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ABSTRACT

M‘ or ”P338819! LID MWGI
or PSYCHOSOHAIIO SIIITDHS

by Judith A. Baseh

the purpose of the present stndy was to determine the
relationship between psychosomatic symptoms and degree of
repression nsing pencil and paper quittionnaires. this
relationdnip was previously reported by neyher (1961, 1967).
Using post-hypnotic stimulation or a.hypnotically-indneed *
conflict to prcdnoe symptoms, he ronnd that as repression
progressively weakens, somatic symptoms tend to be replaced
by psychological or snbjective ones. ‘1n both investigations,
the number or symptoms were ronnd to be inversely correlated
with the degree of repression.

linety-two introductory psychology stndents were asked
to complete a onestionnaire which consisted of the Byrne
(1961) Repression-Sensitizatien Scale and a 1h-itam.inventory or
psychosomatic symptoms. rho stndy was replicated nsing
32 subjects. Only nonsomatic itemu or the 3-3 Scale which
relfected three different degrees or drive representation
were used to assess degree or repression.

The results showed that there is a significant rela-
tionship between the degree of repression and nnmber of
somatic symptoms and lend support to the theory that the
type of psychopathology is a rnnction or the degree or

repression (Reyher, 1961: 1967). /§;L3( {K/Z::>Aé:
g ,5: C.» I ‘1“ 6 S”
/ /

DBG‘ 01' HIPRESSiOl LID FREQUEICI
Oi" PSYCHOSOHLIlC SEPTOHS

by

Judith APQBasch

L THESIS

Submitted to
Michigan State University
in partial rnlrillment or the reqnirements
tor the degree or

EASTER or LETS
Department of Psychology

1968

LGKNOWEEDGEHEITS

The present writer would like to express her sincere
thanks and appreciation to her chairman, Dr. Joseph Reyher,
without whose ideas, encouragement, and understanding the
writing of this paper would not have been possible. i'hanxs
also to Dr. Bertram Karon and Dr. John Hurley, committee
lembers idiose helprnl suggestions were appreciated.

Fellow students who helped in the collection or data
were Larry Smyth and Donald Beere. Thanks. to them and
especially to Robert i. Bush who helped considerably in
the scoring and analysis or the data.

-11

AQKNOHLEDGEHENTS .
iNTBODUOTiON . .
m THOD O O O O

TABEE OF CONTENTS

Subjects and Materials

Procedure .
RESULTS . . . .
DISCUSSION . . .
BlBLlOGRAPHX' . .
TABEB 1 . . . .
APPENDIX . . .

111

Page

11

somO‘O‘OH

11
13

iNTRODUCTiOH

in discussing the concept of psychosomatic disorder, it
is customary ror psychoanalytically oriented investigators
to dirrerentiate between conversion (hysterical) and
vegetative symptoms. Both kinds of symptoms are psyohogenic
with the former being symbolic or repressed conflicts and
the latter being an indicator or unrelieved emotional tension.
It is the vegetative type or symptom, with its medically
identiriable physiological loci, that is derined as psycho-
somatic. .A psychosomatic disorder is a real physical
illness, but it has a.psychological etiology.

Two major theoretical issues in psychosomatic research
are: (l) the reasons tor a certain individual developing
a psychosomatic symptom.and (2) the principles that govern
the selection or the organ system.that is rinally arrested.
Several hypotheses have been set forth to resolve one or
both of these issues. Hendelson, Hirsch, and Hobber (1956)
have reviewed some major theoretical models which they have
classified in four major types.

One or the earliest theories, representative or the
'Personality Profiles” type, was proposed by Dunbar (1935)
who attempted to refute the conversion theory or psychoso;
matic symptoms and to demonstrate the proposition that
certain diseases have a high correlation with certain per-
sonality types; that is, certain speciric personality types

develop certain diseases.

Representing the ”Conrlict Situations and Speciric
Responses” type, Alexander (1950) theorized that personality
type is not critical in the rormation or a given disorder,
but a speciric conrlict situation develops in individuals
with varying personalities. Known as the ”speciricity
theory”, Alexanderes model mmkes use or the idea that dirrer-
ent emotional states have dirrerent patterns or discharge;
that is, each psychosomatic disorder results rrom.a speciric
constellation of omotions and defenses against thom.

Representing the 'rrotective Adaptive Response” type,
Holt: (1950) postulated that individuals respond somatically
to stress and ccnrlicts or many dirrerent kinds in a rashion
that is consistent ror them and determined on a.hereditary
basis. Serious disturbance occurs rirst in the bodily organ
which is most vulnerable innately.

Representing 'Physioletical Regression“ type, Hichaels
(l9hh) proposed that the somatic expression or psychological
disorder is the result or physiological regression or the
adult to an inrantile physiological level. One charac-
teristic reatnre or this inrantile mode or runctioning is
relatively greater reactivity to stimuli. rhere is a
quantitatively:more marked disturbance or homeostasis.

The increase in physiological variability, due to the
regression, is beyond the narrower limits or the adult,
producing a breakdown in function.

the preceding theories have their own particular

weaknesses when they are put to the test or explaining or
conceptualizing the vast amount or experimental and empiri-
cal data collected in psyohosomatic research. However,

a more basic conceptual problem is their inability to explain
the entire continuum or psychopathology rrom.the purely
physiological symptoms at one end to purely symbolic or
psychic symptoms at the other» the major theories or
psychosomatic disorders have been oriented toward the phy-
siologieal end or the ecntinuum.or psychopathology (ulcers,
colitis, hypertension, etc.) without at the same time being
able to explain the more psychic or psychological symptoms
(compulsions, obsessions, anxidty, etc.) ror instance,

none or these theories accounts tor the apparently whimsical
change or symptoms in some patients , both.physical and
mental, over time. Most certainly, rather than being into-
grative, these theories have served to isolate psychosomatics
as a branch separate rrom.the rest or psychopathology when
this division has no validity.

An attempt at such an integrative theory was made by
Reyher (l9dh) as a result or two investigations concerning
the posthypnotic stimulation or hypnotically-induced conrlict.
'Decply' hypnotized subjects were given a parmmnesia which
generated intense reelings or anger and a destructive act
toward a given person. Ehey were to tear up some important
papers belonging to this individual after they’were awakened
in response to prearranged cues. Observation alone revealed

that as subjects became increasingly aware or less repressive

h

of their hostile impulses, their symptoms seemed to change
from those of a somatic nature to others of a psychic or
psychological nature. Only a few symbolic symptoms (conversion
reactions) were noted. in view of their intrinsic interest,
the obtained reactions were placed in categories that seemed
to be clinically meaningful. Repression was conceptualised
as a continuum.and an objective index of repression of the
induced conflict was obtained for each subject. in the
two investigations reported by Reyher (1967) the degree of
repression was round to correlate .7u and .?8 (.05 and
.01 levels of significance) with the relative frequency of
somatic symptoms. Correlations of -.68 and -.80 between
the degree of repression and number of symptoms were also
reported for the two investigations (Reyher, 1967). The
latter finding was verified by Perkins (1965).

The classification of symptoms is given below:

1. Symptoms characterised by dominance of autonomic
system.innervation such as feelings of nausea,
gastric distress, headache, tiredness, sleepiness,
tachycardia, pressure in head, sweating, flushing,
skin disturbances, organ dysfunctions, heaviness,
temperature alterations, and such feelings as
”queasy” and 9antsy!.

2. Symptoms dominated by innervation of somatic or
muscular nervous systom.such as stiffness, aches,
pains, tension, tics, tremors, physical discomfort,
etc.

3. Disturbances of affect
a. flattening: lack of reeling, apathy.

b. Superegc reactions: feelings of beans alone,
gbandoned, ashamed, depressed, disgusted,
guilty, worried.

e. inversion: definite feelings of well being
upon recognition of a critical word.

d. Alienation: feelings that seem.weird, strange,
runny, unreal, unnatural, foreign.

h. 'Unspecified distress that cannot be clearly cate-

5.

7.

8.
9.
10.
11.

12.
13.

5

gorized as either physical or emotional in nature,

in S*s frame of reference, and are expressed in

such conventional terms as being upset, fidgety,
jittery, nervous, on edge, restless, bothered,

e c.

States of emotional agitation that reflect the

reaction of the ego to the threat of complete

breakdown of repression, such.as feelings of
anxiety, fear, apprehension, terror, etc.

States of confusion, doubt and disorientation that

include statements that one*s thoughts are being

pushed or pulled and that the content of thought
cannot be specified.

‘Dissociative reactions

a. Somatic and ideational delusions, such as
limbs feeling detached and paranoid ideas.

b. Strong compulsive urges not carried out in
behavior, such as wanting to move hands around,
scratch at something, etc.

o. Compulsive destructive urges acted out in
behavior without awareness of relevant hostile
or destructive impulses.

Disturbance or distortion in perception of the

tachistoscopic stimulus.

Derivatives of the induced conflict.

Conscious correlates of the unconscious hostility,

such as feelings of irritation, annoyance,

frustration, etc.

‘Delayed awareness of one or both aspects of the

conflict.

immediate awareness of one aspect of the conflict.

immediate and complete awareness of both aspects

of the conflict.

The theoretical basis for the obtained relationship

between the degree of repression and type of psychopathology

has been presented elsewhere (Reyher, l96h) and denotes

shifting patterns of excitation and inhibition in the

Central lervous System.as an impulse is progressively

represented over higher levels of cortical integration.

The purpose of the present investigation was to verify

Reyherfis reported relationship between the number of symptoms

and the degree of repression using paper and pencil question-

naires.

METHOD

Subjects Egg Materials

linety-two psychology students at Michigan State
University in an introductory course were given the Byrne
(1961) Repressor-Scnsitiser Scale and a 7h-item.symptom

questionnaire.

Procedure

The Byrne (1961) Repression-Sensitization Scale was
rejected for three reasons: (1) it contains many smmatic
items: consequently, when correlated with the symptom
questionnaire the outcome would represent a simple test-
retest of S's tendencies to report sometieowymptoms$h¢2) the
R-S Scale indicates the probability of whether a person
represses, not the degree of repression or certain drives
and impulses; and (3) the experimenters preferred a
theoretical rather than an empirical approach to the
development of such a scale.

ror these reasons, only non-somatic items of the
3-8 Scale were used which could be scored for the degree
to which drives or impulses were repressed. The senior
investigator scored the items in terms of level of awareness
of the impulse or feeling. Three degrees of repression
were used: those questions which.were weighted 3 are
indicators of impulses on the brink of awareness, whereas

those questions weighted 2 or I are progressively remote
.6

indicators of impulses. With the use of this scoring

systom, a numerical score indicating the degree of repression
of an affect or impulse was obtained for each S. Table 1
shows the items from.the Byrne Scale and the 7h-itom

questionnaire that were used.

insert Table 1 about here.

The two questionnaires were scored individually for
(l) the total number of somatic symptoms (categories 1
and 2) and (2) the degree of repression (the summation
of weighted items).

Subjects were then grouped according to the total
number of somatic symptoms exhibited, beginning with those
So with only one symptomt The types of somatic reactions
for each group were recorded. Since both Reyher (1967)
and Perkins (1965) reported that the number of symptoms
is a function of the degree of repression, it is expected
that the ratios between categories 1 and 2 for Se with
meny symptoms would tend to be smaller than those ratios
for So with few symptoms :;:,~ as repression weakens,
.mere symptoms representing category 2 should be added.

A replication study was conducted using 32 Se.

RESULTS

The relationship between degree of repression (R)
and the total number of somatic symptoms was tested by
obtaining the Spearman rank order correlation between R
and the number of somatic symptoms for the 92 So. The
obtained correlation of .h3 (significant beyond the .01
level) is consistent with the earlier research reported
by Reyher (1967) and Perkins (1965). The replication
study indicating a correlation of .57 (significant beyond
the .01 level) lends further support to the hypothesis
mentioned above.

when the ratios were examined, there were no significant
trends noticeable although it was difficult to analyse
since for Se with 5 symptoms and over, there were no
”new" symptoms. Also, the numbers of symptoms in categories
1 and 2 were unequal and would cause category 1, with a
greater number of *gzitoms, to be favored. Finally base
rates for these symptoms are unknown and arepresumed

to be unequal.

DISCUSSIOH

The significant correlations found in both the original
and replication studies were surprising considering the
crudity of the instruments. Investigators who expouse an
empirical approach.might criticize the judgemental or
subjective element in categorizing the items of the Byrne
Scale and the 7h-item.questionnaire in terms of degree of
repression: however, the replication group justifies,
on empirical grounds, the theoretical frame of reference
employed. The favorable outcome of the replication sample
also obviates the need for a measure of inter-rater relia-
bility although such information is always of interest. A
low correlation between raters might merely reflect a differ-
ence in their sensitivity to assessing data in terms of
degree of repression or as derivatives of unconscious drives
and impulses. Our experience with training students in
'free imageryI (Reyher, 1963, 1968: Reyher a Smeltser,
1968) indicates that there are gross individual differences
in acquiring this sensitivity to unconscious processes.

The results of this study are consistent with the
findings of laboratory research involving the posthypnotic
stimulation of hypnotically-induced conflict and lend
further support to the clinical relevance of hypnotically-
induced psychopathology (Perkins, 1965: Reyher, 1962,

1963. 1967).
The significance of the results for clinical practice

9

10

is apparent when one considers the possibility that shifts
in symptoms may indicate either an increase or decrease of
repression. If this is the case, then the clinician may

be able to determine whether his treatment is reinforcing

or weakening repressive forces.

1.

BIBLIOGRAPHY

Alexander, 1". Psychosomatic medicine. New York:
Norton, 1950.

Byrne, D. The repression-sensitization scale: rationale,
reliability, and validity. g, 2231,, 1961, 29,
33h-3h9.

Dunbar, H. r. Emotions and bodily changes. New York:

‘ Columbia Univ. Press, 1935.

Mendelson, M., Hirsch, S., & Webber, C. S. A critical
examination of some recent theoretical models
in psychosomatic medicine. Psychosom. £133.,

1956. 13. 363-373.

Michaela, J. J. a psychiatric adventure in comparative
pathophysiology of the infant and adult. g. 2251'
919331. 11:51., 191411., 100, 19.

Perkins, h. Repression, psychopathology, and drive
representation: an experimental hypnotic investi-
gation of the management of impulse inhibition.
Unpublished doctoral dissertation, Michigan State
Univer., 1965. ‘

Reyher, J. Posthypnotic stimulation of hypnotically
induced conflict in relation to psychosomatic
reactions and psychopathology. Psychosom. 1121.,
1961, 23, 38h-391.

Reyher, J. A paradigm for determining the clinical
relevance of hypnotically induced psychopathology.

11

9.

10.

11.

12.

13.

114..

15.

12

Psychol. £911., 1962, 59, 3144-352.

Reyher, J. A reply to Levitt' s cements. Psychol.
gull” 1963, 60, 330-332.

Reyher, J. Free imagery: an uncovering procedure.

,1. 311.5. Psychol., 1963. 19. ash-1m.

Reyher, J. Brain mechanisms, intrapsychic processes
and behavior: a theory of hypnosis and psycho-
pathology. A_me;_£. J. 311.3. HM” 1961;, 7, 107-119.

Reyher, J. Hypnosis in research on psychopathology.
In J. E. Gordon (Ed.), Handbook 25: clinical :21
experimental hypnosis. New York: Macmillan Co.,
1967.

Reyher, J. Hypnosis. in introduction to ggneral
psycholog: a self. selection text book.

 

 

Dubuque, lows: Wm. C. Brown Co., 1968.

Reyher, J., a Smeltzer, H. Uncovering preperties of
visual imagery and verbal association: a
comparative study. 1. abnorm. Psychol., 1968,
73, 218-222.

Wolff, H. S. Life stress and bodily disease: a

formulation. in Proceedings 25 the association

 

 

for research in nervous and mental disease.

Baltimore, Md.: Williams and Wilkins, 1950, 29.

Table 1. items used to measure degree of repression and
their respective weights.

 

weight or
each item 1 2 3

 

Byrne R-S Scale

Number or item. 105 T 156 T 70 k
m9 T as T
1&8 T 155 T
114.0 T
129 i"
12 T

71i-item

symptom

questionnaire

Number of item. h5 T 53 T 6 T
17 33 T 18 T
11 r 73 T
66 T 72 T
6h r h3 T
59 r

 

13

APPEHDix
Seventy-four item.Symptom.Questionnaire
This questionnaire consists of some numbered statements.
Read each.statoment carefully. if it is true as applied
to you, mark T on the answer sheet and if false mark r.
r13... answer all statcments as accurately as you can.
1. i do not often feel bothered.

2. l have never been paralysed or had any unusual weakness
of any muscle .

3. I find that I must urinate frequently.

h. I go to sleep without thoughts or ideas that make
me feel guilty.

5. i frequently notice my hand shakes when i try to do
something.

6. At times 1 amLon the brink of having a feeling or
impulse but am at a loss to know what it is.

7. i hardly ever feel pain in the back of my neck.

8. when something goes wrong, 1 generally feel that 1
mm the blame.

9. i never wake up at night frightened.

10. Sometimes i feel as if i must injure either myself
or someone else.

11. i am never ashamed of my thoughts and of the things
that i do.

12. i am bothered by a persistent cough.

13. Parts of my body often have feelings like burning,
tingling, or crawling.

1h. 1 often notice that my body is tense and 1 have
difficulty in relaxing.

15. Once a week or oftener i feel suddenly hot all over
without apparent cause.

16. There have been times when i felt like jumping 011
when on a.high place.

1h

17.
18.

19.
20.

21.
22.

23.
2h.
25.

26.
27.

28.

29.
30.

31.
32.
33.
3h.

35.
36.

lb

1 often feel as if things were not real.

At times i feel as if something dreadful is about
to happen.

At times i have trouble swallowing.

I am.not usually afraid of things or people which i
know cannot hurt me.

I practically never blush.

Sometimes i have strange, unnatural feelings which.are
hard to describe.

At times i have a strong urge to do something harmful
or shocking.

At times when things are going particularly well for
me, i become suddenly depressed.

Often, even though everything is going fine for me,
i feel that i donit care about anything.

There are very few periods when i am on edge.

There are persons who envy my thoughts and ideas and
would like to call them.their own.

i have never had attacks in which i could not control
my movements or speech.but in which.i knew what was
going on around me. -

i hardly ever notice my heart pounding.

There are some people who seem.to have it in for me.
Sometimes without any reason or even when things are .
goigg wrong, i feel excitedly'happy, 'on tap of the
wor d. _ .

‘Hven though i know I do not have arthritis or rheumatism,
I often have soreness in some of my joints.

I deserve severe punishment for my sins.

There are never times when i lose my bearings and am
at a loss to know where i am.

At times my eyelid twitches for no accountable reason.

I feel weak all over much or the time.

37.

38o

39.

no.

kl.
ha.
113.

1+5.

h6.
1+7.

“.5 e
h9.
50.
51.
52.
53-
5h-

55.

16

My thoughts have never raced ahead faster than i
could speak theme

My mind seems to be divided into two parts which appear
to be struggling with one another.

Sometimes I have a loss or feeling or numbness in a
part of my body.

Sometimes 1 break out in a sweat even though it is
not hot.

i have never had a fainting spell.
My sleep is sometimes fitful and disturbed.

There have been times in my life when i felt panic
or terror without any accountable reason.

i sometimes develop hives or raah for no apparent
reason.

i love my parents dearly and wish that i could live
up to their expectations. .

i am.neldom.short or breath.

I am.nlmost never bothered by pains over the heart
or in my chest.

i seldom or never have dizzy spells.

in the presence of friends and familiar surroundings,
i sometimes feel as if the people around me were
strangers and the setting unfamiliar.

My mouth feels dry much.of the time.

i have noticed on occasion that parts of my body have
felt detached as if they were not a part creme.

There are periods during which.i have abdominal cramps
for no apparent reason.

1 cften feel irritated or annoyed without any particular
reason for it.

At times i have problems with either constipation or
diarrhea.

I never feel that all my friends and loved ones will
abandon me.

56.
57.
58.
59.
60.

61.

62.
63.
65.
65.

66.
67.
68.
69.

70.
71.
72.

73.

7h.

17

I have periods or great restlessness.

i feel anxious almost all the time.

i am bothered by acid stomach several times a week.
I have never had strange and peculiar thoughts.

At tunes I become depressed and think that 1 am no
good at all.

i have little or no trouble with my muscles twitching
of jumping.

I.hardly ever feel like smashing things.
I am easily frightened.
I hardly ever become upset without knowing why.

There are times that I suddenly become aware that I
have been gritting my teeth.

At times i feel i lose control over my mind.
i feel frustrated much of the time.
I often notice that i am fidgety.

During sad moments, I never find myself laughing out
loud or having the urge to do so.

I never get the jitters.
i sometimes feel that i am hbcut to go to pieces.

There are times when i-don't have any emotions or
feelings at all, even though i wish I had.

I am.aware of the presence of certain thoughts or ideas
which i am.nnable to grasp.

i am not bothered by people outside, on streetcars,
in stores, etc. watching me.

"‘injignluppjg1111mm“

 

7915