THE EMOTIONAL PROBLEMS OF HIGH BLOOD PRESSURE

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Abstract
The organic tradition in medicine has been responsible for a narrow (physical) view of the etiology, pathogenesis, and treatment of essential hypertension. The psychosomatic approach recognizes the physical problems, but considers also the role of emotions. It emphasizes the multiple factors in etiology, pathogenesis, and treatment, and attempts to evaluate the resulting composite clinical picture. Such studies of 150 unselected patients with essential hypertension encountered in the out-patient department indicate that symptoms of hypertension usually arise in a social setting of emotional stress. Hence, one must always question their relation to the high blood pressure itself, and attempt to understand them from the viewpoint of behavior. With the discovery of hypertension "blood pressure phobia" begins and often dominates the clinical picture; new symptoms are only an exaggeration of the premorbid personality trends. These symptoms respond readily to psychotherapy, but we have no evidence that the course of hypertensive vascular disease can be influenced by psychotherapy no matter how intensive or prolonged. Therefore, while hypertension itself is not an indication for psychotherapy, emotional problems in association with hypertension are; and because they are so common, psychotherapy is indicated in the great majority of patients with hypertension. There is no reason why psychotherapy cannot be combined with medical and surgical treatment. Hypertension occurs in personalities from normal to psychotic, but there is a great preponderance of neurotic personalities with strong compulsive trends. No specific personality conflicts nor specific personality structures were discovered that seem related to the hypertension. Repressed hostility is not peculiar to hypertension, as opposed to other psychosomatic disorders. Observations indicate that hypertensive predisposition and the personality fault are parallel disturbances, the one inherited and exhibited in the somatic sphere, the other manifesting itself in the emotional life. When the life situation becomes sufficiently disturbing for the particular personality, hypertension may appear as one aspect of the personality decompensation. Having appeared, it usually pursues an irrevocable course. Failure to deal adequately with hypertension stems largely from concern about "bringing the blood pressure down," and from failure to recognize the emotional origin of most of the symptoms attributed to the high blood pressure.

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