心身症における医師-患者関係

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When we pay attention to the relationship between doctor and patient, we can realize that hypochondriac complaints easily swing and change according to the doctor's attitudes. In our psychiatric practice at a general hospital, we found that hypochondriac complaints often got worse due to some kinds of doctor's attitudes. In this paper, we chose 9 patients hypochondriasis who showed negative feelings toward their doctors. We examined their doctor-patient relationship, referring to 5 typical hypochondriac cases in detail. In those cases, hypochondriac complaints were usually reinforced by some doctor's attitudes. These attitudes include 1) rigid scientific attitudes on the part of the somatic doctor, which resulted in, for example, sadistic examinations and excessive administration of drugs, and 2) psychological attitudes on the part of the psychiatrist that the origins of hypochondriac symptoms were of psychogenic nature. The patient's reaction against those doctors' attitudes tends to increase hypochondriac complaints. We call the phenomenon as "micro-hypochondriac reaction." The hypochondriasis as a clinical entity is formed through the recurrence and accumulation of these micro-hypochondriac reactions. Therefore, the first step for treatment of hypochondriac patients should be our attempt to resolve each micro-hypochondriac reaction. However, we don't think that only the doctors' attitudes are responsible for the formation of hypochondriasis. We consider that those doctors' attitudes are also the reaction against the patient hypochondriac complaints. The more a hypochondriac patient complains, the less empathetic the doctor becomes. Then the patient reinforces his hypochondriac complaints. Thus, a vicious circle of hypochondriasis is established. In hypochondriasis, the problem involves such a mutual reinforcement of negative feelings and attitudes between doctor and patient. The patients with hypochondriasis show the characteristic attitudes similar to that of a narcissistic personality disorder conceptualized by H. Kohut. Those attitudes are so called idealized transference and mirror transference, in which the patients try to assign the role as "self-object (Kohut)" to the doctor. The doctors' negative feelings may be his psychological resistance to the role assigned by patients, because the role is usually incompatible with the role as a professional doctor.
日本心身医学会の論文
1987-12-01

心身症における医師-患者関係

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