Mind v. Matter

Since psychosomatic medicine became fashionable, surgeons have suffered a lot of uplifted psychiatric eyebrows. Why perform operations if the patient is suffering less from a stomach ulcer than from an ingrowing mother-in-law? Last week Chicago Surgeon William C. Beck glared back.

Everybody has psychic conflicts of some kind, he wrote in the American Journal of Surgery. A psychiatrist can find these conflicts if he looks hard enough. But that does not necessarily mean that the patient's pain is all mental; the psychiatrist, Dr. Beck pointed out, cannot "differentiate the right lower quadrant pain of psychosomatic origin from that of the recurrent inflammation of appendix." Furthermore, a patient may be neurotic, but he may also have acute appendicitis, an inflamed gallbladder, or cancer. Dr. Beck's clincher: "Almost every patient who dies of carcinoma . . . has been diagnosed as a psychoneurotic."

Dr. Beck would like less talk about emotional ills and more concentration on such old-fashioned diagnostic aids as X rays and laboratory tests. Even if no organic trouble shows up the first time, said Dr. Beck, the doctor had better make sure that later symptoms of a psychoneurotic patient are not due to some newly developed organic cause.

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