Rheumatic Disease, with Special Reference to Psychosomatic Diagnosis and Treatment

Abstract

Sufferers from rheumatic disease are divided into 2 groups with distinctive personality differences. The first group comprises patients with acute rheumatic fever characterized by polyarthritis but with little or no cardiac damage. The 2d group comprises patients who are hospitalized because of heart disease but who are without a clear history of acute rheumatic fever. The 1st group is further divided into 2 sub-groups with corresponding sub-personality types as follows: Type A personality, which is unlikely to develop cardiac damage; Type B personality, the cardiac type. Patients of the latter type have many personality traits in common with those in other groups suffering from cardiovascular syndromes. The conclusion is reached that recurrences in rheumatic fever, Type A, could be prevented by brief psychotherapy in a large majority of cases. In Type B and in patients with well developed rheumatic heart disease, the most that can be hoped for in the majority of cases is diminution in invalidism and decrease in the number of acute attacks. Where the structural damage is slight and the defenses not too rigid, dramatic improvement may be accomplished by brief psychotherapy directed toward relief of anxiety. In view of the relative inadequacy of present methods of management of rheumatic fever, it is emphasized that brief psychotherapy should be considered whenever feasible for all sufferers from this disease. It is stressed that attention should be directed toward controlling the environment of these patients[long dash]at least until they have gained more ability to cope with environmental difficulties.