[Psychodynamic factors in disk irritations].

The patients here concerned had a faulty psychical development. During the caracter-building period of early childhood they were unable, to assert themselves sufficiently enough to be accepted, or to feel that they are loved. Therefore they tried by means of overcompensatory efforts in the sense of extreme adjustment to others, to make up for this lack. Increasingly confined, as a preponderant attitude they finally developed a forced "assistant" pose (W. Schwidder). Under these circumstances the personality of the patients could not develop sufficiently in the way, that they were able to make free decisions by maintaining legitimate interests of selfassertion. As a rule, they did not experience their own subconscious, arbitrary strong protest against their overwhelming neurotic obligations, especially as their "backbone" did not make possible the establishment of any suitable or sufficient representation of their own desires or needs corresponding to the largely obsessional structure of most patients. The vicious circle, leading to the loss of inner balance makes understandable the determinant preponderance of self defense against complete exhaustion of strength. Therefore the necessary relaxation cannot be acquired and at the same time the fixation of the bodily ailments becomes unavoidable. In comparison with the study of Reischauer, with regard to our patients there cannot be established any special imperilled type; by these patients, however, a specific failure in trying to master their lives becomes a probability. By reason of our experiences, even though they are limited and still to be tested in other ways, conservative measures, which stimulate the activeness of the patients are to be preferred. If one interrupts that sort of pliant texture operatively-unless their is an urgent indication-unprofitable results must be expected, which correspond to orthopedic experiences. In the case of chronic manifestations and unusually deep fixation of the syndroms in the psychical area, no real improvement is obtained by psychoanalytic measures. Also, if one should succeed in transferring the patients in the acute state to a mental therapist in spite of the rapid reduction of their somatic pain complex, the prognosis for the more functionally concerned ones would then be burdened cosiderably by the long period of difficult differentiation against the largely somatic progression of the discs.