title: Silence as resistance to medical intervention.
abstract: A group of 47 individuals initially silent about their physical symptoms and/or dysfunction were studied after they finally had come to medical attention. They were then interviewed, using the associative anamnesis technique, to evaluate the psychologic aspects of their silence. It was found to be a key element in the defensive complex directed against intense neurotic feelings activated by the patient's current physical condition. The tendency toward silence appeared to have been reinforced by emotionally traumatic experiences involving physical illness or injuries in early life. Also found associated with silence were such different factors as a series of ostrich-like denying rationalizations, a fanatic commitment to cultist beliefs, a conviction that emotional conflict is the primary cause of organic illness, and motivations linked to retention of power in reality situations. Clinical examples drawn from these categories are given. Means of increasing the awareness that such silence exists and methods of dealing with it are discussed.
mesh_terms: D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000523:psychology; D003674:Defense Mechanisms; D003717:Denial, Psychological; D004194:Disease / Q000523:psychology*; D004381:Duodenal Ulcer / Q000523:psychology; D005260:Female; D006167:Guilt; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011127:Polyps / Q000523:psychology; D012068:Religion and Medicine; D012891:Sleep Apnea Syndromes / Q000523:psychology; D014062:Tongue Neoplasms / Q000523:psychology; D014594:Uterine Neoplasms / Q000523:psychology