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We investigated the relation of psychosocial risk factors to mortality in a prospective study of 1353 inhabitants of Crvenka, 619 of whom died between 1966 and 1976. All 38 lung cancer deaths occurred in those with high scores for rationality and antiemotionality (R/A), a factor related to suppression of aggression. Compared with lower R/A, high R/A was also associated with a relative risk of mortality of 29 for other cancer, 4.3 for ischaemic heart disease and 6.5 for stroke. Standardising for R/A reduced the smoking/lung cancer association, virtually eliminated the smoking/other cancer and smoking/heart disease relationships and reduced the association of heart disease with blood cholesterol, blood sugar and hypertension. Long lasting hopelessness was also independently associated with cancer as was anger with heart disease, though not so strongly as for R/A. Psychosocial variables are important predictors of mortality and decisively modify the effect of physical risk factors such as smoking.

Traumatizing events and traumatizing conflicts may lead to defense mechanisms which in the course of time become part of character formation. In psychosomatic medicine much attention has been paid in the past to the so-called psychosomatic character profiles. Though discussions about psychosomatic specificity have remained controversial, it still seems advisable to take into account the power of induction of specific defense strategies. In this paper special attention is paid to the fact that asthmatics, patients suffering from hypertension or coronary heart disease, as well as patients suffering from other psychosomatic syndromes, and even patients suffering from carcinoma may induce their own defense strategies in interviewers and therapists, who usually are not sufficiently aware of the fact of such transference phenomena. A distortion of the normal psychotherapeutic process is more often a result of induction processes than has been thought of.

Microanalysis of the first interview is a technique developed by the author for the subtle translation of the verbal aspects of the doctor-patient contact. Every bit of information, derived from the patient, is translated in the traditional historical dimension, e.g., when did the complaint start, and in the here and now dimension, e.g., in how far does the information imply a cry for help and understanding. Psychosomatic patients, who are usually well adapted, suppress or repress their problems and emotions so much that they are hardly able to express these quite openly. Psychosomatic symptoms reflect the effort of the patient not to behave in a hysterical way. This means that the overt cry for help and attention, which is so characteristic for hysterical patients, is warded off. Especially the microanalytic translation of this hidden cry may be used by the interviewer to detect what the basic problems of the patient are and how the optimal climate for an efficient therapeutic contact can be established. In the Leyden Department of Psychiatry the technique is used to facilitate the training in interview technique. In the paper models will be given for the understanding of the interrelationship of psychiatric and psychosomatic symptoms.