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Tribute to Felix Deutsch.

In his article in the 50th anniversary issue of Psychosomatic Medicine (Vol LI:597-607, 1989) Don Lipsitt pays tribute to Felix Deutsch as one of the first analysts to make a significant contribution to psychosomatic medicine. That Felix Deutsch deserves such recognition there can be no doubt, since this is evident from one of his earliest papers (1). Lipsitt cites Alexander and Selesnick who stated that Felix Deutsch and Georg Groddeck were "the most consistent proponents of the significance of emotion factors, not only in hysterical conversion symptoms but also in chronic organic disease" (2). However, Alexander and Selesnick also stated that Felix Deutsch and Georg Groddeck "uncritically attempted to explain all symptoms . . . as the direct expression of highly repressed ideas of fantasies" and furthermore Deutsch "applied Freud's concept of conversion to all dysfunctions of the body" (3). That there is justification in Alexander's criticism is evidenced from Deutsch's writing long after 1939. In 1955 he wrote "the treatment of any psychosomatic disorder is to purify and liberate the bodily functions from their unconscious cathexis" (4). In discussing epilepsy he wrote that "convulsive seizures represent the gratification of hostile or aggressive tendencies . . . in the seizures the sado-masochistic tendencies are acted out" (4). The idea of giving meaning to seizures was negated some years before Deutsch's chapter on epilepsy (5). Lipsitt does mention Deutsch's "emphasis on the role of symbolization in the etiology and course of illness" but lauds it "as landmark efforts to go beyond mere descriptive reductionistic approaches to diagnosis and treatment." I cite Alexander's criticism with which I agree, since I believe they are pertinent to the case report which is the vehicle Lipsitt uses to illustrate Deutsch's contribution to psychosomatic medicine. The patient with anorexia nervosa whose case is beautifully presented by Lipsitt was first seen by Deutsch in 1938 and by Lipsitt in 1961 and then followed by him until the present. In reviewing the chart at the time of the admission when the patient was seen by Deutsch, Lipsitt was impressed by Deutsch's words "that no improvement can be hoped for until this patient is given insight and placed in an environment removed from the mother." Lipsitt endows these words as prophetic since after the patient's mother died in 1968 she was placed in a nursing home where she remains to this very day. I too would endow the words as prophetic but I see them as a self-fulfilling prophesy since they may have been responsible for instituting a course of treatment that was doomed to failure. In my opinion the one thing the patient did not need was analytically oriented insight therapy, which was given in abundance. Also the order "to be removed from the mother" was probably responsible for the attempts by various therapists to separate the patient and her mother which only aggravated the problem. It should have been clear from the start that only death could separate such an intense symbiotic relationship. I believe that not only in retrospect, but in 1938 some analytically oriented clini-