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Some Current Methodological Problems In Psychosomatic Research
Some Current Methodological Problems In Psychosoluatic Research JACK TRACKTlR,
• The war on thl:' widely varying psychosomatic disorders is a vast frontier which has rapidly becoml:' one of the most important research areas in the medical and psychological fields. Research gains during the past twenty years have been extraordinary. More research into the naturl:' of the effect of emotions upon physiological function has been undertaken during this period than in the previous century. Yet research is a slow process and even the most astute investigator often confesses that his findings seem to raise more questions than they answer. While there is general agreement that emotions do affect physiological function, and while these interactions have heen demonstrated clinically and experimentally in innumerable instances, there is still no appreciable agreement as to the precise nature of the relationship. Science attempts to establish relationships hetween events. The basic problem here is to manipulate circumstances or events in connection with the experimental subject in such a way that the subject will respond to these events. The responses made must have some logical relationship to the circumstances which are presumed to evoke them, these evoking circumstances consisting of all the events which takes place before the subject, in fact, does respond. It is a part of the task of the I:'xperimenter to find these relationships and report them in a fashion that will be agreed to hy other investigators. However, the controlled experiment and statistics in science are, relatively speaking, of very recent origin. One of the major difficulties inherent in a study of psychosomatic problems has been the inability of the experimenter to define or specify adequately the emotion under observation. Only recently has the veil of darkness Doctor Traektir is from the Derartment of Psyl'hiatrv, Baylor University Colle~e 0 \1edicine, Houston, Texas. January-February, 1966
PH.D.
woven about hypnosis by ignorance, superstition, prejudice and quackery been torn away. Out of this shadow has emerged the tool which enables the investigator to produce and control various emotional states under laboratory conditions and to observe thl:' effl:'cts of hypnotically induced emotions upon autonomic function. Since Beaumont' reported his ohservations on the changes in human gastric function which accompanied various emotional states, the digestive system has been a major area of investigation in the attempt to arrive at a definition of specific psychosomatic relationships. Investigations concerning gastric functions have been carried out not only with subjects under hypnosis hut also with suhjects in the non-hypnotic state. These experiments are difficult to evaluate for two major reasons. First, there is the prohlem of the ambiguity of the reported emotional states. Do the subjects in fact actually experience the emotions attributed to them by the experimenter? The second major difficulty is the small numher of suhjects often used in these studies. Parenthetically, it must be acknowledged at this point that it is easy to tear apart someone else's work. Any investigator has no difficulty in being dissatisfied with another worker's methods or findings. But he must do more than criticize. He must record observational and experimental data, formulate more adequate methods, offer them for scrutiny. and meet the reception that will gladly be provided by other critical investigators. It is evidently possible that even when one would employ the most advanced methodology with the most proper kind of scientific spirit, one will nonetheless often find it impossible to avoid one or more of the errors which appear to he inherent in studies of this type. For example, Wolf and Wolff (1943) work43
PSYCHOSO~IATICS
ing with a subject in the non-hypnotic state attempted to classify emotional reactions in their one subject from observing spontaneously occurring problems and conflicts which arose in the setting of the subject's home life as well as in the laboratory. The investigators stated that it was usually possible to recognize one or two dominant emotional reactions. The presumed dominant response was then correlated with changes in gastric function. In another study, Mittleman and \\lolff" attempted, by intervieu.;, to induce in the laboratory, emotional states similar to those resulting 'from their subject's experience in everyday life and to observe any changes in gastroduodenal functions that might occur. They reported that the degree of change varied from individual to individual. Floyer and Jennings" administered a testmeal to medical students who were awaiting the results of an examination. They found that acid secretion in response to the test-meal remained within the range of normal expectancy and concluded that anxiety did not result in increased acid secretion. Heller and co-workers' observed the effects of a continuing and normally induced anxiety upon gastric secretion over an extended period of time. The subjects of this study were ten hospitalized male patients, five of whom had presenting symptoms referable to the upper gastrointestinal tract, and all of whom were undergoing a routine diagnostic survey. These authors found that there was an increase in gastric acid secretion with anxiety. Szasz, et al'" from clinical and experimental observation of a patient during psychiatric interview concluded that fear inhibited acid secretion while anger increased the secretion of acid gastric juice. Other studies of subjects on the non-hypnotic level report similar contradictions in findings. From an examination of these reports one must conclude that investigators have not been able to define or specify adequately the observed emotional states, and that in some studies changes in gastric function may be due to differences in personality pre-disposition. In listing two of the principal problems concerning psychosomatic research with subjects in the non-hypnotic state, it was noted that one of the problems concerned the number of subjects employed in the investigations. In 44
this connection hypnosis offers no improvement. On the other hand, concerning the problem of ambiguity of reported emotional states, hypnosis may be of considerable value. This ambiguity rests on two bases. In the first place it is difficult to control all of the stimulating events surrounding the experimental subject, and in the second place, it is difficult to ascertain just what emotional states the suhject is experiencing. By means of hypnosis it appears to be possible to eliminate or otherwise control all stimuli in the subject's environment except those to which the experimenter wishes his subject to respond. Hypnosis does give us the means by which investigators can induce and control emotions in the laboratory under experimental conditions. A pioneering study is that of Bennett and Venables' who hypnotized a pilot of World \\'ar I and suggested that he was flying over enemy country and had to make a forced landing in foggy weather. His test-meal response was higher in acid secretion under hypnosis than it was under control conditions. Luckhardt and Johnson l l investigated the secretion of gastric juice in response to suggested eating and found that the increase in secretion was comparable with results obtained when an actual meal had been eaten. Wittkower (1953) reported that the relationship between anxiety and gastric acid secretion showed great variation from individual to individual. He found that hypnotically induced fear states in his subjects resulted in increased acid secretion in some cases and in decreased acid secretion in others. He stated that whichever change did occur was consistent with the suhject. More recently Ikemi, et al" have reported on what is, to date, probably the most extensive investigation of this type. These investigators employed several of the above mentioned techniques in their study. They utilized interviews to produce emotions, hypnotic suggestions of hallucinatory feeding, and hypnotically induced emotional states and observed the effects upon gastric secretion, gastric and colonic motility, changes in blood and urine pH and anti-bacterial activity of human blood. Among their many findings they report that in thirtyfour of thirty-six subjects, gastric acid secretion was increased by the hypnotic sugQestion of taking "a delicious meaL" while the suggesVolume VII
\IETHODOLOGICAL PROBLEMS-TRACKTIH
tion of. "gastric disturbance," inhibited gastric secretion in the majority of subjects. They also ohserved that hypnotic suggestion of apparently the same kind of emotion seems to induce diHerent psycho-physiological reactions, depending on the condition of the subjects at the time of experiment, their personalities, the technique of hypnosis, and "other factors." TIle direction of physiological reaction to a certain emotion which is ohserved in the greater numher of students is considered to he the major physiological reaction to this emotion. These writers add that it is very difficult to find a certain direction of physiological reaction to a special kind of emotion. Moreover, they make the ohservation, as provocative as it is crucial, that a more fundamental classification of emotions other than such simple ones as joy, sadness, resentment or fear. lIIay he necessary in order to find a definih' relationship hetween psychological conditions and the direction of physiological reactions and suggest that further studies should he done in this respect. They suhmit that the only conclusion which can he drawn at present is that emotions, no matter what kind they may he, have definite influence upon the physiological function of the digestive system. Admirahly modest as he is, Ikemi mav 1)(' doing hims~1f and his research an injusti~e hy lIIinimizing to such an extent the inestimable value of his work. His has been the most comprelwnsive and detailed investigation of this type reported to date and has pointed the way for further advances in our knowledge. lIo\\'ever. it is still difficult to evaluate the several hypnotic experiments. Indeed it is as difficult to evaluate these as it is the nonhypnotic studies and for precisely the sam(' reasons. The problem of the amhiguity of the reported emotional states still exists. In many studies test-meals have heen employed to stimulate secretion and in others suggestion of hallucinatory feedings have Iwen given. It is difficult to know whether reported changes in gastric function are due to the test meal. hallucinatory feeding, or to the emotional state. LeCron and Bordeaux 1o suggested that reporting methods of all hypnotic investigation should be standardized. They call attention to the fact that investigators who wish to evaluate or interpret the results of reported hypnotic research according to their own experience, January-February, 1966
find little of value in the available literature because the experimenter fails to state the exact wording of the suggestion given subjects and frequently does not indicate his own attitude, both being extremely important. These observations are still highly appropriate, as are the words of Gorton:; 'The methodological problems involved in tht' use of hypnosis are considt'rable and account for much of the contradictions to be found in the literature. If the effects of hypnosis are to be invl'stigated, it is essential that hypnosis and not sleep be studied, and suitable precautions are Ill'ct'ssary to that end. It is highly desirable to standardize the method of induction of hypnosis, preferahly by a period of training following which hypnosis may be induced at a pre-arranged signal by the operator. Controls arc necessary both in the waking state and in the trance in order to establish that the efft,ct under investigation is actually dne to hypnotic suggt'stion and not to other secondary factors. In studying the effects of emotions suggested under hypnosis, care must he takt'n that the emotional stimuli an' (,ffpcliVt' and adapted to till' subject."
Cognizant of the ahove mentioned methodological problems, Tracktir,14 and Eichhorn and Tracktir"-" in a series of reports, described their observations on the relationship between anxiety, hypnotically induced emotions and gastric secretion. They employed 24 subjects who were selected on the basis of hypnotizahility, tolerance to gastric intubation, and freedom from symptoms referable to the gastrointestinal system. After a period of training they were conditioned to enter the trance at a pre-arranged standardized signal. By us(' of the Taylor Scale of Manifest Anxiety the suhjects were divided into high, median, and low anxiety groups. Anxiety was selected hy reason of its central position in psychological dysfunction. Emotional conditions of fear, anger and contentment were induced under hypnosis by single word stimuli. Controls were employed in the waking states and hypnotically induced emotional responses were verified by a post hypnotic independent measure as well as by clinical observation. (A detailed description of methodology and results is included in the original reports.) Under these conditions the suggestion of fear produced an increase in fasting gastric secretion in the high anxiety group. The same suggestion resulted in a decrease of acid secretion in the low anxiety group. On the other hand
45
PSYCHOSOMATICS
the suggestion of anger resulted in a decrease in acid secretion in the high anxiety group and an increase in the low anxiety group. Contentment resulted in an increase of acid secretion in the entire group regardless of anxiety classification. These writers submit that contradictory findings reported by previous investigators concerning the effects of emotion upon gastric secretion may be resolved by considering the interaction effects between anxiety levels of the subjects and emotional condition. It is conceivable that Ikemi's suggestion of "a delicious meal" and "gastric disturbance" are the emotional equivalents of Eichhorn and Tracktir's suggestions of "contentment" and "fear" respectively. If this is true, the findings in both studies are similar if we consider the possibility that those of Ikemi's subjects who reacted to his suggestion of "gastric disturbance" by a decrease in secretion might fall into our low anxiety category. It will be recalled that Wittkower found that hypnotically induced fear resulted in increased acid secretion in some subjects and in decreased acid secretion in others. \Vas he working with a high anxiety group and a low anxiety group? If so, then his findings are also consistent with the above. When Szasz reported that fear inhibited, while anger increased acid gastric juice, was he observing a low anxiety subject? If so, then his findings, too, are in keeping with the others. Are reported results as contradictory as they appear at first glance, or are we at fault in 01lT methodology and lack of standardized communication? Perhaps a more critical analysis will tell us that we are all finding what we should be finding. This paper is not offered as the solution to all problems in methodology but to raise ques-
46
tions. Errors in the design of psychosomatic investigation are relatively easy to make. Each experimenter contributes both by his findings and by his mistakes. BIBUOGRAPHY
1. Beaumont, W.: Experiments and Observations on the Gastric Juice and the Physiology of Digestwn. Boston: Lilly, Wait and Co., 1834. 2. Bennett, F. I., and Vl'nables. J. F.: The Effects of the Emotions on Gastric Secretion and Motility in the Human Being. Brit. Med. J. 2:662663, 1920. 3. Eichhorn, H., and Tracktir, J.: The Effect of Hypnosis Upon Gastric Secretion. Gastroenterology, 29:417, 1955. 4. Eichhorn, H., and Tracktir, J.: The Effect of Hypnotically Induced Emotions Upon Gastric Secretion. Gastroenterology. 29:432, 1955. 5. Eichhorn, H., and Tracktir, J.: The Helationship Between Anxiety, Hypnotically Induced Emotions amI Gastric Secretion. Gastroenterology. 29:422, 1955. 6. Floyer, ~I., aud Jennings, D.: Fractional Test Meals on Students Awaiting Examination HesuIts. Lancet. 251 :356-357, 1946. 7. Gorton, B. E.: The Physiology of Hypnosis. Psychiatric Quart. 23:322, 1949. 8. Heller, M. H., et al: Gastric Acidity and Normally Produced Anxiety. PSYC1IOS(}1II. .\fed. 15:509, 1953. 9. Ikemi, r., et al: Experimental Studil's 011 the Psychosomatic Disorders of the Digl'stive System. Proc. 'Vorld Congress Ga.stroenterology. Washington, D.C. 169, 1959. 10. LeCron, L. M., and Bordeaux, J.: HYlllultism Today. Gnme and Stratton, Inc. New York, 1947. 11. Luckhardt, A. B., and Johnson, R. L.: The Psychic Secretion of Gastric Juice Under Hypnosis. Amer. J. Physiol. 70:174, 1924. 12. Mittleman, B., and Wolff, H. G.: Experimpntal Studies on Patients with Gastrities, Duodpntis and Peptic Ulcer. PsychOS011I. .\ted. 4:5-61, 1942. 13. Szasz, T. S., et al: The Role of Hostility in the Pathogenesis of Peptic Ulcer. PSyclIOSOIll ..\fed. 9:331, 1947. 14. Tracktir, J.: Thp Rplationship Between Anxiety, Hypnotically Induced Emotions and Castric Secrdion. Dodoral dissertation, Univprsitv IIf IIollSton, 1954. . 1712 The Medical ToteeTs HOI/stOll
2.5.
Texas
Volume VII
• The war on thl:' widely varying psychosomatic disorders is a vast frontier which has rapidly becoml:' one of the most important research areas in the medical and psychological fields. Research gains during the past twenty years have been extraordinary. More research into the naturl:' of the effect of emotions upon physiological function has been undertaken during this period than in the previous century. Yet research is a slow process and even the most astute investigator often confesses that his findings seem to raise more questions than they answer. While there is general agreement that emotions do affect physiological function, and while these interactions have heen demonstrated clinically and experimentally in innumerable instances, there is still no appreciable agreement as to the precise nature of the relationship. Science attempts to establish relationships hetween events. The basic problem here is to manipulate circumstances or events in connection with the experimental subject in such a way that the subject will respond to these events. The responses made must have some logical relationship to the circumstances which are presumed to evoke them, these evoking circumstances consisting of all the events which takes place before the subject, in fact, does respond. It is a part of the task of the I:'xperimenter to find these relationships and report them in a fashion that will be agreed to hy other investigators. However, the controlled experiment and statistics in science are, relatively speaking, of very recent origin. One of the major difficulties inherent in a study of psychosomatic problems has been the inability of the experimenter to define or specify adequately the emotion under observation. Only recently has the veil of darkness Doctor Traektir is from the Derartment of Psyl'hiatrv, Baylor University Colle~e 0 \1edicine, Houston, Texas. January-February, 1966
PH.D.
woven about hypnosis by ignorance, superstition, prejudice and quackery been torn away. Out of this shadow has emerged the tool which enables the investigator to produce and control various emotional states under laboratory conditions and to observe thl:' effl:'cts of hypnotically induced emotions upon autonomic function. Since Beaumont' reported his ohservations on the changes in human gastric function which accompanied various emotional states, the digestive system has been a major area of investigation in the attempt to arrive at a definition of specific psychosomatic relationships. Investigations concerning gastric functions have been carried out not only with subjects under hypnosis hut also with suhjects in the non-hypnotic state. These experiments are difficult to evaluate for two major reasons. First, there is the prohlem of the ambiguity of the reported emotional states. Do the subjects in fact actually experience the emotions attributed to them by the experimenter? The second major difficulty is the small numher of suhjects often used in these studies. Parenthetically, it must be acknowledged at this point that it is easy to tear apart someone else's work. Any investigator has no difficulty in being dissatisfied with another worker's methods or findings. But he must do more than criticize. He must record observational and experimental data, formulate more adequate methods, offer them for scrutiny. and meet the reception that will gladly be provided by other critical investigators. It is evidently possible that even when one would employ the most advanced methodology with the most proper kind of scientific spirit, one will nonetheless often find it impossible to avoid one or more of the errors which appear to he inherent in studies of this type. For example, Wolf and Wolff (1943) work43
PSYCHOSO~IATICS
ing with a subject in the non-hypnotic state attempted to classify emotional reactions in their one subject from observing spontaneously occurring problems and conflicts which arose in the setting of the subject's home life as well as in the laboratory. The investigators stated that it was usually possible to recognize one or two dominant emotional reactions. The presumed dominant response was then correlated with changes in gastric function. In another study, Mittleman and \\lolff" attempted, by intervieu.;, to induce in the laboratory, emotional states similar to those resulting 'from their subject's experience in everyday life and to observe any changes in gastroduodenal functions that might occur. They reported that the degree of change varied from individual to individual. Floyer and Jennings" administered a testmeal to medical students who were awaiting the results of an examination. They found that acid secretion in response to the test-meal remained within the range of normal expectancy and concluded that anxiety did not result in increased acid secretion. Heller and co-workers' observed the effects of a continuing and normally induced anxiety upon gastric secretion over an extended period of time. The subjects of this study were ten hospitalized male patients, five of whom had presenting symptoms referable to the upper gastrointestinal tract, and all of whom were undergoing a routine diagnostic survey. These authors found that there was an increase in gastric acid secretion with anxiety. Szasz, et al'" from clinical and experimental observation of a patient during psychiatric interview concluded that fear inhibited acid secretion while anger increased the secretion of acid gastric juice. Other studies of subjects on the non-hypnotic level report similar contradictions in findings. From an examination of these reports one must conclude that investigators have not been able to define or specify adequately the observed emotional states, and that in some studies changes in gastric function may be due to differences in personality pre-disposition. In listing two of the principal problems concerning psychosomatic research with subjects in the non-hypnotic state, it was noted that one of the problems concerned the number of subjects employed in the investigations. In 44
this connection hypnosis offers no improvement. On the other hand, concerning the problem of ambiguity of reported emotional states, hypnosis may be of considerable value. This ambiguity rests on two bases. In the first place it is difficult to control all of the stimulating events surrounding the experimental subject, and in the second place, it is difficult to ascertain just what emotional states the suhject is experiencing. By means of hypnosis it appears to be possible to eliminate or otherwise control all stimuli in the subject's environment except those to which the experimenter wishes his subject to respond. Hypnosis does give us the means by which investigators can induce and control emotions in the laboratory under experimental conditions. A pioneering study is that of Bennett and Venables' who hypnotized a pilot of World \\'ar I and suggested that he was flying over enemy country and had to make a forced landing in foggy weather. His test-meal response was higher in acid secretion under hypnosis than it was under control conditions. Luckhardt and Johnson l l investigated the secretion of gastric juice in response to suggested eating and found that the increase in secretion was comparable with results obtained when an actual meal had been eaten. Wittkower (1953) reported that the relationship between anxiety and gastric acid secretion showed great variation from individual to individual. He found that hypnotically induced fear states in his subjects resulted in increased acid secretion in some cases and in decreased acid secretion in others. He stated that whichever change did occur was consistent with the suhject. More recently Ikemi, et al" have reported on what is, to date, probably the most extensive investigation of this type. These investigators employed several of the above mentioned techniques in their study. They utilized interviews to produce emotions, hypnotic suggestions of hallucinatory feeding, and hypnotically induced emotional states and observed the effects upon gastric secretion, gastric and colonic motility, changes in blood and urine pH and anti-bacterial activity of human blood. Among their many findings they report that in thirtyfour of thirty-six subjects, gastric acid secretion was increased by the hypnotic sugQestion of taking "a delicious meaL" while the suggesVolume VII
\IETHODOLOGICAL PROBLEMS-TRACKTIH
tion of. "gastric disturbance," inhibited gastric secretion in the majority of subjects. They also ohserved that hypnotic suggestion of apparently the same kind of emotion seems to induce diHerent psycho-physiological reactions, depending on the condition of the subjects at the time of experiment, their personalities, the technique of hypnosis, and "other factors." TIle direction of physiological reaction to a certain emotion which is ohserved in the greater numher of students is considered to he the major physiological reaction to this emotion. These writers add that it is very difficult to find a certain direction of physiological reaction to a special kind of emotion. Moreover, they make the ohservation, as provocative as it is crucial, that a more fundamental classification of emotions other than such simple ones as joy, sadness, resentment or fear. lIIay he necessary in order to find a definih' relationship hetween psychological conditions and the direction of physiological reactions and suggest that further studies should he done in this respect. They suhmit that the only conclusion which can he drawn at present is that emotions, no matter what kind they may he, have definite influence upon the physiological function of the digestive system. Admirahly modest as he is, Ikemi mav 1)(' doing hims~1f and his research an injusti~e hy lIIinimizing to such an extent the inestimable value of his work. His has been the most comprelwnsive and detailed investigation of this type reported to date and has pointed the way for further advances in our knowledge. lIo\\'ever. it is still difficult to evaluate the several hypnotic experiments. Indeed it is as difficult to evaluate these as it is the nonhypnotic studies and for precisely the sam(' reasons. The problem of the amhiguity of the reported emotional states still exists. In many studies test-meals have heen employed to stimulate secretion and in others suggestion of hallucinatory feedings have Iwen given. It is difficult to know whether reported changes in gastric function are due to the test meal. hallucinatory feeding, or to the emotional state. LeCron and Bordeaux 1o suggested that reporting methods of all hypnotic investigation should be standardized. They call attention to the fact that investigators who wish to evaluate or interpret the results of reported hypnotic research according to their own experience, January-February, 1966
find little of value in the available literature because the experimenter fails to state the exact wording of the suggestion given subjects and frequently does not indicate his own attitude, both being extremely important. These observations are still highly appropriate, as are the words of Gorton:; 'The methodological problems involved in tht' use of hypnosis are considt'rable and account for much of the contradictions to be found in the literature. If the effects of hypnosis are to be invl'stigated, it is essential that hypnosis and not sleep be studied, and suitable precautions are Ill'ct'ssary to that end. It is highly desirable to standardize the method of induction of hypnosis, preferahly by a period of training following which hypnosis may be induced at a pre-arranged signal by the operator. Controls arc necessary both in the waking state and in the trance in order to establish that the efft,ct under investigation is actually dne to hypnotic suggt'stion and not to other secondary factors. In studying the effects of emotions suggested under hypnosis, care must he takt'n that the emotional stimuli an' (,ffpcliVt' and adapted to till' subject."
Cognizant of the ahove mentioned methodological problems, Tracktir,14 and Eichhorn and Tracktir"-" in a series of reports, described their observations on the relationship between anxiety, hypnotically induced emotions and gastric secretion. They employed 24 subjects who were selected on the basis of hypnotizahility, tolerance to gastric intubation, and freedom from symptoms referable to the gastrointestinal system. After a period of training they were conditioned to enter the trance at a pre-arranged standardized signal. By us(' of the Taylor Scale of Manifest Anxiety the suhjects were divided into high, median, and low anxiety groups. Anxiety was selected hy reason of its central position in psychological dysfunction. Emotional conditions of fear, anger and contentment were induced under hypnosis by single word stimuli. Controls were employed in the waking states and hypnotically induced emotional responses were verified by a post hypnotic independent measure as well as by clinical observation. (A detailed description of methodology and results is included in the original reports.) Under these conditions the suggestion of fear produced an increase in fasting gastric secretion in the high anxiety group. The same suggestion resulted in a decrease of acid secretion in the low anxiety group. On the other hand
45
PSYCHOSOMATICS
the suggestion of anger resulted in a decrease in acid secretion in the high anxiety group and an increase in the low anxiety group. Contentment resulted in an increase of acid secretion in the entire group regardless of anxiety classification. These writers submit that contradictory findings reported by previous investigators concerning the effects of emotion upon gastric secretion may be resolved by considering the interaction effects between anxiety levels of the subjects and emotional condition. It is conceivable that Ikemi's suggestion of "a delicious meal" and "gastric disturbance" are the emotional equivalents of Eichhorn and Tracktir's suggestions of "contentment" and "fear" respectively. If this is true, the findings in both studies are similar if we consider the possibility that those of Ikemi's subjects who reacted to his suggestion of "gastric disturbance" by a decrease in secretion might fall into our low anxiety category. It will be recalled that Wittkower found that hypnotically induced fear resulted in increased acid secretion in some subjects and in decreased acid secretion in others. \Vas he working with a high anxiety group and a low anxiety group? If so, then his findings are also consistent with the above. When Szasz reported that fear inhibited, while anger increased acid gastric juice, was he observing a low anxiety subject? If so, then his findings, too, are in keeping with the others. Are reported results as contradictory as they appear at first glance, or are we at fault in 01lT methodology and lack of standardized communication? Perhaps a more critical analysis will tell us that we are all finding what we should be finding. This paper is not offered as the solution to all problems in methodology but to raise ques-
46
tions. Errors in the design of psychosomatic investigation are relatively easy to make. Each experimenter contributes both by his findings and by his mistakes. BIBUOGRAPHY
1. Beaumont, W.: Experiments and Observations on the Gastric Juice and the Physiology of Digestwn. Boston: Lilly, Wait and Co., 1834. 2. Bennett, F. I., and Vl'nables. J. F.: The Effects of the Emotions on Gastric Secretion and Motility in the Human Being. Brit. Med. J. 2:662663, 1920. 3. Eichhorn, H., and Tracktir, J.: The Effect of Hypnosis Upon Gastric Secretion. Gastroenterology, 29:417, 1955. 4. Eichhorn, H., and Tracktir, J.: The Effect of Hypnotically Induced Emotions Upon Gastric Secretion. Gastroenterology. 29:432, 1955. 5. Eichhorn, H., and Tracktir, J.: The Helationship Between Anxiety, Hypnotically Induced Emotions amI Gastric Secretion. Gastroenterology. 29:422, 1955. 6. Floyer, ~I., aud Jennings, D.: Fractional Test Meals on Students Awaiting Examination HesuIts. Lancet. 251 :356-357, 1946. 7. Gorton, B. E.: The Physiology of Hypnosis. Psychiatric Quart. 23:322, 1949. 8. Heller, M. H., et al: Gastric Acidity and Normally Produced Anxiety. PSYC1IOS(}1II. .\fed. 15:509, 1953. 9. Ikemi, r., et al: Experimental Studil's 011 the Psychosomatic Disorders of the Digl'stive System. Proc. 'Vorld Congress Ga.stroenterology. Washington, D.C. 169, 1959. 10. LeCron, L. M., and Bordeaux, J.: HYlllultism Today. Gnme and Stratton, Inc. New York, 1947. 11. Luckhardt, A. B., and Johnson, R. L.: The Psychic Secretion of Gastric Juice Under Hypnosis. Amer. J. Physiol. 70:174, 1924. 12. Mittleman, B., and Wolff, H. G.: Experimpntal Studies on Patients with Gastrities, Duodpntis and Peptic Ulcer. PsychOS011I. .\ted. 4:5-61, 1942. 13. Szasz, T. S., et al: The Role of Hostility in the Pathogenesis of Peptic Ulcer. PSyclIOSOIll ..\fed. 9:331, 1947. 14. Tracktir, J.: Thp Rplationship Between Anxiety, Hypnotically Induced Emotions and Castric Secrdion. Dodoral dissertation, Univprsitv IIf IIollSton, 1954. . 1712 The Medical ToteeTs HOI/stOll
2.5.
Texas
Volume VII