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I would like to consider a phenomenon which has been observed over many years, namely, the greater likelihood of symptoms, especially psychogenic symptoms, on the left side of the body, i.e. the sinistrality of symptoms. The symptom is at the heart of all medical encounters. This encounter begins with one symptom and then goes on to diagnosis, prognosis and treatment. But at the very core of this encounter, in the very conception of the symptom, there is a semantic confusion which becomes obvious in distinctions between organic and functional, real and imaginary, organic and hysterical and so on. It was the problem of hysterical symptoms which gave rise to psychoanalysis and its many psychotherapeutic offshoots. The possibility of a relationship between imagination and symptom formation was seriously considered well before the nineteenth century. Let us consider Robert Burton’s seventeenth century work, The Anatomy of Melancholy (Burton, 1948), for some historical perspective on this matter. Burton was a Christian minister, whose book was referred to by the famous physician William Osier as “a medical treatise, the greatest indeed written by a layman...” (Jackson, 1989). Burton saw the root cause of melancholy or depression, as well as other symptoms, in a “damaged imagination”, i.e. an imagination which somehow had escaped from the control of reason to become a faculty that “is most powerful and strong, and often hurts…”. The faculty of imagination when corrupted, hurt, misaffected, depraved, or damaged, he saw as the cause of melancholy. The damaged imagination, he said, misrepresents matters to the understanding, and makes patients see and hear “that which indeed is neither heard nor seen”. Burton seems to be distinguishing here between imagery and perception. In reviewing the work of other physicians Burton singles out the work of Thomas Fienus (1567–1631) for whom he had the highest regard, referring to him as “worth all of them together” (Rather, 1967). Fienus presented a model in which the imagination was seen to stir up the emotions—leading to bodily changes in the humours and spirits, which in turn lead to bodily symptoms. This is essentially a psychosomatic model, wherein a disturbed imagination produces physiological changes leading to psychogenic symptoms. This sixteenth century model prefigures contemporary understanding of the relationship between imagination and symptoms.

As in any human endeavor, the definition of the objective is critical both for its success and the effectiveness with which such success is achieved.

D was a 35-year-old male who was upset and distraught over two aspects of his life. He was involved in a love relationship, informed that he was too cold, uncaring, and indecisive, and was given an ultimatum that he either get help or the relationship would end. The other concern referred to work. He had periodic episodes of losing control of his anger, was worried about its effect upon others, and suffered greatly from a feeling of guilt. When they occurred, he would go over them endlessly in his mind until they could be rationalized. He repeated each step of his actions until he could somehow assure himself he had done right.

Most System’s approaches to Psychopathology have been centered in methods leading to nosological delimitation and classification, or else in the specification of choice of observable data or still on theoretical constructs which finally serve these same purposes. In our view, the fact that those classifications are based on “clinical indicators” of heterogeneous origin, is not generally recognized. Even the references to System’s Theory using surface metephors may paradoxically obliterate the evolution that the contribution the System’s Theory may bring to Psychopathology. Using more rigorous methods by means of which data would be acquired in well controlled environmental, and expecially social interactions, would provide some help to guide us in the epistemic muddle of clinical diagnostic classifications, provide some needed cross-validation to purely clinically oriented systems and more important than that, help us in finding ways of explaining psychopathological phenomena in a relational-analytic manner. The Psychology Group of the Fac. of Medicine made during the last nine years some experiments on interpersonal relationships which involved the free behaviour of a single person with a restrict group of subjects which reacted towards within strictly ritualized form.

Contemporary Buddhist treatment of narcotic addiction and neurotic-psychosomatic symptom formation is performed in Thailand at many monasteries and shrines, of which we have selected two as examples because each represents a different therapeutic approach that is rooted in Thai cultural traditions. In the following we are presenting a brief analysis of the therapeutic factors operant in these approaches. Our analysis is based on discussions with religious therapists, voluntary assistants and patients, as well as on our observation of the treatment procedures.

The proverb “all that glitters is not gold” is one of the traditional gentle injunctions used by parents and educators to urge their young charges to look beyond first impressions in evaluating the world around them. In an attempt to communicate some understanding of the complexities involved in the formation of pain as a symptom, one could perhaps begin with a gentle reminder to all of us raised on the Western medical model that “all that hurts is not somatic”. This has a double meaning, which is intended. On the one hand it refers to the long historical record (Merskey and Spear, 1967), expressed in literature, etymology, religion and philosophy of “pain”, “hurt”, and related words being used as much to refer to emotional events as to physical ones. A second meaning is that pain in the clinical situation does not always have an identifiable somatic basis or so-called “peripheral input”. Particularly in the case of patients with chronic pain, keeping these two basic concepts in mind will contribute greatly to their understanding and to more effective clinical management.

Let me first express my delight at the chance to discuss the psychoanalysis of shame and guilt with neuro-behavioral scientists. I have been devoting the past 25 years of my life to these two grisly states — in my view human beings’ principal moral emotions. And of course it does not take much thinking to realize that the reason I have had to focus on shame and guilt is that in psychoanalytic work and psychotherapeutic work of any kind these are the two prevailing emotions with which clients address us.

This report represents the crystallization of knowledge derived from supervising the psychotherapy of alcoholic patients in a clinic setting. The therapists were psychiatric residents, social workers, and social work students. The therapy was once-a-week psychotherapy based on psychoanalytic concepts and principles and was, by design, supportive and informative.

Several developments in the past few years have had an impact on psychosomatic medicine. As Lipowski has emphasized, “psychosomatic medicine is vigorous scientifically, it is diversified, it is expanding, and it is growing rapidly.” It is also a fact that the holistic approach based on the biological, psychological and social dimensions has been accepted universally and has contributed greatly to the growth of this field.