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SCHMALE ARTHUR H. JR. M.D.
Psychosomatic Medicine: July 1958
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Summary

This is one of a series of studies being made to investigate the relationship of “separation and depression” to the onset of medical disease.

In this report a group of 42 semiprivate hospitalized medical patients between the ages of 18 and 45 was studied for predisease setting based on reported object-relationship changes and reported and observed major affective reactions to such changes.

Twenty-nine patients and/or family members reported loss of an object and feelings of helplessness and hopelessness immediately preceding the onset of the symptoms of the illness which led to hospitalization.

Five patients reported feelings of helplessness or hopelessness prior to the onset of symptoms but reported no loss of an object.

In 41 of the 42 patients the investigator felt that there was verbal and/or nonverbal evidence for the interpretation of actual, threatened, or symbolic object loss as well as evidence for feelings of helplessness or hopelessness prior to the onset of disease.

Thirty-one patients developed the onset of their disease within one week after what was considered the final or only change in relationship to which the patient experienced a feeling of helplessness or hopelessness.

Early life losses or threats of loss, past conflicts reawakened or still unresolved, and the incidence of past separations preceding changes in past health of this group of patients were also reported.

"Separation and depression" as defined refers to the psychic pattern of unsuccessful resolution of object loss. Starting with a change in a relationship, this concept involves the actual or fantasied loss of an object upon which the self has real or symbolic dependence and includes the attempts and final failures to reestablish or give up the lost or threatened relationship, as evidenced by feelings of helplessness or hopelessness.

Case examples are appended to illustrate how the setting of the current disease onset was reported and how the investigator made his interpretations of this material.

Received January 13, 1958

Copyright © 1958 by American Psychosomatic Society

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