Table Of ContentPSYCHOSOMATIC
DISORDERS
IN ADOLESCENTS
AND YOUNG ADULTS
Proceedings of a conference held by the
Society for Psychosomatic Research at the
Royal College of Physicians,
London, November I960
Edited by
JOHN HAMBLING
and
PHILIP HOPKINS
SYMPOSIUM PUBLICATIONS DIVISION
PERGAMON PRESS
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Copyright © 1965
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First Edition 1965
Library of Congress Catalog Card Number 64-2222
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PREFACE
THE conference had two objectives, to consider psychosomatic disorders
occurring between the ages of 15-25 years, and to discuss the mental
transformation from childhood to adult maturity.
Only the adolescent knows how important is this period of his life. Usu
ally it is written and spoken of as if it were mainly a problem of behaviour,
either when it upsets mum and dad, or when it alarms society. We do not
have a place for adolescence in our customs and everyone seems devoutly
to hope that each generation will settle rapidly into being a replica
of its parents or a fulfilment of their hopes. But in truth adolescence
is a highly personal adventure in self-realization on which so much
depends, for there is not only the obvious thing of physical growth and
the realization that one is a child no more but is rapidly becoming, by
physical and sexual development, part of an adult world, there is also
the fact that this fairly short phase of physical maturing is the beginning
of an emotional awakening and a radical change in relationships with
other people.
Adolescence begins with the physical growth to bodily maturity and
continues as a metamorphosis of mind and spirit, a transformation and
an emergence of personal qualities that determine the character, ambitions,
values, resources, personal freedom and inner happiness of the man and
his ultimate mastery of life. That is why this conference was concerned
with adolescence and young adulthood, to cover the period of life that
earns the maturity of purpose for embarking on parenthood; for we can
take successful parenthood as a proof of the metamorphosis of the child
into the adult.
First and foremost we sought to understand adolescence. We were
middle-aged doctors talking about our young patients. In fact the adoles
cent was allowed to speak for himself only at the eleventh hour in the
fascinating session where we saw the interaction of our subject with his
professional welfare workers and with ourselves. At this critical weaning
period in the life of Western man we expected to find clinical evidence
for emotional stress in characteristic syndromes of illness, but the evidence
is not easily found, for adolescents are by and large a physically healthy
VI PREFACE
lot, who have only been studied as a group in certain special situations,
in factories, at university and in pregnancy. Most of us had "jobbed
back" to adolescence from research findings about characterology of
patients with psychosomatic disorder in their fourth and fifth decades.
Again and again these reports have called attention to such traits of emo
tional immaturity as inordinate needs for love, intensely ambivalent
parental fixations, and dependency longing beneath a façade of indepen
dence. If the adolescent phase had gone right, these things should not be.
Here was a phase then in human development where we might find a
key to an understanding of how things go wrong and lay up trouble for
later life, first in bodily dysfunction and subsequently in organic illness.
Psychotherapeutically it would be interesting to see how things could be
helped to go right at the time when nature's impetus for change flows
at its strongest. From first to last, the orientation had to be normative.
"What is mental health?" was the first question. "What is maturity?"
was the last. Having organized previous conferences on stress disorder
of adult life and then on those of childhood, the Society for Psycho
somatic Research turned to adolescence as a matter of pressing con
cern. The passage of time will no doubt prove some of our conclusions
to be of historical interest only, for our concepts and values are likely
to be more culturally bound than we know. Perhaps in our very demands
of maturity we are asking a price of human nature that will have to be
paid in psychosomatic disorder.
We need to understand and to accept this vital phase that has erupted
on a mass scale with the unprecedented earning power and freedom from
restraint that school-leavers now enjoy. Adolescence has arrived. Its life
enhancing aspects must be encouraged by giving form and status in our
culture to its needs and aspirations. We publish these Proceedings for
the interest of doctors and all those whose professional concern is with
young people. We hope to attract also general readers and politicians
who know that adolescence poses the social challenge of our times, but
who may not realize that it also presents an opportunity to renew the
vitality of our people.
The delay in the appearance of this volume was unexpected and
unfortunate. Since the problems dealt with were fundamental, the con
tributions do not date and have in no way lost any of their values.
JOHN HAMBLING
PHILIP HOPKINS
THE SOCIETY FOR PSYCHOSOMATIC
RESEARCH
THIS SOCIETY was founded in May 1955, to promote psychosomatic
research, by arranging regular meetings and occasional conferences to
provide a congenial forum for the discussion of problems by workers in
various disciplines.
Officers of the Society, 1959-60:
President: J. O. Wisdom
Vice-President: P. Hopkins
Secretary : H. H. Wolff
Treasurer: R. F. J. Withers
Council Members: M. L. Abercrombie
B. Mandelbrote
P. Schurr
CONCEPTS OF MENTAL HEALTH
KENNETH SODDY
MAY I say how much I appreciate the honour and the responsibility of
opening the Conference today. In an opening paper on concepts of
mental health at a conference on psychosomatic disorders in adolescents
and young adults it seems one is faced with a nasty little outcrop of defini
tions of terms to stumble over. On this occasion the definition of psycho
somatic disorder, no mean task in itself, I can happily leave to more
eloquent tongues than mine. That of adolescence I shall be taking as that
period which follows the establishment of puberty up to the completion
of significant bodily growth, say somewhere between 17 and 18 years.
My embarrassment as a member of a culture that tries its 17-year-olds
in adult courts of law, is willing to hang some of its members at 18 years
and may require others to die in battle at 18| is only one reason that
prevents me from following the common transatlantic custom of extend
ing the conventional period of adolescence into the twenties.
It is often stated, naively in my opinion, that there is no satisfactory
short definition of mental health, but I wonder what people expect to find
when they look for definitions of complex biological states. I doubt if
there is a really satisfactory short definition of an elephant, either, but
descriptive analyses of the latter have been made that enable the creature
to be identified when encountered. The same may apply to mental health,
but in the latter case many people appear to hope that a succinct pheno-
menological description might, in some magical way, make all things
about mental health clear to them.
This conference needs no such magical aids, and I will limit my defin
ing to sketching in the field of discussion. We are concerned here with the
concepts that people have about mental health and not necessarily with
what the thing actually is: i.e. with our own concepts, those of the adoles
cents and young adults whom we are studying, and also those of the people
in the lives of these youngsters.
Among the many possible components of mental health the capacity
of the individual to conduct harmonious interpersonal relationships is
perhaps one of the most important. This is presumably a complex of
3
4 KENNETH SODDY
qualities which includes the formation of good object relations, the modi
fication, control and sublimation of instinctual drives including the man
agement of aggression arising out of instinctual frustration, the formation
of identifications, of systems of values and so on. The description of
mental health in such terms at once goes beyond the boundaries of the
individual; or in other words, mental health cannot be regarded as a
quality possessed by an individual. In this respect any parallel drawn
with bodily health, which is often rightly or wrongly interpreted as
something one possesses for oneself, tends to be misleading. Mental
health is never less than a result of a complex couple, that is, a state that
arises out of the interaction of the individual and the groups with which
he communicates. Many people regard it as arising, more properly, out
of at least a triad —the individual, the group, and a transcendental or
alternatively an abstract value system.
This is a big subject indeed, and I propose to limit the scope of our
attention to the proposition that mental health is as much a factor of the
culture as of the individual; that it is one of the products of the inter
action of the individual with his culture. This can be illustrated by look
ing at some contrasting stereotypes. Let us take for an example a traditional
society of fixed, extended, family form, such as persisted for many cen
turies in Confucian China (though what is really happening to it today
no one knows). In this society a very high value was given to acceptance
by the individual of his or her social role, which was minutely defined in
all qualities and degrees of relationship. Thus the Confucian ideal was that
the son should behave to his father as the ideal son, and the father as the
ideal father, and so on. Behaviour was prescribed at all degrees so that
the role behaviour of the second cousin once removed was expected to be
ideal, also. Confucian precept is given predominantly in terms of behaviour,
and role behaviour at that. A society based on such values can tolerate
only role-conforming behaviour and it is scarcely possible that its members
will develop a separable concept of mental health. To them conforming
behaviour is "good"; non-conforming is "bad" or, conceivably "sick".
Both dependent and independent behaviour are rigidly prescribed by
family relationships; attitudes to experiences are sanctioned by duly
constituted authority and so on. It is not difficult to forecast what a
member of this culture will conceptualize when, or if, he begins to think in
terms of mental health.
Let us take as a contrast the example of a rapidly industrializing and
urbanizing society, given to extensive internal migration and with a
nuclear type of family structure. (This last is characteristic of much of the
CONCEPTS OF MENTAL HEALTH 5
ILS.A. and parts of the British Commonwealth, including the U.K., today.)
Such societies do not have narrowly defined relationship roles, and among
them interpersonal communication is determined by the personalities
of the individuals involved. A man owes no obligatory duty of obedience
to his grandfather, but he may both respect and obey him should their
mutual relationship be inclined that way. On the contrary, there are many
pressures in these societies that impel the individual towards indepen
dence, including it may be in some sections, a positive value set on non-
conforming behaviour. It is noteworthy that in these societies the con
cept of mental health has become more explicit than anywhere else in
the world, and one is quite safe in saying that nowhere among them are
the Confucian-promoted qualities of dependence upon elders, of rigid
conventionality of behaviour and so on, regarded as evidence of mental
health; in fact the reverse tends to be true.
Therefore the part that society takes in the individual's relationships
ought to be introduced into the spectrum of mental health components.
Society's role here has many facets, but among the most important are
the amount of demand that a society makes on the individual to conform
to rigid behaviour patterns, the degree of choice and free-will left to the
individual, the range of aspirations and desires that are stimulated in the
individual by life in that society, and the satisfactions of such desires that
society permits, or, perhaps, forbids. Among the Samoan islanders, for
example, there are societies where the demands made upon the individual
for effort are negligible, where Nature is prodigal, where the society sti
mulates little desire and practically no aspiration; in short, where dolce
far niente is the order of the day. It may be that normal adolescent beha
viour, which in Samoa would pass for mentally healthy if there were
such a concept there, would be darkly suspected as beatnik at best, or
schizophrenic at worst, in a London grammar school. This is a crude
example, of course, but it illustrates the point vividly.
Another important factor influencing the concept of mental health
that may be held in a society is the distance between the individual and
the seat of authority in his human relationship system. If distant, such
as in the person of the head of the family — grandfather or great-grand
father — then obedience and conformity in behaviour are likely to be
valued as mentally healthy. If near, such as in a young father or in the
individual himself or herself as soon as adulthood is reached, then capacity
to take responsibility, to tolerate insecurity and to have trusting sibling
relationships, will be mental health values.
Among a number of other important dimensions I will refer to only
6 KENNETH SODDY
one more. I have written elsewhere* of the possibility that there may be
important differences between the value set on warm interpersonal affect
in the families of the Hebrew/Christian tradition and that set in the fixed-
form family traditions of the major oriental religious systems. I have
suggested that in the former case the concept of the love of God has
illuminated human relations so that high values have been set on the content
and quality of interpersonal relations; whereas in the latter case the
high values are attached to the form of interpersonal relationships and on
the behaviour of family members to each other; and not, to anything
like the same extent, on their feelings about each other.
Thus in the Hebrew/Christian tradition the resolution of love and
hate is an intensely personal issue. To split love and hate is mentally un
healthy in this tradition, but to be able to quarrel within the family and to
rebel against society can in many circumstances indicate mental health.
Neither of these would be the case in the oriental tradition, where the
resolution of love and hate, as far as the institutional form can permit
them to conflict, can be achieved only according to accepted institutional
forms of social role behaviour. There, bitter family quarrels may be
almost unthinkable; but callousness about the misfortunes of non-relatives
can be regarded as mentally healthy. Again, in relation to the splitting
off of hate and its projection, the Westerner would be inclined to question
the mental health of those who, for example, habitually take part in
anti-foreigner or anti-unpopular minority riots and acts of cruelty;
but this is hardly true of the East.
These examples illustrate the thesis that concepts of mental health are
dominated by cultural influences, but there is at least one common factor
to be noted, which is that everywhere and in every society adolescents
occupy a characteristic position, and specific stresses play upon them
that are in many ways common to the world. Actually this over-broad
generalization can scarcely apply in the typical oriental fixed-form family
to which I have referred, because there will be, in such families, prescrib
ed forms of adolescent role behaviour that will minimize the disturbances
of this period and probably exteriorize them in group behaviour such as
the quasi-organized student riots (so-called student but really school
children), about which we have become accustomed to hear.
In the case of the simpler societies, one might generalize and say
that when the society is not exposed to enforced change, adolescence
*Soddy, K., Chairman's Address to the Association of Child Psychology and
Psychiatry, 1960.
CONCEPTS OF MENTAL HEALTH 7
tends to be a short and formal affair, often nothing more than a prescribed
period of initiation rites. In more complex societies and when simpler
societies are subjected to change, adolescence tends to be prolonged and
to be disturbed. It is interesting to note that in Tudor England the beha
viour normally expected of apprentices might be regarded as considerably
disturbed, by modern standards. The concept of adolescent mental
health had an aggressive flavour at that time, and society as a whole
appears to have been afraid of its apprentices. Perhaps in some ways
we still are.
In the British culture since the industrial revolution, there has developed
what might be described as a culture of change by evolution, spontaneously
evolving, I believe, out of an amalgam of geographical and economic
factors operating upon a particular form of family relationship that
enabled the extended family to fragment without being destroyed. And
in this setting adolescence has been prolonged, but because of the continuity
of tradition (and no doubt other factors, too) it is not necessarily disturbed.
On the contrary adolescence is not really often disturbed and, in spite
of what I have just said, we do not fear our adolescents very much.
Or at least most of us don't.
The U.S.A. is a culture of change too, in many ways more so than
the U.K., but perhaps not so much by spontaneous evolution as by force
of circumstances, such as migration and settlement. Adolescence by all
accounts seems to be considerably more disturbed and more painful
for all concerned in that country; and in people's thinking, more prolonged,
too. Many Americans talk as if adolescence starts at 11 or 12 and carries
on until the early twenties. And recently in the States I attended a small
conference on "Pre-adolescence", and this turned out to be the 10 -
11-year period which, it transpired, was the long shadow of adolescence
being cast before it.
Reverting to our own country, there can be little doubt that adolescents
occupy a special position in the thoughts of most of us. To me the centre
of the interest of the subject of the concept of mental health as applied
to adolescence is that it concerns a major period of transition within
a culture that is itself in a continuous state of change by evolution. There
is then a double shift going on, a condition of affairs that makes any
static or backward looking reference system for behaviour quite inappro
priate.
We might briefly consider, what are the special stresses on the British
adolescent? At the risk of an alarming oversimplification I am going
to hazard the statement that the best key to the understanding of the
