project at Yale University, under which auspices I conducted the psychoanalytic treatment of a psychoneurotic woman. Shortly after her second year of the treatment, the patient developed an organic disorder in her leg, which, on advice of several physicians, required surgery. Detailed observational records were kept concerning this patient's emotional reactions, fantasies, and free associations during all psychoanalytic sessions. The records from the sessions immediately preceding and following the surgical operation proved to be an extraordinarily rich source of clues concerning unconscious psychological processes. The primary purpose of the volume is to highlight the theoretical implications by conveying what has been learned concerning the dynamics of human adjustment to stressful life events. Secondarily, an attempt has also been made to draw attention to some of the main practical implications with respect to three important types of problems: (a) The formulation of policies of medical management which take account of the psychological needs of sick people; (b) the improvement of diagnostic procedures relevant for predicting high or low stress tolerance; and (c) the development of effective methods of psychological preparation which could be widely applied as part of a mental health program designed to reduce the disruptive emotional impact of many different types of potential disasters." (PsycINFO Database Record (c) 2006 APA, all rights reserved).