Da medicina psicossomática à psicologia médica: a trajetória teórica e institucional de Julio de Mello Filho / From psychosomatic medicine to medical psychology: the theoretical and institutional trajectory of Julio de Mello Filho

Resumo Os estudos sobre as causalidades das patologias e da relação médico/paciente a partir de formulações psicanalíticas receberam duas denominações no Brasil: medicina psicossomática e psicologia médica. O médico e psicanalista Julio de Mello Filho assumiu o protagonismo dessa proposta a partir da doença incapacitante do psiquiatra e psicanalista Danillo Perestrello. A estruturação da concepção teórica do movimento psicossomático e as estratégias institucionais utilizadas para a consolidação desse campo disciplinar no cenário brasileiro são o objeto deste estudo. Por meio de um referencial epistemológico e histórico, conclui-se que a proposta inicial de transformação do modelo médico hegemônico perde força e observa-se um deslocamento da psicologia médica como um campo da psicologia da saúde.

Abstract Studies on the causality of pathologies and the doctor/patient relationship based on psychoanalytic formulations received two denominations in Brazil: psychosomatic medicine and medical psychology. The physician and psychoanalyst Julio de Mello Filho took a leading role in this movement after the psychiatrist and psychoanalyst Danillo Perestrello was incapacitated by illness. This study investigates how the theoretical concepts of the psychosomatic movement were structured and the institutional strategies used to establish this discipline in Brazil. From an epistemological and historical point of view, the initial notion of transforming the hegemonic medical model was seen to lose force, followed by a shift in medical psychology as a field of health psychology.

Retorno al siglo XX: setenta años de psiquiatría, psicoanálisis y medicina psicosomática en Santiago de Chile / Return to the 20th century: seventy years of psychiatry, psychoanalysis and psychosomatic medicine in Santiago de Chile

Este trabajo resume los cambios en la psiquiatría clínica y el psicoanálisis y la medicina psicosomática en el siglo pasado, destacando a dos médicos chilenos, un internista y un psiquiatra que influenciaron profundamente al autor. Los Drs. Hernán Alessandri Rodríguez e Ignacio Matte Blanco fueron formadores de médicos no solo en la Facultad de Medicina de la Universidad de Chile, sino a nivel nacional e internacional, dejando su sello hasta hoy. El artículo recorre la historia de esa Facultad, así como de la Clínica Psiquiátrica Universitaria, cuyo primer director fue el Prof. Matte. Este fue también el promotor de la Asociación Psicoanalítica Chilena, admitida en agosto de 1949 como sociedad componente de la Asociación Psicoanalítica Internacional. Se revisan los antecedentes históricos del psicoanálisis freudiano y de la medicina psicosomática hasta la mitad del siglo XX, para luego analizar los desarrollos posteriores tanto de la psiquiatría clínica, del psicoanálisis post-freudiano y de la salud mental chilenas. Se concluye subrayando cómo las personalidades, sus vinculaciones familiares y el contexto socio-cultural marcan los avances y las dificultades de los progresos en salud.

Clinical Hypnosis Today.

Freud's objections to hypnosis have little relevance to modern approaches. Contemporary hypnosis has evolved beyond direct suggestion to include the suspending of critical thinking in order to allow the patient's unconscious mind to take over and make internal changes. Aspects of the author's experiences as a patient, trainee, and practitioner are noted by way of dispelling some common misunderstandings. The growing profession of hypnosis has support from research in neuroscience. A rapprochement with psychoanalysis may be possible.

Jean-Martin Charcot's influence on career of Sigmund Freud, and the influence of this meeting for the brazilian medicine / Influência de Jean-Martin Charcot na carreira de Sigmund Freud, e a influência desse encontro para a medicina brasileira

Background - Jean-Martin Charcot had a profound influence on Sigmund Freud's life and career. The founders of Brazilian neurology and psychiatry were influenced by the ideas of Charcot and Freud. Objective - To describe Charcot's influence on Freud, and both on the beginning of Brazilian Neurology and Psychiatry. Results - After Freud's stay in Charcot's neurology service during the winter of 1885-1886, there was a shift in his interest from general neurology to hysteria, hypnosis and other psychological issues, which greatly influenced the development of psychoanalytic theory. Like Charcot, Freud would become an admirer of the arts, literature, and culture. When Freud began his collection, in the late 1890s, Charcot served as an important model. In Salpêtrière Hospital, Charcot was staging a show different from modernity, capable of inspiring Freud. Antonio Austregesilo founded the first Brazilian school of Neurology, in Rio de Janeiro, inspired in Charcot. Austresegilo also practiced psychiatry, and, together Juliano Moreira and others, is considered propagator of Freud's ideas in Brazil. Conclusion - The ideas of Charcot and Freud were fundamental in the formation of physicians who helped to found and to consolidate the Brazilian neurology and psychiatry.(AU)

Introdução - Jean-Martin Charcot exerceu uma profunda influência na vida e na carreira de Sigmund Freud. Os fundadores da neurologia e da psiquiatria brasileiras foram influenciados pelas ideias de Charcot e de Freud. Objetivo - Descrever a influência de Charcot sobre Freud e de ambos sobre o início da Neurologia e da Psiquiatria brasileiras. Resultados - Após a permanência de Freud no serviço de neurologia de Charcot durante o inverno de 1885-1886, houve uma mudança em seu interesse da neurologia geral para histeria, hipnose e outras questões psicológicas, o que influenciou muito o desenvolvimento da teoria psicanalítica. Como Charcot, Freud se tornaria admirador das artes, literatura e cultura. Quando Freud começou sua coleção, no final da década de 1890, Charcot serviu de modelo importante. No Hospital Salpêtrière, Charcot era a representação da modernidade, capaz de inspirar Freud. Antonio Austregésilo fundou a primeira escola brasileira de Neurologia, no Rio de Janeiro, inspirada em Charcot. Austresegilo também praticou psiquiatria, e, juntamente com Juliano Moreira e outros, é considerado propagador das ideias de Freud no Brasil.Conclusão - As ideias de Charcot e Freud foram fundamentais na formação de médicos que ajudaram a fundar e consolidar a neurologia e a psiquiatria brasileiras.(AU)

The History of Mind (Psyche)-Body (Soma) Medicine: Practical Examples.

This article discusses the relationship between health and disease, considering the mind/body dichotomy that has occurred in the history of medicine, both in Western and Eastern cultures. The author begins by referring to the magical concept of disease, passing through the classical Greek period, and the medieval and Renaissance vision, to the evolution of modern concepts proposed by psychoanalysis. The author references some practical examples about the importance of the mind-body relationship, such as the psychological steps experienced by the oncological patient, as well as the psychiatric disorder.

Freud's Rejection of Hypnosis, Part II: The Perpetuation of a Rift.

Freud's rejection of hypnosis gave rise to a rift between clinical hypnosis and psychoanalysis that has endured for over a century. A review of Freud's rationales (Kluft, 2018a/this issue) demonstrates that while some stemmed from what he considered advances, others appear strongly influenced by his promoting the superiority of his "psycho-analysis" at the expense of hypnosis. Mainstream psychoanalysis continues to endorse the perpetuation of rationales Freud asserted nearly a century ago, and an oral lore of related supportive statements. This oral lore proves difficult to sustain upon closer scrutiny. It bypasses concerns that, if studied in depth, would demonstrate significant shortcomings. Problems encountered in this oral lore include: (1) the importance of information unavailable to Freud; (2) the ongoing impact of certain errors of Freud's thinking; (3) the distorting force of Freud's compelling drive to be a "conquistador" of the mind and create a heroic theory; (4) the implausibility, upon inspection, of certain long-accepted assertions about Freud's motivations; and (5) Freud's discomfort with his own dissociative symptomatology. It is argued that the "oral lore" promulgated in connection with Freud's rejection of hypnosis, like Freud's decision to reject hypnosis itself, is not firmly grounded and deserves careful reassessment.

Freud's Rejection of Hypnosis, Part I: The Genesis of a Rift.

Modern psychoanalysis begins with Sigmund Freud's study of hypnosis and the treatment of the grand hysterics of the fin de siècle. In the process of developing his own paradigm, Freud came to reject the use of hypnosis and turned his attention away from the severe hysterias. These decisions began what has become, notwithstanding noteworthy exceptions, over a century of estrangement and disengagement between the fields of hypnosis and psychoanalysis. The current communication reviews the 75 archived Psychoanalytic Electronic Publishing resources from Freud's scientific work and correspondence in which reference is made to hypnosis. A close examination of Freud's stated rationales for abandoning hypnosis suggests that both the ideas he developed and the rift between hypnosis and psychoanalysis that they created may prove to have been problematic as well as innovative. They and their consequences merit thoughtful review and critical reconsideration.

Reconsidering Hypnosis and Psychoanalysis: Toward Creating a Context for Understanding.

Sigmund Freud developed what became psychoanalysis in the context of his experiences with hypnosis and the treatment of the grand hysterics of his era, conditions largely classified among the dissociative disorders in contemporary systems of diagnosis. He rapidly constructed understandings of the human mind and human distress that replaced the concept of dissociation and a model of pathology that was passive (associated with reduced psychic cohesion), with the paradigm of an active defensive process he termed repression, and an understanding that psychological discomfort was the outcome of intrapsychic conflict. In short order Freud repudiated hypnosis, initiating the schisms that subsequently separated the study and practice of hypnosis from the study and practice of psychoanalysis. It is timely to reexamine these schisms anew, challenge the basis of the arguments thought to justify them, and explore whether these schisms have deprived psychoanalysis and hypnosis alike of the potentially helpful ideas and approaches each might offer the other. This contribution invites students of hypnosis and psychoanalysis alike to put aside both traditional and stereotypic notions of each other's field of endeavor, revisit the origins, rationales, and outcomes of these schisms that have divided them, and explore their commonalities and their differences from fresh perspectives.

Pierre Janet and Auguste Forel: Two Historical Contributions.

This paper discusses two 19th century French-speaking authors, Pierre Janet and Auguste Forel, who both employed hypnosis and in various ways were early influences on psychoanalysis. To acquaint the reader with the clinical works of these pioneers, a long case history by Janet, and a case history by Forel are presented. The connections between these two authors and modern developments are discussed. Both historical figures were contemporaries of Freud and their at times contentious relationships became part of their legacy.

Spinoza to Freud: The unraveling of a psycho-analytical perspective on moral responsibility and law.

The status that Spinoza and Freud assign to law has some convergence, for both embrace the positivity, the mere conventionality and utility, of law and eschew any real or eternal moral norms (that is, they thoroughly reject the Natural Law tradition) that law might capture and embody. In addition, both put forth a biological account of human nature, rather than a theological one or even quasi-theological one, and that biological nature is the springboard in each case for defining the overall purpose of law. In addition, for both, human biology is a source of the sociality, the psychic attachments, that make an emotional union of individuals into a group possible. Nevertheless, it is in the specific elaborations of human biology that we can discern the beginning of a parting of the ways, for in their conceptions of human nature and the nature of nature Freud and Spinoza diverge in significant respects.

Trauma and the state with Sigmund Freud as witness.

Just before and after the end of World War I, Sigmund Freud took on an activist role and in his writings and speeches, redirected the concept of war trauma from individual failure to a larger issue of community responsibility. Testifying in Vienna as an expert witness for the state, Freud said that the military psychiatrists-not the soldiers-had "acted like machine guns behind the front" and were the "immediate cause of all war neurosis." Freud was called on by the legal community when Julius Wagner-Jauregg, a future Nobel Prize winner (and also future Nazi Party adherent), head of the municipal Clinic for Psychiatry and Nervous Diseases, was accused of the lethal use of electrotherapy on shell-shocked soldiers. As sociological as psychoanalytic in his responses, Freud's withering critique came just 2years after he avowed that "it is possible to foresee that the conscience of society will awake." That speech on the human right to mental health care affirmed Freud's alliance to the social democratic position and inspired the second generation of psychoanalysts to develop community-based clinics throughout Europe where treatment was free of cost, for war neurosis and beyond.

GEORG GRODDECK: "THE PINCH OF PEPPER" OF PSYCHOANALYSIS(.).

The life and works of Georg Groddeck are reviewed and placed in historical context as a physician and a pioneer of psychoanalysis, psychosomatic medicine, and an epistolary style of writing. His Das Es concept stimulated Freud to construct his tripartite model of the mind. Groddeck, however, used Das Es to facilitate receptivity to unconscious communication with his patients. His "maternal turn" transformed his treatment approach from an authoritarian position to a dialectical process. Groddeck was a generative influence on the development of Frieda Fromm-Reichmann, Erich Fromm, and Karen Horney. He was also the mid-wife of the late-life burst of creativity of his friend and patient Sándor Ferenczi. Together, Groddeck and Ferenczi provided the impetus for a paradigm shift in psychoanalysis that emphasized the maternal transference, child-like creativity, and a dialogue of the unconscious that foreshadowed contemporary interest in intersubjectivity and field theory. They were progenitors of the relational turn and tradition in psychoanalysis. Growing interest in interpsychic communication and field theory is bringing about a convergence of theorizing among pluralistic psychoanalytic schools that date back to 1923 when Freud appropriated Groddeck's Das Es and radically altered its meaning and use.

Sobre los efectos de la nocién de «lo arcaico» en la escucha del analista / On the effect of the notion of the «the archaic» upon the analyst´s listening

La aurora resume cuatro maneras en que las diferentes corrientes del psicoanálisis contemporáneo intentan comprender «lo arcaico»: en términos de lo traumático y lo no representado, como lo informe corporal, como fantasias inconscientes primitivas de carácter sensorial y presimbólico y desde la óptica del encuentro profundo con el otro. Se plantea entonces la siguiente pregunta: ¿en qué condiciones pueden las diversas concepciones de «lo arcaico» ampliar la escucha del analista o, por el contrario, saturarla y cerrar el acceso a aquello que precisamente se intenta alcanzar? Tras recordar la invitación de Bion a respetar tanto la individualidad del paciente como la del analista, la aurora discute la tension entre un psicoanálisis centrado en los contenidos y un psicoanálisis atento a los procesos. Esta problemática viene ilustrada por una viñeta en la que se discute la presentación de un análisis en un seminario clínico y el fracaso del intento de elaboración grupal (AU)

The author summarizes four ways in which the different currents of contemporary psychoanalysis comprehend «the archaic»: in terms of the traumatic and unrepresented; with regard to the formless corporeal; in connection with primitive unconscious phantasies of a sensorial and presymbolic nature and from the viewpoint of the profound encounter with the other. She then formulates the following question: under which conditions may the diverse conceptions of «the archaic» broaden the analyst’s listening or, conversely, saturate it and close off access to precisely that which we are attempting to reach? Calling to mind Bion’s invitation to respect both the analyst’s as well as the patient’s individuality, the author discusses the tension between a psychoanalysis focused upon the contents and a psychoanalysis attentive to the processes. This predicament is illustrated by a vignette which discusses the presentation of an analysis in a clinical seminar and the failed attempt at group working-through (AU)

Winifred Rushforth and the Davidson Clinic for Medical Psychotherapy: a case study in the overlap of psychotherapy, Christianity and New Age spirituality.

The activities of both Winifred Rushforth (1885-1983), and the Edinburgh-based Davidson Clinic for Medical Psychotherapy (1941-73) which she directed, exemplify and elaborate the overlap in Scotland of religious discourses and practices with psychoanalytic psychotherapy. Even as post-war secularization began to affect Scottish culture and society, Rushforth and the Davidson Clinic attempted to renew the biographical discourses of Christianity using the idioms and practices of psychoanalytic psychotherapy. Furthermore, alongside these Christian-inflected activities, Rushforth promoted a psychoanalytically-informed New Age spirituality. This parallel mode of belief and practice drew on Christian life-narrative patterns, preserving them within psychoanalytic forms grafted onto a vitalist worldview informed by the work of Pierre Teilhard de Chardin.

The legacy of Michael Balint.

Michael Balint's lead article, "Repeat Prescription Patients: Are They An Identifiable Group?" inaugurated the first issue of Psychiatry in Medicine, Vol. 1, No. 1, 1970. A few years later, this Journal would be renamed International Journal of Psychiatry in Medicine (IJPM). Who is this author of over 165 papers, 10 books, practicing psychoanalyst from 1926 to 1970, director of the Budapest Psychoanalytic Institute from 1935 to 1939, consultant at the Tavistock Clinic from 1948 to 1961, President of the British Psycho-Analytical Society from 1968 to 1970, literary executor of Sandor Ferenczi, a foremost theorist of object relations, and international educator and statesman for general practitioners? We would like to review for you some of the formative experiences in Michael's life that wedded psychoanalysis and general practice, and how they contributed to his major educational commitment over 40 years to furthering the understanding and integration of psychosocial factors in the practice of primary healthcare as experienced by doctors all over the world. We would also like to highlight some of his major insights and see to what extent they are incorporated in contemporary medical education and practice. We believe that some of his major insights have been neglected and others have been further amplified and extended. Our intention is to speak not only to medical students who desire to pursue medicine related directly to patient care but as well to seasoned practitioners who continue on a daily basis to care for individual patients and their families.