Some Perspectives for Observing and Interpreting Biopsychologic Relations and Doctor-Patient Relations

5OME PERSPECTIVES FOR OBSERVING AND INTERPRETING BIOPSYCHOLOGIC RELATIONS AND DOCTORPATIENT RELATIONS WILLIAM A. GREENE, JR., ?.?.* Psychosomatic study ofpatients with leukemia and lymphoma—men, women, and children with their mothers—indicated that the manifest disease develops in a setting ofdepression associated with loss ofa significant object or goal (1-3). There seemed to be no plausible correlation between reticuloendothelial dysfunction and personal object loss. Only by extending some current, basically psychoanalytic, formulations to encompass physiologic parameters could I derive working hypotheses. As a perspective for viewing and interpreting many types ofpsychophysiologic disease, I postulate an umbilical or vascular stage ofdevelopment comparable to the traditional oral, anal, phallic, and genital stages (4, 5). Elsewhere I have developed these concepts with respect to the early life of the human infant and its object relations delineated in terms of physiological functionings of the infant and mother (ó). In this essay I will develop these ideas about object relations and describe their possible relevance in biopsychologic relations and doctor-patient relations. I. Problems in Depicting and Defining a Relation It has been customary to depict a relation between A and B by two straight or curved arrows, as in Figure 1. Here A and B may be molecules, compounds, phases, cells, organs, persons, groups, and so forth. These reciprocating arrows indicate a relation which may also be expressed in the words "interaction," "transaction," or other terms, depending upon one's interpretation of "relation." * Departments of Medicine and Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York. This material is based on investigations supported by a research grant (M857) from the National Institute of Mental Health and the Foundations Fund for Research in Psychiatry. 453 Fig. r A.SUBSTANTIATION AND PERSONIFICATION OP THE CONCEPT "RELATION" "Relation," in most scientific parlance, means a process describable by reference to activities of two or more definable things, systems, persons, etc. Also, this term is often used as though a process ofrelating had substance , as though the relation were a thing. A process ofrelating also frequently becomes personified in some theories . Substantiation or personification is in part a reflection ofwhat kinds ofentities are being related—'chemicals, persons, etc. Colby attributes the personification ofmanypsychoanalyticprocess terms to clinicalconceptual necessity (7). This practice, in addition, may be a function ofthe observation itselfwhen persons in relation to other persons are also in relation to the observer. Here I am interested in the term "relation" as used in the concept "object relations," which means "subject (or object) relating to or with object (or subject)." Theprocess—relatingwith—is bothconceptualizedandverbalized sometimes as though it were a substance or thing and sometimes as though it were a person. B.THE PROBLEM OP INTERRELATING RELATIONS The reciprocating arrows in Figure 1 may indicate a number ofassociated relations between A and B and between B and C, as in Figure 2. A Fig. 2 series ofrelations or a system ofrelations may then be expressed in a linear fashion, as in Figure 3. Ifone shifts focus from the nodal points ofA, B, or C, etc., to the relation only, the reciprocal relation represented by the arrows may be depicted as an oval as though the relation were something Fig. 3 454 William A. Greene,Jr. · Biopsychologk Relations Perspectives in Biology and Medicine · Summer 1959 visible or tangible, an object identifiable and reproducible in space and time. A series ofrelations can then be indicated by a series of linear ovals, as in Figure 4. A-B B-C C-D D-E E-F Fig. 4 The variations in a relation may be viewed and measured in terms of exchange of some observable substance, in terms of signals or information , in terms ofrates, or—as is frequently done—m terms ofany change assumed to be indicative of"energy exchange." Consider again Figure 4, a series of relations. The relation A-B represents a component relation and is not considered in terms ofthe poles or objects which subsume the relation. Using this diagram ofa series ofrelations, I will now "play electric train," viewing the ovals as though they were railroad tracks. Assume that in the track system—A-B through E-F-a toy engine is started in relation A-B...