Page    1  2  of this article. Somatic Biopathies Part II   Charles Konia   Cholelithiasis and Other Biopathies Involving the Annular Muscles of the Diaphragmatic Segment Determining which organ or organ system will become diseased in the presence of armoring of a particular segment in part involves understanding which tissues in a given segment are the prime targets in the sympathotonic reaction. Stated differently, what is the response of a given tissue to the effects of chronic sympathetic excitation? Clinical experience reveals a wide range of individual differences in the susceptibility of various tissues to sympatheticotonia. In the following case, the involved tissue was the annular muscles of the organs of the diaphragmatic segment, specifically the sphincter of Odi, which produced cholelithiasis and resulted in cholecystectomy one year prior to presentation, and the annular muscles of the pylorus and cardia, which resulted in pyloric and esophageal spasms during the course of therapy. This tendency for the annular muscles to go into spasm may have been the reason that cholesterol nucleated (crystallized) more rapidly in this patient who developed gallstones than in others who do not have this tendency. It is known that, in the pathogenesis of cholelithiasis, dietary factors, excess production of cholesterol by the liver, or decreased production of bile pigment are probably not significant (4). The increased incidence of gallstones in patients who have undergone truncal vagotomy supports the role of chronic sympatheticotonia in the pathogenesis of this biopathy. The generalized, severe sympatheticotonia, which was immediately apparent from a biophysical standpoint in this patient, affected the organs under the diaphragm to a degree that resulted in the appearance of overt signs and symptoms of somatic biopathies of the annular muscles of the gut in this segment. The biophysical basis for these somatic biopathies was a combination of a fairly high energy level and a very low capacity to tolerate expansion, in particular pleasurable impulses.   Case Presentation This 49-year-old, single, white female came to therapy complaining of being "too old." She stated, "I have no way to live and no way to end it." She also complained of "extreme depression," although this was not evident. Past history revealed she had felt suicidal at age 23 but never attempted to hurt herself. She saw a psychoanalyst at that time for nine years. She married, not out of love for her husband but to please her analyst, and she had two children. While raising her children, she was asymptomatic for about 10 years but trouble started again when her children reached adolescence and she no longer felt needed. She was living in a warm climate during the time she felt asymptomatic, which she felt made a difference in her sense of well-being. As her children grew apart from her, and she felt the need for help, she saw a "Reichian" therapist in California. When he made sexual advances toward her, she left and saw a medical orgonomist. Although she had a great deal of fantasied revenge against the "Reichian," she never was able to express any hatred openly. Instead, she punched herself in the stomach when she felt anger toward him.4 Past medical history revealed she developed pertussis and diphtheria at six years of age. At this time, she felt a distinct change in her personality occurred, and she became a "good girl." One year prior to presentation, she had a cholecystectomy for gallstones. She smoked one to two packs of cigarettes a day. Biophysical examination revealed an extremely tense, short-statured, haggard-looking, white female who appeared 10-15 years older than her age like a pathetic old woman. Her head appeared to be compressed into her torso and she seemed to have no neck. There was mild depression present and a great deal of bitterness and smoldering rage at how badly she had been treated by others when she allowed them to get close to her. She had an extremely cruel streak which was always self-directed and which had a slightly exhibitionistic flavor to it. She whined and complained incessantly and always belittled herself. Despite her enor-mous need for warmth and affection, she never allowed anyone to get too close because of a conscious fear of being hurt. She was heavily armored throughout. Her chest was emphysematous and her respiratory excursions were restricted. Her diaphragmatic segment had the appearance of a tight rope around it. The epigastrium was tense and tender, as was the abdomen, and there was a surgical scar over the right upper quadrant. The general biophysical appearance was one of a taut bladder ready to burst. She was unable to shout fully, hitting was held back, and she developed pain in her thighs when asked to kick. Although the occiput was tender and her eyes were distrustful, there was no evidence of a perceptual split. She had a suffering and pained facial expression. When asked to breathe on the couch, a pelvic reflex appeared. She immediately clamped down in the upper segments and felt miserable. My initial diagnostic impression was: 1.  Premature iatrogenic pelvic mobilization. 4 This was understood as an attempt to relieve the tension from the solar plexus. 2.  Possible masochistic character. 3.  Possible depressed manic-depressive character.   The diagnosis of schizophrenia was ruled out, in part, on the basis of her ability to establish strong transference reactions and, in part, despite her muddled thinking, on the absence of perceptual splitting. My immediate therapeutic objective was to mobilize the expression of anger from the upper segments. This had two goals in mind - one therapeutic and one diagnostic. Therapeutically, mobilizing the ocular segment would produce a generalized parasympathomimetic effect and would help clamp down the pelvis. Diagnostically, this effect would help determine the patient's diagnosis. If she could tolerate the expan-sive push without reacting masochistically, then the diagnosis of manic -depressive character could be made. This carries a more favorable prognosis than if she reacted masochistically, in which case would most likely be a masochistic character. In light of her past medical history, the possibility of a recurrence of a somatic biopathy could not be excluded. Efforts to express rage were followed by brief periods of expansion lasting from a few moments at the early stages of therapy to several days later on. This was invariably followed by fear of being punished and intensification of somatic armoring. These reactions were centered particularly in the diaphragmatic segment and led typically to the appear-ance of a full-blown masochistic reaction consisting of feelings of hope-lessness, self-belittlement, acting provocatively in a stupid or suffering manner, awkwardness, and, later, when she could trust me more fully, in an overtly provocative fashion, testing my patience to the limit. These reactions to therapeutic efforts aimed at providing an expansive effect on her biosystem confirmed the initial diagnostic impression of masochistic character. Her red thread was that of a spiteful, suffering old woman. She stated in her typical whining and pathetic manner that, in the past, she was told she was "too old" to have what she wanted and, therefore, she had to sacrifice herself for the sake of others, especially her younger siblings and, later, her children. Now, she felt she was "over the hill" to have anyone, especially a man, of her own. As if this kind of morbid self--abuse were not enough, she would then proceed to flagellate herself mercilessly with self-belittling thoughts of being "stinky," "old," "ugly," etc. She would also manipulate others to treat her sadistically. After one such incident, she developed a strong pain over the pylorus. Gentle mas-sage of this area produced deep sobs, which she recognized as a familiar cry when she was disappointed by others. This momentarily relieved the diaphragmatic spasm, and she felt more outgoing and expansive with a brief absence of masochism. She was able to discuss in a rational manner what her emotional needs were and what she wanted out of life. Kicking helped prolong her expansive reaction but invariably she became terror-stricken and felt bands of contraction around her thighs. This led to masochistic fantasies in which her legs were being beaten by her father because she displeased him. I continued mobilization of the posterior aspect of the diaphragmatic segment, producing fear in her and clonisms of the torso which again were followed by momentary relief and a brief feeling of clarity in her head. By the following session, she was wallowing in her suffering again. I gradually became impressed by the enormity of her fear of expansion.5 She had a recurrent dream: She is taking care of an old woman. She has no life or money to do anything for herself. This dream vividly portrayed her predicament. Further attempts at liberating diaphragmatic rage again resulted in a brief expansive reaction with a warm feeling centered around the diaphragm and abdomen followed by a return of a spasm in this region. Feeling a constriction around her waist, she had a sense memory of being tightly wrapped around the waist with a diaper and then being force-fed by her mother. She remembered being terrified by her. Slowly as she began to tolerate biophysical expansion to a greater extent, she began experiencing sexual feelings. She reacted violently to these feelings: "I don't want these feelings; there's no one out there for me; it is no use," were her words. Her use of anger to keep everyone at a distance so she did not have to be sexually threatened became increasingly clear to both of us. Accompanying this reaction to sexual feelings, she again clamped down in the diaphragm with pain over the right hypochondrium and substernal area together with an intensification of masochism. Gentle pressure over these areas again produced gagging and clonisms of the torso. This time she felt fear over the epigastric region and she recognized the diaphragmatic segment as the main source of trouble. She said, "That's where the battle takes place." Unlike the ordinary neurotic who also has similar fears, this patient felt mortally afraid, as if her life were in danger.5 Mortal fear as a reaction to expansion is characteristic of masochistic patients. Unlike the ordinary neurotic, the masochist has no other defenses to rely on. Because of the severity and duration of this episode of diaphragmatic spasm, I requested that she have a medical evaluation. The significant results of an esophagram and an upper G.I. series were as follows: Slight narrowing of the distal esophagus (esophageal spasm) and a small degree of reflux into the esophagus during water siphon testing. There was no evidence of abnormality in the stomach or duodenum. The results of the esophagram confirmed the clinical impression that armoring of the diaphragmatic segment was extensive and involved organs deep within it. The specific manifestation of armor was in the form of spasms of the annular muscles of the gastrointestinal tract in the region of the diaphragm. A similar constriction most probably resulted in gall bladder abnormalities several years previously, resulting in cholecystitis, chotelithiasis, and removal of the gall bladder. The diaphragmatic block was central and responsible not only for inhibiting impulses from the vegetative core (solar plexus) so that pleasurable sensations never reached the periphery but also, by extending into the annular musculature of this area, resulted in signs and symptoms of the involved organs.   Duodenitis and Peptic Ulcer This condition results from the digestive action of acid gastric juice on the mucosal lining of the distal esophagus, stomach (usually lesser curvature), and upper portion of the duodenum. Duodenitis is a non-specific inflammation of the duodenum and represents an early phase of the acid attack on the gastric mucosa. It frequently progresses to peptic ulcer formation. The basic problem and pathophysiologic process is, therefore, peptic ulcer formation.   Etiology The reason for the failure of the mucosa to withstand acid attack in certain individuals prone to develop peptic ulcer (the predisposition to illness) is, in the vast majority of cases, not understood by classical medicine. Contrary to popular belief, there is no hard evidence that dietary factors cause, perpetuate, or aggravate this condition (5). Reich showed that chronic sympatheticotonia, with its tendency toward increased acid production in the stomach and spasm of the intestinal wall, is only the somatic aspect of peptic ulcer disease, while repressed hatred is its psychic counterpart. The basis for both the psychic and somatic component of this illness is a chronic energetic contraction of the diaphragmatic segment. This is the biophysical basis for what is commonly referred to as the predisposition to ulcer formation. With armoring of the diaphragmatic segment, the mucosal lining of the organs contained in this segment becomes contracted with a restriction of blood. Vasospasm leads to greater mucosal susceptibility to ulcer formation with the final sequellae of perforation and hemorrhage. Sympatheticotonia consists of a severe energetic contraction of the diaphragmatic segment. Chronic sympathetic excitation in this illness contains enormous quantities of repressed hatred. Only by expressing hatred from this segment can the "predisposition" for ulcer formation be eliminated.   Case Presentation This patient, a 23-year-old, single, white male, came to therapy stating he felt he could "get something out of therapy." Since childhood, he was bothered by a "queer sensation " in his penis and a feeling he was being bodily restrained. These feelings made him restless and he had an urge to squirm. He also felt "numb" in his body, and he knew he could never make up his mind about important issues in his life. Sexual relations with his girlfriend were not satisfying. Speaking in a flat and confused manner, he said he felt very little. At most he could only feel extremes of feeling. Usually he felt nothing. He was quick to anger and did not get along well with people, especially those in authority. When angered, he became sarcastic, argumentative, and challenging. This was followed by withdrawal. While at school, he destroyed property and was expelled. Past history revealed separation from his mother at birth. Prior to adoption at three months of age, he was cared for in a hospital. As a young adult, he took LSD and marijuana for over one year which resulted in paranoid reactions. He was drug-free for one year prior to presentation. Biophysical examination disclosed a mesomorphic, tense male who gave the appearance of an "angry young man." He glowered and stared menacingly as if ready to attack anyone who threatened him. His eyes were frightened and frozen. His occiput became tense especially when is anger intensified. His right eye was myopic. He looked out of the left but in a suspicious manner. He felt himself "holding back" in his right eye and "watching out" in the left. There was a severe throat block which came into play as soon as his anger threatened to erupt. During the first part of therapy, this anger originated primarily from the diaphragmatic segment. On the couch, he seemed ready to explode and barely able to maintain control over the enormous amounts of rage centered in the diaphragm. He seemed to be holding back against expressing this rage as if in one piece. The diagnosis was catatonic schizophrenia. In the first session, he told me he had to be a "good boy" and ingratiate himself otherwise "people will be hassled" and get back at him. He was clearly terrified underneath his "angry young man" facade. Al though his affect block was too strong for him to feel the emotion of rage, shouting itself did provide physical relief. Gradually, he began feeling the enormous anger as he shouted. He felt like belittling and challenging everyone in authority including me. He felt like smashing me for telling him what to do. He asked defiantly why I charged so much for therapy. At the same time, his anger was a source of his fear of others. Expressing this fear of being punished by me if he became too angry, he gave in to an uncontrollable outburst of rage with shouts and wild swings of his limbs. This was followed by a bout of anal fantasies and the expression of anal rage. His anger was expressed in the transference as defiance of me for expecting him to behave and feel in accordance with my wishes. Being relieved of his enormous rage, he found himself to his surprise becoming more sociable. This was followed by the emergence of soft feeling. He began crying and feeling vulnerable in my presence. This period of well-being was short-lived as his distrust of me and his confusion returned in full force. I returned to mobilization of the ocular segment and waited to see what would happen next. Gradually the throat block became the primary focus and he felt a painful spasm in the cervical musculature. Shouting produced strong trembling of his torso and gradually strong murderous impulses alternating with periods of contactlessness began to surface. Ocular mobilization cleared the latter and allowed expression of his hatred. This was accompanied by violent clonisms of the torso and a fear of losing control. His pupils dilated with fear. He felt like an angry child ready to have an explosive tantrum. Strong murderous rage then emerged from the diaphragm accompanied by uncontrollable hitting and kicking. These outbursts alternated with periods of intense holding back with arching of his torso. As the outburst of rage increased in intensity, the pelvic reflex began to break through again, alternating with strong pelvic retraction. Since his volatility, personality type, and the intensity of his rages were not unlike those seen in epilepsy, a neurological examination was requested. An EEG done with hyperventilation and photic stimulation was negative. With continuous intense outbursts of rage from the diaphragmatic segment, he developed persistent epigastric pain and distress. An upper G.I. series revealed pathological findings consistent with duodenitis and pylorospasm. Continued expression of hatred from the diaphragmatic segment (he shouted "murder," "kill") relieved the acute contraction of the diaphragmatic segment and the accompanying early manifestations of peptic ulcer disease. The appearance of the prodromal signs and symptoms of peptic ulcer disease in the patient was a direct consequence of both mobilizing enormous quantities of murderous hatred from the diaphragmatic segment and the intense reaction of holding back against it. (To be continued) Page    1  2  of this article.   REFERENCES 1. Reich, W.: "Orgonomic Functionalism, Part II," Orgone Energy Bulletin, 4(l):1-12, 1952. 2. Reich, W.: Character Analysis, New York: Orgone Institute Press, 1949. 3. Dew, R.: "The Somatic Biopathies," Journal of Orgonomy 2(2):155-170, 1968. 4. Schoenfield, L.: "Gallstones, "Clinical Symposia", CIBA-Geigy. 40 (2) 1988. 5. Friedman, G.: "Peptic Ulcer," Clinical Symposia, CIBA-Geigy. 40 (5), 1988. 6. Baker, E. F.: Personal Communications.