The Role of Intentionality in Recovery

II. Operational ConceptsSAMUEL R. WARSON, M.D. and WILLIAM P. HUEY, M.A.

• A background for the consideration of in-tentionial thinking as a determinant in re­

covery was covered by the senior author in aprevious paper1

• Evidence from folklore, cul­tural references, clinical experience and re­search would support the inclusion of thoughtprocesses in a comprehensive medical modelof illness. However, medicine has lagged inthe development of a conceptual frameworkfor illness global enough to include inter-rela­tionships between the patient as a thinkingperson and his disease. In the service of con­tributing to such a framework we proposed,in the paper noted above, to use the conceptof "intentionality" to explore inter-relation­ships between thought and bodily processesin postsurgical recovery, using wound healingas a parameter.

"Intentionality" can be defined opera­tionally as the process of development of "in­tentional" subject-object relationships throughthinking that brings these together as an"inner reality". (Very simply: when I think,I think about something). "Intentional" asused here implies the subjective awarenessof thoughts as motives rather than the con­sideration of such thoughts as motivated be­havior, although these views are obviouslycomplementary in a framework that incor­porates existential, psychodynamic and phy­siologic data.

The subject-object relationship that con­cerns us in medicine is the patient and hisdisease, the product of which, as Feinstein2

From Department of Psychiatry, College ofMedicine, University of Florida, Gainesville, Flo­rida.

Presented at the annual meeting of the Aca­demy of Psychosomatic Medicine, Miami, Florida,December 4-7, 1969.

JUly-August 1969

pointed out, is his "illness". The phenomenaof the "inner reality" of his illness for the pa­tient may be revealed directly as an experi­ence, or studied more objectively through theuse of psychological concepts such as "self­image" and psychophysiological conceptssuch as "arousal" with its capability of phy­siological measurements3

•

From Brett's History of Psychology~ itappears that investigations of the process ofthought were stimulated by Kant's observa­tion that the actions of the mind cannot beunderstood without knowing how the mindworks. Unfortunately, Kant relegated thisarea of investigation to metaphysics becausehe believed that the data of subjective experi­ence could not be approached through thescientific method. How much Kant set theclock back for medicine and psychiatry by hisseparation of subject and object in terms ofinvestigative approaches is difficult to esti­mate. Kraepelin in his One Hundred Years

of Psychiatry" noted that the attempts ofearly German psychiatrists to use a meta­physical approach took them far away fromthe medical model in their approach to thementally ill.

Historically, the medical model has al­ways included the thinking, feeling and act­ing of the patient as observational data. Whenpsychiatry became differentiated as a spe­cialty it not only continued to approach"thinking" symptomatically in the formula­tion of clinical syndromes but also used itempirically in treatment procedures such as"attitude therapy" and "hypnotherapy." Withthe advent of dynamic concepts of disease,attention was drawn to the content and mean­ing of thought as motivated behavior, but asRapaport6 pointed out, comparatively littleattention was given to the process of thought

225

The Role of Intentionality in Recovery

II. Operational ConceptsSAMUEL R. WARSON, M.D. and WILLIAM P. HUEY, M.A.

• A background for the consideration of in-tentionial thinking as a determinant in re­

covery was covered by the senior author in aprevious paper1

• Evidence from folklore, cul­tural references, clinical experience and re­search would support the inclusion of thoughtprocesses in a comprehensive medical modelof illness. However, medicine has lagged inthe development of a conceptual frameworkfor illness global enough to include inter-rela­tionships between the patient as a thinkingperson and his disease. In the service of con­tributing to such a framework we proposed,in the paper noted above, to use the conceptof "intentionality" to explore inter-relation­ships between thought and bodily processesin postsurgical recovery, using wound healingas a parameter.

"Intentionality" can be defined opera­tionally as the process of development of "in­tentional" subject-object relationships throughthinking that brings these together as an"inner reality". (Very simply: when I think,I think about something). "Intentional" asused here implies the subjective awarenessof thoughts as motives rather than the con­sideration of such thoughts as motivated be­havior, although these views are obviouslycomplementary in a framework that incor­porates existential, psychodynamic and phy­siologic data.

The subject-object relationship that con­cerns us in medicine is the patient and hisdisease, the product of which, as Feinstein2

From Department of Psychiatry, College ofMedicine, University of Florida, Gainesville, Flo­rida.

Presented at the annual meeting of the Aca­demy of Psychosomatic Medicine, Miami, Florida,December 4-7, 1969.

JUly-August 1969

pointed out, is his "illness". The phenomenaof the "inner reality" of his illness for the pa­tient may be revealed directly as an experi­ence, or studied more objectively through theuse of psychological concepts such as "self­image" and psychophysiological conceptssuch as "arousal" with its capability of phy­siological measurements3

•

From Brett's History of Psychology~ itappears that investigations of the process ofthought were stimulated by Kant's observa­tion that the actions of the mind cannot beunderstood without knowing how the mindworks. Unfortunately, Kant relegated thisarea of investigation to metaphysics becausehe believed that the data of subjective experi­ence could not be approached through thescientific method. How much Kant set theclock back for medicine and psychiatry by hisseparation of subject and object in terms ofinvestigative approaches is difficult to esti­mate. Kraepelin in his One Hundred Years

of Psychiatry" noted that the attempts ofearly German psychiatrists to use a meta­physical approach took them far away fromthe medical model in their approach to thementally ill.

Historically, the medical model has al­ways included the thinking, feeling and act­ing of the patient as observational data. Whenpsychiatry became differentiated as a spe­cialty it not only continued to approach"thinking" symptomatically in the formula­tion of clinical syndromes but also used itempirically in treatment procedures such as"attitude therapy" and "hypnotherapy." Withthe advent of dynamic concepts of disease,attention was drawn to the content and mean­ing of thought as motivated behavior, but asRapaport6 pointed out, comparatively littleattention was given to the process of thought

225

PSYCHOSOMATICS

itself. (The recent interest in "cognition" maybe a step in this direction.)

Brentano', a 19th century empirical psy­chologist attempted to bridge the gap betweensubject and object created by Kant's separa­tion of investigative procedures through hisconcepts of intentionality. He conceived ofthe process of thought as a mode of activelyrelating to or "intending" an object throughits presentation to consciousness as a judg­ment. Such presentations develop from per­ceptions that involve feeling, memory andother associatilms in the process of thinkingand judging. Intentions emerge as choicesmade through man's awareness of himself andhis situation or his "human condition", andin that sense are existential. However, Bren­tano like Freud, who reportedly attendedsome of his lectures, did not deny the impor­tance of physiology; they believed that psy­chology and physiolgy should supplement oneanother.

Neurophysiology, like psychology, hascome a long way since Brentano's time. Con­cepts such as "reverberating circuits" havehelped us to understand reciprocating inter­actions between the cortex and other partsof the nervous system, just as concepts of"feedback" and "arousal and inhibition" haveenlarged the scope of our understanding ofpsychophysiological activities. In a 1952 sym­posium on "The EEG in Relation to Psy­chiatry," Lindsleys stated that neurophysio­logists were getting closer to the mechanismsneeded to explain psychological phenomena.He pointed out, however, that this is not a"one-way street" and that there is a need forpsychological data to help explain neurophy­siological observations. Hopefully, these com­plementary endeavors would shed light on thepsychophysiology of thought processes. Sincethen progress in the correlation of psychologi­cal and physiological phenomena has beenmade through sleep and dream research. Thishas led to studies such as those currently beingcarried out at the University of Florida onrelationships between EEG phenomena, sleep,dreams, the "mental status" and observable

226

biological disturbances such as angina. It ishoped that such psychophysiological studiescan be used eventually to translate inten­tionality into psychobiology and help to ex­plain what happens in terms of disease whena patient decides to get well or die andwhether such a decision is a symptom or amotivating force.

An illustration of the situation in whichsuch questions are raised occurred recentlyon our consultation service. A 62-year-oldmarried white male was referred because ofdepression and a wound of the left flankwhich was not healing. This was the exit ofa self-inflicted gunshot wound of the upperabdomen that had occurred 6 weeks prior tothe referral when he aimed a shotgun at hisheart.

For several years this patient had beenconcerned about decreasing mental capacities;in fact, he had retired the previous year. Heapparently became quite depressed and evenalienated from his family following retire­ment. A few weeks prior to admission, a smallnodule was found in his prostate on routineexamination. Although a needle biopsy show­ed this to be benign, he felt he was no longera man, had nothing to live for, and decidedto end his life.

The extensive abdominal surgery wastechnically successful but his recovery ,wasmuch slower than expected. Psychiatric ex­amination six weeks after admission revealedan apathetically depressed man who wasdefinitely slow in this thinking and reactions.There was some question of a relatively mildorganic brain syndrome. His responses weresuperfically socially acceptable in that he ex­pressed regret for his actions and said hewould not do it again, but his deeper feelingcould be inferred from remarks such aswhether it is "worth picking up the pieces andgoing ahead."

He continued on a downhill course andbecame much worse when he developed alung infection on the right side. In view ofhis apathy and "giving up" attitude, thenurses expected him to die. Parallel situations

Volume X

PSYCHOSOMATICS

itself. (The recent interest in "cognition" maybe a step in this direction.)

Brentano', a 19th century empirical psy­chologist attempted to bridge the gap betweensubject and object created by Kant's separa­tion of investigative procedures through hisconcepts of intentionality. He conceived ofthe process of thought as a mode of activelyrelating to or "intending" an object throughits presentation to consciousness as a judg­ment. Such presentations develop from per­ceptions that involve feeling, memory andother associatilms in the process of thinkingand judging. Intentions emerge as choicesmade through man's awareness of himself andhis situation or his "human condition", andin that sense are existential. However, Bren­tano like Freud, who reportedly attendedsome of his lectures, did not deny the impor­tance of physiology; they believed that psy­chology and physiolgy should supplement oneanother.

Neurophysiology, like psychology, hascome a long way since Brentano's time. Con­cepts such as "reverberating circuits" havehelped us to understand reciprocating inter­actions between the cortex and other partsof the nervous system, just as concepts of"feedback" and "arousal and inhibition" haveenlarged the scope of our understanding ofpsychophysiological activities. In a 1952 sym­posium on "The EEG in Relation to Psy­chiatry," Lindsleys stated that neurophysio­logists were getting closer to the mechanismsneeded to explain psychological phenomena.He pointed out, however, that this is not a"one-way street" and that there is a need forpsychological data to help explain neurophy­siological observations. Hopefully, these com­plementary endeavors would shed light on thepsychophysiology of thought processes. Sincethen progress in the correlation of psychologi­cal and physiological phenomena has beenmade through sleep and dream research. Thishas led to studies such as those currently beingcarried out at the University of Florida onrelationships between EEG phenomena, sleep,dreams, the "mental status" and observable

226

biological disturbances such as angina. It ishoped that such psychophysiological studiescan be used eventually to translate inten­tionality into psychobiology and help to ex­plain what happens in terms of disease whena patient decides to get well or die andwhether such a decision is a symptom or amotivating force.

An illustration of the situation in whichsuch questions are raised occurred recentlyon our consultation service. A 62-year-oldmarried white male was referred because ofdepression and a wound of the left flankwhich was not healing. This was the exit ofa self-inflicted gunshot wound of the upperabdomen that had occurred 6 weeks prior tothe referral when he aimed a shotgun at hisheart.

For several years this patient had beenconcerned about decreasing mental capacities;in fact, he had retired the previous year. Heapparently became quite depressed and evenalienated from his family following retire­ment. A few weeks prior to admission, a smallnodule was found in his prostate on routineexamination. Although a needle biopsy show­ed this to be benign, he felt he was no longera man, had nothing to live for, and decidedto end his life.

The extensive abdominal surgery wastechnically successful but his recovery ,wasmuch slower than expected. Psychiatric ex­amination six weeks after admission revealedan apathetically depressed man who wasdefinitely slow in this thinking and reactions.There was some question of a relatively mildorganic brain syndrome. His responses weresuperfically socially acceptable in that he ex­pressed regret for his actions and said hewould not do it again, but his deeper feelingcould be inferred from remarks such aswhether it is "worth picking up the pieces andgoing ahead."

He continued on a downhill course andbecame much worse when he developed alung infection on the right side. In view ofhis apathy and "giving up" attitude, thenurses expected him to die. Parallel situations

Volume X

ROLE OF INTENTIONALITY-WARSON AND HUEY

are seen in Richter's" concept of sudden deathin experiments with laboratory animals andEngel's'" "giving-up - given-up" complex.However, this patient's family rallied aroundhim and apparently succeeded in dispellinghis feeling that they were not interested orconcerned about him. He improved in re­sponse to their demonstrable concern. Hemade it clear to the psychiatrist that he hadchanged his mind - now that he felt he hadsomething to live for he would fight to getwell. This type of aggressive approach haslong been considered in medicine to be a fac­tor in recovery, and indeed, this patientshowed a marked clinical improvement. Hissubsequent course, however, was complicatedby severe reactions to treatment procedures(e.g., a penicillin reaction) and problems withhis colostomy. Later, he again became un­certain as to whether it was "worth pickingup the pieces," but when last seen he hadimproved again "because my family wantsme to get well."

We frequently encountered difficulties ineliciting the intentions of patients directlythrough a phenomenological approach inclinical situation. These difficulties seemed tofall into two broad categories: first, when thedisclosure involves moral judgments, andsecond, when such revelations would jeopard­ize the position taken by the patient.

An example of the first is a case vignetteof a 4lyear-old married white woman whowas advised to have an elective cardiac opera­tion. Plans for surgery were made and every­one involved seemed to be taking the comingevent in a matter-of-fact manner until the pa­tient, a few days before her scheduled hos­pitalization, told her physician that shewanted to postpone the operation because shefelt depressed. He had noted depressive trendsprior to this but did not think they weresevere enough to warrant the psychiatric re­ferral which she now wished.

The psychiatrist found her to be moder­ately depressed but well motivated for psy­chotherapy. At first she attributed postponingthe operation to feeling depressed and being

July-August 1969

unable to carry out her usual active involve­ment in community affairs. Then, she beganto delve into feelings about the operation interms of her past experience and life style ­which was to maintain high standards anddeny feelings. It was not until the 10th inter­view, however, that she disclosed that it hadbeen her intention to use the operation as away out of what she defined as a meaninglessexistence. In fact, she was aware of this in­tention some time before the scheduled oper­ation and she could even remember whenshe made the decision. She had eagerly Ic::::k­ed forward to the operation, which she knewcarried with it a definite risk, as a solution toproblems with which she had been strugglingfor many years. Through surgery she woulddie in an acceptable or "appropriate" manner,She began to question her thinking abouther situation and this solution only after shebecame involved in caring for a close friendwho had developed a terminal illness. Thealternative of psychiatric help then appealedto her and she disclosed her depressivesymptomatology to her physician in the hopethat he would refer her.

Of course, we do not know what wouldhave happened had she undergone the oper­ation, but we do know that her surgeonwould not have operated had he known thatshe intended to use him as the instrument ofher demise. Weisman and Hackett" wroteabout this type of patient and "appropriatedeath" in their "Predilection to Death" study,but they did not indicate how difficult itmight be to elicit the pertinent information.Our experience with this patient and othersraises the question of how frequently the in­tention to die may be undetected before sur­gery and what effect it may have on recovery.

How the position of the patient may createdifficulties in eliciting intentions was exemp­lified by the case of a 54 year old marriedwhite woman who was referred to psychiatryafter several admissions to a surgical servicefor non-healing lesions on her face. The sur­geons suspected that her lesions were fact­itial. Healing occurred while she was in the

227

ROLE OF INTENTIONALITY-WARSON AND HUEY

are seen in Richter's" concept of sudden deathin experiments with laboratory animals andEngel's'" "giving-up - given-up" complex.However, this patient's family rallied aroundhim and apparently succeeded in dispellinghis feeling that they were not interested orconcerned about him. He improved in re­sponse to their demonstrable concern. Hemade it clear to the psychiatrist that he hadchanged his mind - now that he felt he hadsomething to live for he would fight to getwell. This type of aggressive approach haslong been considered in medicine to be a fac­tor in recovery, and indeed, this patientshowed a marked clinical improvement. Hissubsequent course, however, was complicatedby severe reactions to treatment procedures(e.g., a penicillin reaction) and problems withhis colostomy. Later, he again became un­certain as to whether it was "worth pickingup the pieces," but when last seen he hadimproved again "because my family wantsme to get well."

We frequently encountered difficulties ineliciting the intentions of patients directlythrough a phenomenological approach inclinical situation. These difficulties seemed tofall into two broad categories: first, when thedisclosure involves moral judgments, andsecond, when such revelations would jeopard­ize the position taken by the patient.

An example of the first is a case vignetteof a 4lyear-old married white woman whowas advised to have an elective cardiac opera­tion. Plans for surgery were made and every­one involved seemed to be taking the comingevent in a matter-of-fact manner until the pa­tient, a few days before her scheduled hos­pitalization, told her physician that shewanted to postpone the operation because shefelt depressed. He had noted depressive trendsprior to this but did not think they weresevere enough to warrant the psychiatric re­ferral which she now wished.

The psychiatrist found her to be moder­ately depressed but well motivated for psy­chotherapy. At first she attributed postponingthe operation to feeling depressed and being

July-August 1969

unable to carry out her usual active involve­ment in community affairs. Then, she beganto delve into feelings about the operation interms of her past experience and life style ­which was to maintain high standards anddeny feelings. It was not until the 10th inter­view, however, that she disclosed that it hadbeen her intention to use the operation as away out of what she defined as a meaninglessexistence. In fact, she was aware of this in­tention some time before the scheduled oper­ation and she could even remember whenshe made the decision. She had eagerly Ic::::k­ed forward to the operation, which she knewcarried with it a definite risk, as a solution toproblems with which she had been strugglingfor many years. Through surgery she woulddie in an acceptable or "appropriate" manner,She began to question her thinking abouther situation and this solution only after shebecame involved in caring for a close friendwho had developed a terminal illness. Thealternative of psychiatric help then appealedto her and she disclosed her depressivesymptomatology to her physician in the hopethat he would refer her.

Of course, we do not know what wouldhave happened had she undergone the oper­ation, but we do know that her surgeonwould not have operated had he known thatshe intended to use him as the instrument ofher demise. Weisman and Hackett" wroteabout this type of patient and "appropriatedeath" in their "Predilection to Death" study,but they did not indicate how difficult itmight be to elicit the pertinent information.Our experience with this patient and othersraises the question of how frequently the in­tention to die may be undetected before sur­gery and what effect it may have on recovery.

How the position of the patient may createdifficulties in eliciting intentions was exemp­lified by the case of a 54 year old marriedwhite woman who was referred to psychiatryafter several admissions to a surgical servicefor non-healing lesions on her face. The sur­geons suspected that her lesions were fact­itial. Healing occurred while she was in the

227

PSYCHOSOMATICS

hospital but would break down soon afterdischarge. Although there was clinical evi­dence of depression, she completely deniedemotional disturbances; this denial persistedeven after transfer to the psychiatric servicewhich she soon left against medical advicein a gesture of defiance.

When patients do reveal their intentionsthese can be related phenomenologically towhat is presented to consciousness as an in­ner reality. W.I. Thomas, an American soci­ologist in the early part of this century, ap­proached the process of presentation from adynamic psychosocial point of view and form­ulated what is presented as "the definitionof the situation"'~. The relationship of thisconcept to that of intentionality in terms of theprocess of thought is evident in Thomas' ob­servation that "preliminary to any self-deter­mined act of behavior there is always a defi­nition of the situation." Operationally his con­cept can also be related to the psychophys­iology of arousal and inhibition in that heconceived of inhibition as necessary to con­trol the effect of arousal and allow the pro­cess of definition to occur.

How the definition of the situation act­ively influences actions is contained inThomas' observation that "if men define situ­ations as real, they are real in their con­sequences." Merton"I later developed theseideas into the concept of "the self-fullfillingprophecy." In terms of illness this prophecymeans that if a patient defines his situation ashopeless, his thought processes help make itso through his disease (or in the words of thatold poetic insight: "Tis our thinking makes itso").

Operationally the definition of the situ­ation expands intentionally to include psy­chosocial factors that become existential forthe patient. In other words, the definition ofthe situation and the selection or choice ofobject reflects the sociocultural backgroundas an element of experience that helps to shapethe image, the life style and the intentionsof the person. Andrew" used this in her studyof relationships between coping styles and

228

learning and recovery from surgery for in­guinal herniorrhaphy. She found definite cor­relations that would suggest that the patient'sdefinition of his situation can influence re­covery and that changes in this definition de­pend on coping styles as well as new infor­mation.

Along similar lines, Ryther'" reported anassociation between the number of social in­volvements and the number of complicationsfollowing herniorrhaphy. When patients withextremes of high and low numbers of comp­lications were compared, there was a markeddifference in their "primary social involve­ments" (relationships with others in their fam­ily, work situations and continuity and com­munity), which could influence the defini­tion of the situation (as it did with the firstpatient discussed in this paper), and the out­come of a relatively simple surgical experi­ence.

The method used by Thoroughman, et al'6.in developing an instrument for predicting thesuccess or failure of surgical intervention forintractable duodenal ulcer symptoms is a sim­ilar approach which uses social factors. Theydevised a "deprivation scale" based on factorsthat they considered to be evidences of en­vironmental deprivation. A high degree ofcorrelation between these factors and the out­come of the surgery was found, but no cor­relations were made with the experience of thepatients or what was in their minds that couldhave actively influenced their recovery.

An extensive review of the medical liter­ature of the past few decades revealed manystudies that would lend empirical and theor­etical support to the hypothesis that thereis a relationship between the process ofthought and the process of disease. There hasbeen difficulty developing a research designthat could bridge the conceptual gap betweenexperimental and objective approaches. Wehave tried to do this by using existential con­cepts that can be defined operationally andrelated to physiological and biological activi­ties through the process of thought.

Volume X

PSYCHOSOMATICS

hospital but would break down soon afterdischarge. Although there was clinical evi­dence of depression, she completely deniedemotional disturbances; this denial persistedeven after transfer to the psychiatric servicewhich she soon left against medical advicein a gesture of defiance.

When patients do reveal their intentionsthese can be related phenomenologically towhat is presented to consciousness as an in­ner reality. W.I. Thomas, an American soci­ologist in the early part of this century, ap­proached the process of presentation from adynamic psychosocial point of view and form­ulated what is presented as "the definitionof the situation"'~. The relationship of thisconcept to that of intentionality in terms of theprocess of thought is evident in Thomas' ob­servation that "preliminary to any self-deter­mined act of behavior there is always a defi­nition of the situation." Operationally his con­cept can also be related to the psychophys­iology of arousal and inhibition in that heconceived of inhibition as necessary to con­trol the effect of arousal and allow the pro­cess of definition to occur.

How the definition of the situation act­ively influences actions is contained inThomas' observation that "if men define situ­ations as real, they are real in their con­sequences." Merton"I later developed theseideas into the concept of "the self-fullfillingprophecy." In terms of illness this prophecymeans that if a patient defines his situation ashopeless, his thought processes help make itso through his disease (or in the words of thatold poetic insight: "Tis our thinking makes itso").

Operationally the definition of the situ­ation expands intentionally to include psy­chosocial factors that become existential forthe patient. In other words, the definition ofthe situation and the selection or choice ofobject reflects the sociocultural backgroundas an element of experience that helps to shapethe image, the life style and the intentionsof the person. Andrew" used this in her studyof relationships between coping styles and

228

learning and recovery from surgery for in­guinal herniorrhaphy. She found definite cor­relations that would suggest that the patient'sdefinition of his situation can influence re­covery and that changes in this definition de­pend on coping styles as well as new infor­mation.

Along similar lines, Ryther'" reported anassociation between the number of social in­volvements and the number of complicationsfollowing herniorrhaphy. When patients withextremes of high and low numbers of comp­lications were compared, there was a markeddifference in their "primary social involve­ments" (relationships with others in their fam­ily, work situations and continuity and com­munity), which could influence the defini­tion of the situation (as it did with the firstpatient discussed in this paper), and the out­come of a relatively simple surgical experi­ence.

The method used by Thoroughman, et al'6.in developing an instrument for predicting thesuccess or failure of surgical intervention forintractable duodenal ulcer symptoms is a sim­ilar approach which uses social factors. Theydevised a "deprivation scale" based on factorsthat they considered to be evidences of en­vironmental deprivation. A high degree ofcorrelation between these factors and the out­come of the surgery was found, but no cor­relations were made with the experience of thepatients or what was in their minds that couldhave actively influenced their recovery.

An extensive review of the medical liter­ature of the past few decades revealed manystudies that would lend empirical and theor­etical support to the hypothesis that thereis a relationship between the process ofthought and the process of disease. There hasbeen difficulty developing a research designthat could bridge the conceptual gap betweenexperimental and objective approaches. Wehave tried to do this by using existential con­cepts that can be defined operationally andrelated to physiological and biological activi­ties through the process of thought.

Volume X

ROLE OF INTENTIONALITY-WARSON AND HUEY

While we do not have any conclusive dataas yet, we have found it possible to developa conceptual framework for illness that takesinto consideration activity as well as com­pliance of the host in interactions with diseasethrough the mediation of the process ofthought. This is based on the concept that theway a person perceives and defines his situa­tion activates him psychobiologically to bringhis inner and outer reality together, throughthe process of thought, and that this can ma­terially alter the process of disease. Medicallythis would mean that the attention of thephysician to the thought process of his pa­tient should be as routine as taking his pulse.

SUMMARY

Medicine has neglected the investigationof relationships between thought processesand illness probably because medicine histor­ically has depended on the natural sciences,and the working of the mind historically hasbeen considered to be in the realm of meta­physics. However, thought processes are bio­logical processes that can be studied psycho­physiologically as well as experientially interms of the patient and his disease.

There has been difficulty developing anoperational model that would be useful in theclinical situation. We have been exploringthe usefulness of the concepts of "intention­ality" and "the definition of the situation" tothis end.

Some of the problems we encounteredwere described by case reports. Expansion ofthe concept of intentionality to include socio­logical data through "the definition of thesituation" offers the opportunity for develop­ing a more comprehensive model of illnessin keeping with the prevailing comprehensivetrend in medicine.

July-August 1969

REFERENCES

1. Warson, S.R.: International Psychic Deter.minates in Recovery. Psychosom., 9: 114,March-April, 1968.

2. Feinstein, A. R.: Clinical Judgment. Balti­more: Williams and Wilkins, 1967.

3. Hill, D. : msease, Reaction, or Posture?Amer., J. Psychiat., 125; 445, October, 1968.

4. Peters, R.S. (ed.): Brett's History of Psycho_logy. Cambridge, Mass.: The M. I. T. Press,1962. Chapter 13.

5. Kraepelin, E.: One Hundred Years Of Psy­chiatry. N.Y.: Philosophic Library, 1962.

6. Rapaport, D. (ed. & tr.): Organization andPathology of Thought. New York: ColumbiaUniversity Press, 1951. Page 689.

7. Brett's History of PS1Jchology, op. cit.8. Lindsley, D. B.: Psychological Phenomena

and the Electroencephalogram. Electroen­ceph. Clin. Neurophysiol., 4: 443, November,1952.

9. Richter. C.P.: On the Phenomena of SuddenDeath in Animals and Man. Psychosom. Med.,19:191. May-June. 1957.

10. Engel, G.L.: A Life Setting Conducive to Ill­ness. Ann. Int. Meel., 69: 293, August, 1968.

11. Weisman, A.D.. and Hackett. T.P.: Predilec­tion to Death. Psychosom. Med., 23: 232, May.June, 1961.

12. Coser, L.A.. and Rosenberg. B. (ed.): Socio­lo.qical Theory. New York: The MacmillanCompany, 1957. Chapter 7. (pages 207.211).

13. Merton, R. K.: Social Theory and SocialStructure. Revised and enlarged edition.Glencoe, Ill.: The Free Press, 1957. Chapter11.

14. Andrew, J.M.: Coping Styles, Stress-RelevantLearning and Recovery from Surgery. Un­published Ph. D. dissertation, University ofCalifornia at Los Angeles, 1967.

15. Ryther, T. E.: Primary Social Involvementand Recovery from Surgery. UnpublishedPh.D. dissertation, Stanford University, 1965.

16. Thoroughman, J.e., et al.: Psychological Fac­tors Predictive of Surgical Success in Pa­tients with Intractable Duodenal Ulcer. psy.chosom. Me-i., 26: 618, September-october,1964.

229

ROLE OF INTENTIONALITY-WARSON AND HUEY

While we do not have any conclusive dataas yet, we have found it possible to developa conceptual framework for illness that takesinto consideration activity as well as com­pliance of the host in interactions with diseasethrough the mediation of the process ofthought. This is based on the concept that theway a person perceives and defines his situa­tion activates him psychobiologically to bringhis inner and outer reality together, throughthe process of thought, and that this can ma­terially alter the process of disease. Medicallythis would mean that the attention of thephysician to the thought process of his pa­tient should be as routine as taking his pulse.

SUMMARY

Medicine has neglected the investigationof relationships between thought processesand illness probably because medicine histor­ically has depended on the natural sciences,and the working of the mind historically hasbeen considered to be in the realm of meta­physics. However, thought processes are bio­logical processes that can be studied psycho­physiologically as well as experientially interms of the patient and his disease.

There has been difficulty developing anoperational model that would be useful in theclinical situation. We have been exploringthe usefulness of the concepts of "intention­ality" and "the definition of the situation" tothis end.

Some of the problems we encounteredwere described by case reports. Expansion ofthe concept of intentionality to include socio­logical data through "the definition of thesituation" offers the opportunity for develop­ing a more comprehensive model of illnessin keeping with the prevailing comprehensivetrend in medicine.

July-August 1969

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