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dc.contributor.authorJones, Maxwellen
dc.date.accessioned2019-02-15T14:31:30Z
dc.date.available2019-02-15T14:31:30Z
dc.date.issued1947
dc.identifier.urihttp://hdl.handle.net/1842/34811
dc.description.abstracten
dc.description.abstractThis thesis is concerned mainly with a study of some of the physiological functions of neurotic cases with effort intolerance. It is convenient, for research purposes to retain the use of the term 'effort syndrome' (E.S.) to indicate cases with effort intolerance as distinct from other types of neuroses --- the alternative would have been to use the psychiatric diagnosis and add 'with effort intolerance' in brackets. The term, effort syndrome, as used here, refers to a relatively excessive response to effort as manifested by breathlessness, palpitation, and subjective feeling of fatigue on even mild exercise, along with excessive vegetative liability on emotional excitement, e.g.; sweating, palpitation, giddiness, etc., as described by the patient or objectively observed. If there is a known organic cause, then that diagnosis is, of course, used in preference to the term effort syndrome. "Syndrome" is a descriptive term generally used to avoid premature aetiological conception; there is apparently no common aetiology to E.S.; and as a descriptive term is generally favoured, the American preference for the term "neurocirculatory asthenia" seems reasonable. In the majority of patients seen here, constitutional (including personality) factors would appear to be more important than psychogenic factors; thus when a breakdown occurs there may be no pronounced affective disorder, and no adequate psychopathology to explain the illness. From this it follows that existing psychiatric classifications, based on aetiological or descriptive grounds, would be difficult to apply. It therefore seems reasonable to use a classification which takes into account constitution and personality more fully than do existing classifications. One can divide the E.S. material into three broad. groups (1) Where the poor physical endowment is the primary factor in producing symptoms. Here we are siupiy dealing with a poor machine, which shows excessive response to physical effort. Here the patient has effort intolerance which has been present since earliest recollection. (2) As above, but the patient responds in a neurotic manner to his constitutional inferiority. in this sense there is a psychological aetiology, but the constitutional factor is the basic one. The emotional reaction may take any ;form, depending on the personality and may simply amount to displeasure. Here the patient feels that he has an effort intolerance, but his disability may actually be less than he believes it to be. Such patients usually give a history of effort intolerance since childhood, but the mere disability of Group 1 frequently changes under . stress to the neurotic attitude of Group 2. (3) Primarily neurotic sere the usual aetiological factors determining/a neurosis will apply. The form may be determined by the constitutional physical inferiority which, if present, colours the whole picture, but is of only secondary importance; or it may be wholly psychogenically determined. Such "illness" tends in our experience to be of comparatively recent origin, and is particularly prone to result from the emotional and physical stresses of wartime. By neurosis is meant an upset of the normal harmonious functioning of the mind and body resulting from some personal inadequacy to meet a psychological situation or problem. Poor general health, weak physical constitution, low intelligence, etc., may predispose to such a neurosis, but these are in themselves not enough; the individual has failed to meet the demands of his environment or of his conscience, and a conflict has been set up. Thus, the Group 1 E.S. has the, symptomatology of the other two groups, but his physical limitation has been satisfactorily met and presents no handicap, so he has no neurosis. The opposite is true of Group 2 E.S. This division into 3 groups of E.S. proved convenient, but unfortunately only an occasional group 1 E.S. was seen (from the definition it is clear that they would only be discovered when examining a large random sample of controls because they do not regard themselves as ill, and therefore would not report sick), and no detailed study of this group has been possible.en
dc.publisherThe University of Edinburghen
dc.relation.ispartofAnnexe Thesis Digitisation Project 2019 Block 22en
dc.relation.isreferencedbyen
dc.titlePhysiological and psychological responses to stress in neurotic patientsen
dc.typeThesis or Dissertationen
dc.type.qualificationlevelDoctoralen
dc.type.qualificationnameMD Doctor of Medicineen


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