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Clinical Applications

A Systematic Approach to
Psychosomatic Disease
Gerald Cartmel
Abstract cal factors in the cause, it is less commonly
This paper describes a systematic ap- understood that the body's response to harm-
proach to the psychologicaland physical fac- ful stimuli is also "psychosomatic" in that there
tors that determine the psychological and are both physical and psychological com-
physical responses in the human body known ponents in the response.
as diseases. The author aims to bridge the The advantage of the transactional analysis
gap between the psychological and medical model is that the simplicity and depth of the
approaches to disease and offers a concise metaphors (diagrams and nomenclature) allow
method of clarifying treatment options. The the client to share in the thinking and to remain
Disease Equation is demonstrated to be a responsible for the self. The diagrams presented
useful and practical model for intervention in this paper have proven useful in treating
in the disease process. Basic rules pertain- psychosomatic disease; they are easily under-
ing to psychosomatic disease are postulated stood by the client and fit comfortably alongside
and clinical examples are given. the TA model.

Contract Setting in Treating Psychosomatic


Basic Approach to Disease Disease
TA teaches the importance of a clear contract
As a family physician and counselor, clients for change (Goulding & Goulding, 1979, pp.
come to me with both physical and psychologi- 50-93) which is understood by client and thera-
cal illnesses. Although more people are pre- pist. The contract may be for social control,
pared to look at the psychological aspect of an intrapsychic or internal cure, or exploration.
illness, many still are not. The difficulty is find- For example, a couple with problems involv-
ing out what approach a client wants to take ing physical violence in a third-degree game
toward treating the disease or discomfort. In- of "Uproar" (Berne, 1964) may develop a
stead of insisting on a certain approach, I in- social control contract that sets safety limits and
vite the client to clearly establish what he or give them time to deal with the reason they are
she hopes to achieve by treatment, and together fighting. The medical model, on the other hand,
we then establish a treatment contract. is not as clear in setting treatment contracts.
Although people commonly believe that dis- Too often the contract is not Adult-Adult, but
ease is an entity in its own right, disease is ac- Parent-Child by way of informed consent. The
tually a process: a manifestation of the body's following diagram (Figure 1) is useful for clari-
response to excessive or inadequate stimulation. fying treatment goals in such a way that the
Both stimuli and responses can be immensely client is able to decide his/her preferred treat-
varied and constantly changing. This paper ment from the Adult ego state. The therapist re-
demonstrates a system that clarifies the process tains the option not to accept the contract.
of stimuli and response seen as disease and ac- In many cases reasonable treatment options
counts for both physical and psychological may be very limited. For example, most of us
components in such a way that a rational ap- would choose surgery (mechanical cure) for
proach to treatment can be developed by client acute appendicitis or antibiotics for pneumonia
and therapist. (chemical cure). A cardiac pacemaker is an ex-
Although in using the term "psychosomatic" cellent example of mechanical control of heart
to describe a disease (process) it is commonly rhythm even though the heart condition cannot
accepted that there are psychological and physi- be cured. Often diabetes can be effectively

212 Transactional Analysis Journal


A SYSTEMATIC APPROACH TO PSYCHOSOMATIC DISEASE

NATURAL CHEMICAL MECHANICAL


Migraine Migraine Cardiac Pacemaker
CONTROL Diabetes Duodenal Ulcer
Depression
Duodenal Ulcer
Migraine Pneumonia Appendicitis
CURE Depression
Duodenal Ulcer

Figure 1
Treatment Mode Options

controlled only by insulin (chemical control), a broader concept of psychosomatic disease us-
and there is no available cure for it yet. ing the disease equation.
However, many illnesses can be treated by
several modes, and this is where the treatment
mode options diagram is useful (Figure 1). For Using the Disease Equation
example, depression can be treated chemical- in Psychosomatic Disease
ly by using drugs, or by psychotherapy which When the client understands that the present-
aims at a natural cure. Migraine can be treated ing symptom is a "response," not "the
by drug control, or a fuller investigation may disease," and is ready to look for a possible
lead to a natural or non-invasive cure. cause for the process, the disease equation can
In many cases of psychosomatic illness, be put to use.
clients are not aware that treatment is directed The first step is to show on a white board
at chemical control only, and other treatment that a problem is a situation with associated
modes aimed at cure are not discussed. Too unpleasant thoughts, unpleasant feelings, or
often clients are not given sufficient informa- unpleasant body responses (Figure 2).
tion to make valid decisions in choosing treat-
ment, and too often choices are made for them. /"!. Unpleasant Thought Response
However, the treatment mode options diagram
is readily understood by clients, and, given a
choice, more people are seeking natural ways
to good health and natural cures to their disease
,
Situation ~ Unpleasant Feeling Response
Unpleasant Body Response

Fixed Body Response


processes.
Figure 2
Because this part of the decision making is
Definition of a Problem
so crucial, I may spend up to twenty minutes
on it, depending on the interest shown by the
client. If the client is interested only in chemical A Problem: With the client I fill in as much
control, then I respect that decision. Factors of the disease equation as possible. This im-
such as beliefs and financial and time com- mediately gives the client insight into possibil-
mitments must be considered. Understandably, ities. For example, a client with a duodenal
a client may choose a one-week supply of ulcer was able to connect "When I am on the
Valium in preference to three months of telephone and having difficulties with a govern-
psychotherapy to control the anxiety triggered ment department and can't get any sense out
by an unwanted visit from in-laws. of them, I feel angry and go and get a cold drink
If a client is interested in further exploration, from the refrigerator while I 'cool off." He
another longer appointment is set up to in- does not express his anger, which is associated
troduce him/her/them (in cases of couples) to with abdominal discomfort which he relieves

Vol. 16, No.4, October 1986 213


GERALD CARTMEL

Feelings May Be: Only explained when applicable


Not on Chart
1. Appropriately Experienced Varies from Society to Society
Appropriately Demonstrated
2. Confused Undifferentiated
3. Blocked Not felt or experienced
4. Contained Felt but not demonstrated
5. Substituted Replacing a feeling (Rackets)
6. Displaced "Dumping" on someone or somewhere else
7. Inappropriately Experienced Varies from Society to Society
Inappropriately Demonstrated
Figure 3
Feelings Chart

with food. Already he connects the


SITUAnON ~ THINK ~ FEEL ~ BODY
RESPONSE. This is an example of first degree
psychosomatic disease because the client can
make this connection.
Exploring Responses: If the client attends
with a spouse, parent, or friend, I often go
........................ through these responses first with the accom-
:~:~:~:~:~:~:~:~:~:~:~:~ panying person. This takes pressure off the
:::::::::::::::::::::::: identified sick person leaving him/her with
........................ room to safely process internally.
::::::::::::::::::::::::
............
.:.:.:.:.:.:.:.:.:.:.:.: Ir:I~_~"7":lri'~,,'~~~1iN
:.:.:.:.:.:.:.:.:.:.:.:.
Example Of Exploring Responses to a
Stimulus:
.:.:.:.:.:.:.:.:.:.:.:.: Q. "When faced with a difficult situation in

t~t~~ttt~
life, what is your emotional (feeling)
response?"
A. "I usually get frustrated."
Thought Feeling Body Q. "What is 'frustration' for you? Anger?"
Response Response Response A. "Yes. Anger. But I can't express it."
Figure 4 (I point to "CONTAINED" on the feel-
Bargram for Example of Exploring Responses ings chart) (Figure 3).
Q. "And when you feel frustrated what is go-
ing on in your mind?"
A. "Well, I always have difficulty in making
decisions however hard I try."
Q. "And when you can't make a decisionwhat
THOUGHT Self do you say to yourself?"
RESPONSE Criticism
A. "I'm not good enough. I'm a failure."
FEELING Q. "And when you feel angry and don't ex-
S~-"'" Contained
RESPONSE Anger press it, where do you feel your anger?"
A. "In my stomach" (See Figures 4 & 5).
BODY Obesity
RESPONSE Those participating in such an explorationare
Figure 5 often surprised to find that they experience
Example of Response System emotions in different parts of the body.
Sometimes anger is felt in the stomach, head,
or arms; fear is felt in the arms, head, or
stomach, etc. When two or more feelings are
214 Transactional Analysis Journal
A SYSTEMATIC APPROACH TO PSYCHOSOMATIC DISEASE

experienced in the same part of the body, this all factors that combine to create the stimulus.
may be associated with confusion of feelings. These factors are called the demand/resource
No feelings, no pressure, or no awareness of system.
body responses is often associated with It is important not to proceed with in-
blocked feelings. vestigating the demand/resource system unless
Frequently, however, the significant con- the client is willing, because the process can
tained feeling is experienced at the site of the be threatening as awareness increases. Many
presenting body response (symptom). And, a people are prepared to look only at the
blocked feeling provides an important clue. As response.
insight develops, few people fail to get in- Exploring the Demand/Resource System: The
volved. Some have already found their ans- potency ofthe stimulus depends on the degree
wers; others need to move on to the left side ofimbalance between demands and resources.
of the equation to deal with the situation or It can be modified by lowering or increasing
cause of the problem. This can be threatening demands or by increasing resources. Too little
for the client, and it takes clinical skill to decide demand on too many resources is equally as
how far to push someone. A client who wants stressful as too many demands for too few
to will go further; a client pushed too far may resources.
stay away forever. Before making a treatment decision it is im-
Exploring the Stimulus and Causes Leading portant to assess demands and resources by
to the Response: The stimulus is defined as the looking at both external or situational factors
sum ofthe imbalance between demands and re- and personal internal factors that may influence
sources (Figure 6). Without stimuli we cannot options for creating and dealing with external
thrive. This is the basis of the stroke economy factors. Usually internal factors determine the
in transactional analysis (Steiner, 1974). Thus, existence or significance of external factors
up to a point, stimuli are necessary for healthy (Figure 8). What is an incapacitating
growth and development. However, when the catastrophe for one person may be a positive
potency of the stimulus becomes excessive, ill- challenge for another.
health and dysfunction may occur (Figure 7).
The potency is related to both the intensity and
duration of the stimulus. Demands Demands
Internal Resources - - -. . External Resources
Figure 8
Imbalance of Demands . . Stimulus __ Response The Relationship Between Internal and
Resources
Figure 6 External Demands and Resources
Defining the Stimulus
Auditing the external demand/resource sys-
tem is usually straight-forward and non-
Health and Development threatening. Often the client admits readily to
Stimulus
< III Health and Dysfunction
significant problems in addition to identified
problems. However, the identified cause ofthe
Figure 7 stimulus is often not the significant cause ofthe
Stimulus Potency stimulus.
Auditing the internal demand/resource sys-
tem is more difficult because the client may not
In psychosomatic disease the potency of the be prepared to delve so deeply. The reasons for
stimulus is important, not the cause of the this reluctance may be practical and related to
stimulus. If the stimulus is so excessive that it the external situation, and there may be strong
elicits a dysfunctional response, then treatment conscious or unconscious motivation for the
options are either to alter the response by client to avoid certain issues.
natural, chemical, or mechanical means or to If a client is not prepared to explore the in-
lower the potency of the stimulus. To lower the ternal demand/resource system, the therapist
potency of the stimulus, it is necessary to assess has no more right to push than a surgeon has

Vol. 16. No.4. October 1986 215


GERALD CARTMEL

to operate against a patient's will. This is a good A good example was a plastic surgeon whose
place to reconsider the original contract for cure Don't Feel was advantageous in the operating
or control. For the contract to remain Adult- theatre and counterproductive in his personal
Adult the clinician can only inform the client life. His "Be perfect" and "Please me" drivers
that full resolution is not possible without in- were also useful in his profession and destruc-
vestigation of the internal system. Often there tive to his sex life.
is no immediate need to proceed, and the client The paradox created by inviting a client to
can be so informed. For example, a client with choose the column or columns in which to place
a history of severe migraine attacks controlled drivers and blockers is a major stimulus for at-
with drugs for many years is in no immediate taining insight into how he or she has been in-
danger. The client does need to know that there volved in creating or maintaining the external
are alternative forms of treatment. demand/resource system (Figure 9).
When the contract is for internal audit, TA Following the audit, a client has new infor-
is ideal. The concepts of drivers (Kahlers & mation and a better understanding of factors
Capers, 1974) (injunctions), blockers (counter- leading to responses. Some elect to change their
injunctions) (Goulding & Goulding, 1976), and external demand/resource systems, others ex-
scripts are basic to transactional analysis and plore ways of changing their internal de-
easily understood. mand/resource systems, and still others choose
It is important to understand that drivers and to accept the situation and change their own
injunctions are inherently beneficial messages responses.
telling us how to succeed in the external world;
they are internal resources. Only when drivers
become absolute rules rather than useful guide- DEMANDS RESOURCES
lines do they become disadvantageous de- EXTERNAL e.g. Large mortgage Well paid job
mands. Drivers can also be mutually incompat- " Sick spouse Supportive
family
ible; e.g., one is invited to "Hurry up" and Demanding boss
"Be perfect" at the same time. Thus, drivers Creative ability
can be placed in either or both the demand and i.
resource columns (Figure 9). ii.
Blockers are often understood as restraints iii.
iv.
or impediments to a person's development. v.
However, a useful metaphor is the gear box of
a car. If it is jammed in low gear there are INTERNAL e.g. Try hard Don't succeed
greater demands on the engine in maintaining " Don't feel Don't feel
Loser script
cruising speed on a flat road. On the other i.
hand, this disadvantage would not be so ap- ii.
parent climbing hills and would be a positive iii.
advantage descending a steep hill, especially if iv.
there was another factor or demand present v.
such as failing brakes. Thus, blockers can be
Figure 9
placed in either or both columns depending
Example Audit of Demand/Resource System
upon the situation (Figure 9).

DEMAND/RESOURCE SYSTEM RESPONSE SYSTEM


THOUGHT

~
INTERNAL EXTERNAL RESPONSE
FEELING
Demands
Resources
Demands
Resources
---_J STIMULUS RESPONSE
BODY
RESPONSE
Figure 10
t
FIXED BODY
The Disease Equation RESPONSE

216 Transactional Analysis Journal


A SYSTEMATIC APPROACH TO PSYCHOSOMATIC DISEASE

Summary ofthe Disease Equation: From the ed as an entity rather than a response process,
treatment mode options, the client will have then the option for further investigation is
opted for control or cure by natural, chemical, eliminated.
or mechanical means. If the client chooses Commonly accepted examples of psycho-
natural cure, the disease equation provides an somatic diseases are some forms of migraine,
approach that leaves him or her in charge asthma, duodenal ulcer, irritable bowel syn-
(Figure 10). There is no preferred starting drome, hypertension, paroxysmal auricular
point, although the internal demand/resource tachycardia, psoriasis, eczema, neuro-
system can be a threatening place to begin. At dermatitis, and pre-menstrual tension. I would
the end the client can opt for further counsel- also include recurrent breast cysts, non-
ing or to revert to more conventional treat- infective prostatitis, and inevitably some
ments. However, the client should be told clear- cancers, although the fact is that there is a
ly that tissue damage requires tissue treatment. psychological component to all disease.
There is no point in proceeding if the client
A Theory of Psychosomatic Disease is not fully invested in getting better, but if he
Psychosomatic disease processes are usual- or she is looking for a natural cure I may pro-
ly open to intervention and cure by natural ceed to in-depth investigation. Investigation is
means, rather than just control by chemical or based on seven principles. .
mechanical means. The word "natural" im-
plies that chemical or mechanical methods are Principles Relating to Psychosomatic Disease
excluded. However, it is important to Rule 1: Psychosomatic disease is a dysfunc-
remember that, as long as the disease is regard- tional response to an excessive stimulus, mani-

Unpleasant

~
Thought Response

An imbalance of ~DE~M~A~N~DS~, .~ STIMULUS -----l.~ RESPONSF Unpieasant


Feeling Response
RESOURCES
Unpleasant
(Demands and Resources are Internal and External) Body Response
~
Fixed Body
Response

Figure 11
Dysfunctional Response to an Excessive Stimulus

Balanced Response Unbalanced Response

......... :~:~:~{{:~:~:~:~:~
~~~\\}\}~ :.:.:.:.:.:.:.:-:.:.:.:.~~~~:+"

;:::;:::::::;:;=;:;:;=;:
........................
:~:~:~:~:~:~:~:~:~:~:~:~
::::=:::::::::::::::::::
Thought Feeling Body Thought Feeling Body
Response Response Response Response Response Response

Figure 12
Balanced and Unbalanced Responses

Vol. 16, No.4, October 1986 217


GERALD CARTMEL

fested by a thought response, a feeling (emo-


tion) response, and a body response. A fixed
body response occurs when the body response
is self-perpetuating and no longer dependent on
the originating stimulus for maintenance
(Figure 11).
Rule 2: Depression of one mode of response
results in an increase in other modes of
response (Figure 12).
Rule 3: It is the size or duration of the
stimulus that determines the response, not the
cause of the stimulus.
Rule 4: The identified cause of the stimulus
is often not the significant cause of the stimulus.
e.g., "I don't know
Rule 5: The internal demands and resources why I have a
largely determine or maintain the external duodenal ulcer
demands and resources.
Rule 6: There are three degrees of
psychosomatic disease. Figure 14
(a) In first-degree psychosomatic disease Second-Degree Psychosomatic Disease
the client is able to connect the stimulus
to the body response to a feeling response
to a thought response (Figure 13).
(b) In second-degree psychosomatic
disease the client is unable to connect the
stimulus to the body response or a feel-
ing response and thought response
(Figure 14).
( c) In third-degree psychosomatic disease the
disease process is no longer dependent on
the stimulus for maintenance (Figure 15).
Rule 7: Tissue damage requires tissue
treatment.

e.g. ,Chronic obstructive


airways disease
after years of
asthma.

Figure 15
Third-Degree Psychosomatic Disease
e.g., "When I getinto
overload at work
I feel angry and
geta stomachache'.'

Figure 13
First-Degree Psychosomatic Disease

218 Transactional Analysis Journal


A SYSTEMATIC APPROACH TO PSYCHOSOMATIC DISEASE

Factors to Consider in Establishing a Treat- Cases Demonstrating Use of the


ment Plan Disease Equation
1. A treatment contract should be established An example of First-Degree Psychosomatic
on the basis of treatment mode options. Disease: Jim, a forty-two-year-old self-
Treatment options are for cure or control, employed electrician, complained of increas-
by natural, chemical,or mechanical means. ing failure to achieve penile erection. He
2. Tissue damage requires tissue treatment. wanted tablets to cure the problem. I explain-
Assessing tissue damage by appropriate ed tablets would probably have only a placebo
consultation, physical examination, and bio- effect and could cause him harm. He agreed
physical investigation is essential before ad- to come with his wife to discuss the problem
dressing psychological components of the on the basis that sexual problems usually in-
disease process. The treatment plan must volve two people.
allow for both psychological and somatic Jim's partner had recently departed, leaving
damage, and treatment priorities require a failing business. Jim did not know what to
careful consideration. do and tried to hide his anxiety from his wife.
3. In first-degree psychosomatic disease the Jim quickly connected the stimulus of the fail-
client can make a connection between a ing business with his contained anxiety and his
stimulus, a thinking response, a feeling erection failures. By definition this is a case of
response, and a body response. A treatment first-degree psychosomatic disease (Figure 16).
contract for natural cure can safely be made Jim established the following prerequisites
if the client is invested in change. for a self-employed electrician:
4. In second-degree psychosomatic disease
there is no connection between the stimulus, Drivers
the thought response, the feeling response, Be Perfect
and the body response. A treatment contract Try Hard (Work hard)
for exploration only can be made. With a Be Strong (Be responsible)
client invested in exploration, a connection Please Me (Please the client)
is usually made in between eight and twen-
ty group sessions, and a contract for cure Blockers
can then be established. Don't feel (Don't show your anxiety)
5. In third-degree psychosomatic disease no Don't Enjoy
contract for cure can be made. Treatment is Don't Be Yourself
aimed at control using natural, chemical, and
mechanical methods. Cure would be a
bonus.

THOUGHTS Inadequate to
INTERNAL EXTERNAL solve
problem

Failing
? Business ---l.~ STIMULUS ~----. FEELING Anxiety
No way (Contained)
out

BODY Failing
RESPONSE erections
Figure 16
Jim's Disease Equation (partial)

Vol. 16. No.4, October 1986 219


GERALD CARTMEL

Once Jim recognized that he had carried these With the insight that his dairy farmer father
messages into his private life, he could share needed to finish a day's work within a day and
his anxiety with his wife and invite her to help to work within rigid quotas, Brian decided that
him solve his/their problems. He was also not he no longer needed to finish his country runs
to try and please her in bed with a perfect in one day, and that his job did not require the
erection. constant perfection and time control that a dairy
A Case of Second-Degree Psychosomatic farm demands.
Disease: Brian, a thirty-four-year-old commer- Four years later Brian is still dyspepsia free,
cial traveler with a wife and two children, gave and, as a bonus, his psoriasis no longer occurs
a three-year history of dyspepsia. A barium (Figures 18 & 19).
meal demonstrated a small duodenal ulcer. He
also suffered from psoriasis around his crotch
area which he controlled with ointment.
Treatment options were discussed. The
dyspepsia was not threatening his health, and
since there was no evidence of bleeding,
chemical or mechanical intervention was not
mandatory. Brian elected to explore the possi-
ble cause rather than treat the response. If the
somatic response, the ulcer, deteriorated he
could always reconsider his options. During
weekly psychotherapy groups Brian was unable Thought Feeling Body
to connect any unpleasant feelings with his Response Response Response
dyspepsia. Therefore, we negotiated a contract
for exploration only. Figure 18
After six nights Brian tracked the "tight gut" Brian's Bargram
feeling back to the age of thirteen. He
remembered, at the age of nine, getting up early
to milk the cows on the family dairy farm
before hurrying off to school, then hurrying THOUGHTS:
back home after school to milk the cows again. I'm not trying
hard enough.
He was under constant criticism from his father
for not doing the job properly or quickly ~ FEELINGS:
enough. A Parent interview (McNeel, 1976) Contained
showed the typical dairy farmer tied to a cow's Blocked
udder and struggling to survive (Figure 17). BODY:
Duodenal Ulcer
Psoriasis
FATHER BRIAN
(age 9) Figure 19
Try Hard Brian's Response System
- Hurry Up .....
Be Perfect p
A Casefor Mechanical Intervention: (It is dif-
ficult to do psychotherapy with dead people.)
Steve looked ill and smelled faintly of alcohol.
Don't Feel He had severe upper abdominal pain and a two-
- Don't Enjoy year history of indigestion. He worked in the
Don't Be the ~ electrical retail trade, and denied excessive
You Are alcohol intake. He had a deep burning anger
toward the Family Court and his ex-wife and
Figure 17
a feeling of impotence.
Brian's Script Matrix

220 Transactional Analysis Journal


A SYSTEMATIC APPROACH TO PSYCHOSOMATIC DISEASE

A barium meal showed a duodenal ulcer. His now getting on with living, rather
hemoglobin level was 55 % of normal, in- than dying. And without psycho-
dicating blood loss. He was started on ap- therapy!
propriate drug treatment for the ulcer and the
anemia, and from a concerned position he was A Client Prepared to Explore His Internal
invited to explore his self-destructive life-style. Demand/Resource System: John suffered a
However, within four days Steve had crashed severe back injury when he was dragged by a
his car and been charged with drunk driving. car, through no fault of his own. There was no
He was admitted to the hospital with bleeding bone damage and no confirmatory evidence of
from the bowel. As I put up his intravenous drip what was obviously a nasty soft-tissue injury.
he was still denying his alcohol intake and curs- He was entitled to compensation. He had been
ing the Family Court. Steve proceeded to off work for six months in spite of various
surgery. He is a good case for mechanical con- treatments by various specialists, and he was
trol/cure. Tissue damage requires tissue becoming depressed and hopeless. He elected
treatment. to attend psychotherapy group at his own ex-
Post-Script: Steve has come to terms with his pense to explore the whole situation (Figures
situation and his anger and is 20 & 21).

THOUGHT Obsessing

~
RESPONSE
Identified cause
of pain: FEELING Sadness
Back Injury RESPONSE Depressed (Blocked)
BODY
RESPONSE
Awareness of
very severe pain
Figure 20
John's Response System

Before Group After Group

Obsessing Depression Very Normal Normal Mild


Severe Good Pain
Pain
.....................
.....................
................... ..
......................
.....................
.........................
..
......................
....................
..................... ..
.....................
.................... .....
.................... ... ..
.....................
....................
..................
.....................
......................... ..
.. ..
......................

I::::::!!i!::::::I:~~~.J
......................
...................... .. .
......................
......................
......................... ..
......................
...................... .
......................
......................... ..
......................

~~~tttf~I
lii.i.ili:.i:j.:j::::i... ....r<roIoII
r"Ir"r"l:.......
}}}}}}
........................
Thought Feeling Body Thought Feeling Body
Response Response Response Response Response Response
Figure 21
John's Bargram

Vol. 16, No.4, October 1986 221


GERALD CARTMEL

After eight nights in group, John had (b) The identified cause of the response is not
gathered enough information to decide: necessarily the significant cause of the
(a) He had chronic pain which, for the pre- response.
sent at least, was incurable. He would (c) The internal demand/resource system
have to accept this and get on with liv- determines or maintains the external de-
ing (Winner's Script) (Berne, 1975). mand/resource system, which in turn deter-
(b) He was bored with his dead-end job in mines the size of the stimulus that leads to
a bank, although he had learned how to the responses.
handle money. (Stimulus: too few de- A Case for Control Only: Joe, a fifty-
mands for too many resources). three-year-old bus driver was involved in
(c) He had left his small country town to be a relatively minor traffic accident that
a success, not a bank clerk. resulted in a disabling backache which con-
(d) He would stop hassling, take a risk, and tinued in spite of varied approaches. He
do something. was discharged from the bus company with
John left the bank, and three years later he substantial compensation. Later, he was in-
owns two milk-rounds, actively engaging in volved in two additional car accidents and
milk delivery. He was in my office recently has received over $80,000 in insurance
with his wife, who was pregnant with their third claims; he will never work again.
infant. I asked about his pain. "Oh! It's much Joe had no internal demand/resource system
the same." "Have you settled your claim, to overcome the external situation. Knowing
yet?" "No, I haven't had time." I suggested him I was able to feel frustration and sadness,
we run further tests with new and better but could not blame him.
diagnostic techniques, but he has not taken up
this option. Joe's Script: Loser
Summary of John's illness: Joe's Game: Wooden Leg (Back)
(a) This is a case of second-degree (Berne, 1964)
psychosomatic disease in that John was
unable to correctly connect the cause of Conclusion: "The Power is in the Patient"
the stimulus with the body response and the (Goulding & Goulding, 1978), and if a client
feeling response. When he made this in- is prepared to go no further than control of
tellectual connection he had an internal de- symptoms, then further effort is a waste of time
mand/resource system that enabled him to and results in the loss of clients from the prac-
get on with living. tice (Figure 22).

NATURAL CHEMICAL MECHANICAL

Rest Drugs Electric


CONTROL Acupuncture Stimulators
etc. etc.

CURE

Figure 22
Treatment Options for Joe

222 Transactional Analysis Journal


A SYSTEMATIC APPROACH TO PSYCHOSOMATIC DISEASE

Summary Family Resource Centre, RMB 1502, Bridge-


An approach to physical and emotional town 6255, W. Australia.
dysfunction is demonstrated that views disease
REFERENCES
as a response to various factors which collec-
tively create a stimulus. Human beings must Berne, E. (1964). Games people play. New York:
respond to a stimulus, and it is the individual Ballantine.
pattern of responses that largely determines if Berne, E. (1970). Sex in human loving. New York:
Ballantine.
and how dysfunction or disease becomes mani-
Berne, E. (1975). What do you say after you say hello?
fest. Clients should have a choice in selecting
London: Corgi Books.
various treatment modes which aim at cure or Goulding, M.M., & Goulding, R.L. (1979). Changing lives
control by natural, chemical, or mechanical through redecision therapy. New York: Brunner/Mazel.
means, and clients should be actively involved Goulding, R.L., & Goulding, M.M. (1976). Injunctions,
in the treatment process. A method facilitating decisions, and redecisions. TransactionalAnalysis Jour-
these aims is described, and rules basic to the nal, 6, 41-48.
model have been formulated. Goulding, R.L., & Goulding, M.M. (1978). The power
is in the patient. San Francisco: TA Books.
Gerald Cartmel, M.B., M.R. C.S., D. Obst., Kahler, T., & Capers, H. (1974). The rniniscript. Trans-
actional Analysis Journal, 4(1), 26-42.
R.C.O.G., D.A., c.u. (lTAA), is a famliy doc-
McNeel, J .M. (1976). The parent interview. Transactional
tor specializing in in-depth medicine and per- Analysis Journal, 6, 61-68.
sonal and family counseling. He has recently Steiner. C.M. (1974). Scripts people live. New York:
established the Personal & Family Resource Grove.
Centre in Bridgetown, W. Australia. Send re- Wyckoff, H. (1971). The stroke economy in women's
print requests to Dr. Cartmel at Personal & scripts. Transactional Analysis Journal, 1(3), 16-20.

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