Denial revisited: reflections on psychosomatic theory.

Certain clinical observations cast doubt on the validity of the traditional psychological explanation of psychosomatic disorders, which invokes the concept of a psychodynamic conflict derived from psychoanalytic theory. Psychosomatic patients appear to be unable to describe feelings in words, show a marked paucity of fantasy, and do not make significant internal psychological changes in these areas in the course of psychodynamically oriented psychotherapy. It is suggested that neurophysiological hypotheses may be more useful for understanding psychosomatic processes and specifically that disturbances in the function of the palleostriatral dopamine tract are related to psychosomatic disorders. Testable inferences from this hypothesis are proposed, including the suggestion that clinically and neurophysiologically, schizophrenia and psychosomatic disorders are the obverse of one another.