FROM PSYCHE TO SOMA AND BACK
Tales of Biopsychosocial Medicine
George Freeman Solomon, M.D.
with Ping Ho, M.A.
From Psyche to Soma and Back subtitled Tales of Biopsychosocial Medicine is a scientific and personal adventure story, that of George Solomon, a pioneer of psychoneuroimmunology (the fast-growing field that studies interactions among brain, behavior, and immunity), who has always tended to tackle problems that others had not or would not. Dr. Solomon tries to solve mysteries, be they scientific or criminal, in bold, unconventional, and often controversial ways. His odyssey is an exposé of conceptual narrowness and ethical shortcomings in clinical medicine, scientific research, criminology, and the military. Stories of real people remain in the forefront throughout. The through-line is the vicissitudes of human aggression. If one cannot stick up for oneself, one is prone to physical illness. If one takes out anger on others, one makes society sick. If one goes against one’s own conscience to commit harm against others under social pressure, one may wind up with a mental disorder.
All of medicine as well as psychiatry and psychology is complexly biopsychosocial in nature, as Dr. George Engel pointed out in 1960. As might be added, so is criminology. To make more sense to the reader of a varied professional life that moves among these domains, sometimes contemporaneously, the book itself is divided into “Biopsycho” and “Psychosocial” sections. However, for the purpose of this outline of content, it makes sense to be descriptive chronologically even though it does not follow the order of the book. A list of chapters is appended. This description will be a first person narrative.
The groundwork for my thinking began with graduate and specialty medical education (Stanford, Washington University, UCSF). I repeatedly observed the inseparability of physical from psychological causes of physical and mental illnesses. There were the exceptionally nice unassertive people who, when deeply distressed, were getting sick with rheumatoid arthritis and other autoimmune diseases (when the immune system attacks the body’s own tissues). Could personality factors influence the immune system? Could Stress? (Later, I did quite well in betting my rheumatologist colleagues that, after a 20-minute non-medical chat, I could determine which patients with short term joint symptoms had rheumatoid arthritis over all possible causes.) There was the catatonic schizophrenic, whose three-month “cure” was triggered by her response to my own emotional grief and ended with my departure. What was going on at the dopamine receptors of her brain neurons during the improvement? It seemed to me that thoughts and feelings can change dopamine just as much as dopamine can change thoughts and feelings. Each clinical case I encountered seemed to solidify my belief in the mind-body connection.
I learned quickly that the only way that I would survive a two-year stint in the Army was to disguise my rebellious nature, a skill that has since served me well in academia. Stationed at Ft. McClellan near Anniston, Alabama (which I privately called “Anus-town” because of its then vicious racism). I was privy to Chemical Corps developments in lethal chemical and biological warfare. (This work was largely carried out by veterinarians because they do not take the Hippocratic Oath.) A main interest at that time was experimentation in the use of psychotomimetic compounds such as LSD as “incapacitating agents”, leading to my making some startling observations. I also served as psychiatrist to the Women’s Army Corps Training Command at Ft. McClellan, where I made special efforts to try to thwart “witch-hunts” against able lesbian soldiers. Based on Alfred Adler’s interest in early memories as a way of betraying something of one’s basic character or life themes, I found that early memories, indeed, proved to be predictive of success or failure in basic training.
My post-residency fellowship in psychiatry at the University of California, San Francisco gave me a chance to pursue research ideas. I had always felt that unconscious conflicts could increase vulnerability to disease and, thus, that psychoanalysis had implications for psychobiology—the shocking shortcomings of some psychoanalysts notwithstanding. In studying psychological factors involved in the onset and course of rheumatoid arthritis with research psychologist Rudy Moos, two attractive sisters were particularly illustrative of the differences that we found between female patients and their healthy sisters. The arthritic patient had left a rewarding experience in the military for a self-sacrificing domestic lifestyle that included dutiful cooking and cleaning for her father, whose sexual abusiveness during childhood she would never discuss with her sister. The healthy sibling was a feisty and fulfilled athlete, who told me that she looked forward to dancing on her father’s grave. Why arthritis in the patient? Why not in the rheumatoid factor (autoantibody) positive sister? In every role-play psychodrama, the sibling was more assertive than the arthritic. Our subsequent studies seemed to validate the notion that psychological health could preserve physical health in the face of genetic vulnerability.
As a new member of the Stanford Medical School faculty, I was made Chief of Psychiatry Training and Research at the Palo Alto Veterans Administration Hospital. I had a few amazing psychotherapeutic breakthroughs with schizophrenic patients. Intensive psychotherapeutic work with highly mentally ill patients is virtually unheard of these days because this side of psychiatry is becoming somewhat of a lost art relative to the biological side. The case of the psychotic who killed a young mother with her own roller skates in order to become an adult—because “everyone knows that adults get away with murder”—underscores the critical necessity for adequate facilities for the chronically mentally ill. I was profoundly influenced by both my father and the counterculture climate of the ‘60s that fostered new ways of looking at accepted conventions. I co-led a weekly psychotherapy group with Dad, with interesting psychotherapeutic influences of our father-son relationship. One group member reported a fascinating recurrent dream that Dad discovered was almost identical to a passage from Lewis Carroll’s Through the Looking Glass, in which Alice is told that she would disappear should the sleeping Red King awake because she only existed in his dream. Dad linked the patient’s bizarre attention-seeking behavior and maintenance of a large, commanding image to her need to exist in the mind of her father. Dad redefined the basic human anxiety (according to classical psychoanalytic theory, fear of castration) as existential anxiety or fear of non-being. “I am thought about; therefore, I am.”
No Monopoly on Evil: Vietnam (Chapter title) offers an exposé of the atrocities that went on in the name of a fight for freedom, as reported by young veterans some of whose traumas could only be revealed under the influence of so-called “truth serum”. For instance, there was the suicidal, 18-year-old Marine who had killed a 14-year-old Vietnamese girl by order for having rebuffed his corporal’s sexual advances. He later shot (“fragged”) the corporal as well—making it look like a Viet Cong kill, and ultimately killed himself. The stresses unique to Vietnam were capable of cau
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