신체형 장애의 정신치료

이무석,Lee, Moo-Suk 한국정신신체의학회 1996 정신신체의학 Vol.4 No.2

A theroretical study was made on the psychodynamism of somatoform disorder. Somatoform disorder is caused by a defense mechanism of somatization. Somatization is the tendency to react to stimuli(drives, defenses, and conflict between them) physically rather than psychically(Moore, 1990). Ford(1983) said it is a way of life, and Dunbar(1954) said it is the shift of psychic energy toward expression in somatic symptoms. As used by Max Shur(1955), somatization links symptom formation to the regression that may occur in response to acute and chronic conflict. In the neurotic individual psychic conflict often provokes regressive phenomena that may include somatic manifestations characteristic of an earlier developmental phase. Schur calls this resomatization. Pain is the most common example of a somatization reaction to conflict. The pain has an unconscious significance derived from childhood experiences. It is used to win love, to punish misdeeds, as well as a means to amend. Among all pains, chest pain has a special meaning. Generally speaking, 'I have pain in my chest' is about the same as 'I have pain in my mind'. The chest represent the mind, and the mind reminds us about the heart. So we have a high tendency to recognize mental pain as cardiac pain. Kellner(1990) said rage and hostility, especially repressed hostility, are important factors in somatization. In 'Psychoanalytic Observation on Cardiac Pain', psychoanalyst Bacon(1953) presented clinical cases of patients who complained of cardiac pain in a psychoanalytic session that spread from the left side of their chests down their left arms. The pain was from rage and fear which came after their desire to be loved was frustrated by the analyet. She said desires related to cardiac pain were dependency needs and aggressions. Empatic relationship and therapeutic alliances are indispensable to psychotherapy in somatoform disorder. The beginning of therapy is to discover a precipitating event from the time their symptoms have started and to help the patient understand a relation between the symptom and precipitating event. Its remedial process is to find and interpret a intrapsychic conflict shown through the symptoms of the patient. Three cases of somatoform disorder patients treated based on this therapeutic method were introduced. The firt patient, Mr. H, had been suffering from hysterical aphasia with repressed rage as ie psychodynamic cause. An interpretation related to the precipitating event was given by written communication, and he recovered from his aphasia after 3 days of the session. The second patient was a dentist in a cardiac neurosis with agitation and hypochondriasis, whose psychodynamism was caused by a fear that he might lose his father's love. His symptom was also interpreted in relation to the precipitating event. It showed the patient a child-within afraid of losing his father's love. His condition improved after getting a didactic interpretation which told him, to be master of himself, The third patient was a lady transferred from the deparment of internal medicine. She had a frequent and violent fit of chest pains, whose psychodynamic cause was separation anxiety and a rage due to the frustration of dependency needs. Her symptom vanished dramatically when she wore a holler EKG monitor and did not occur during monitoring. By this experience she found her symptom was a psychogenic one, and a therapeutic alliance was formed. later in reguar psychotherapy sessions, she was told the relaton between symptoms and precipitating events. Through this she understood that her separation anxiety was connected to the symptom and she became less terrifide when it occurred. Now she can travel abroad and take well part in social activities. 신체형장애의 정신역동에 대하여 이론적 고찰을 하였다. 신체화(身體化)란 본능적 욕동을 방어하는 과정에서 생긴 갈등을 정신적으로 처리하지 못하고. 신체 증상으로 처리하는 것을 말한다(Moore 1990). Ford(1983)는 인생을 사는 방법 중의 하나라고 하였고, Dunbar(1954)는 정신 에너지가 신체증상으로 바뀌어진 것이라고 했다. Schur(1955)에 의하면, 신체화(身體化)는 갈등에 의해서 일어나는 하나의 퇴행현상이라고 한다. Schur는 이런 현상을 '재(再) 신체화(身體化)(resomatization)'라 했다. 갈등의 신체화(身體化) 반응중 가장 흔한 것이 통증(痛症)(pain)이다. 통증(痛症)은 어린시절의 경험에서 유래한 무의식적 의미를 가지고 있다. 통증(痛症)(pain)은 사랑 획득의 방법이며, 잘못한 행동에 대한 벌로 사용되기도 하고, 속죄(贖罪)의 수단이 되기도 한다. 통증(痛症)중에서도 흉통(胸痛)(chest pain)은 특별한 의미를 갖는다. 일반적으로 '가슴이 아프다'는 말은 '마음이 아프다'는 의미와 같이 쓰인다. 그리고 가슴은 마음을 상징하고 마음은 심장을 생각나게 하여 마음의 아픔을 심장의 통증(痛症)(pain)으로 인식하는 경향이 높다. Kellner(1990)는 적개심과 분노, 특히 억압된 적개심이 신체화(身體化)의 중요한 인자라고 하였다. 정신분석가인 Bacon(1953)dms '심장동통(心臟疼痛)에 대한 정신분석적 관찰'에서 정신분석 시간에 사랑받고 싶은 욕구가 좌절된 환자가 이로 인한 분노와 두려움 때문에 왼편 가슴에서 왼쪽 팔로 뻗쳐 내려가는 심장동통을 호소하는 증례(症例)들을 발표했다. 그녀는 심장동통과 관계된 욕구들이 의존욕구와 공격욕구라고 하였다. 신체형장애의 정신치료에서는 공감적인 관계와 치료적 동맹이 필수적이며, 증상시작의 시점을 중심으로 유발인자를 가려내고 증상과 유발인자의 관계를 이해하도록 돕는 것이 출발이다. 증상을 통하여 표현되고 있는 환자의 심리내적인 갈등을 발견하여 해석해 주는 것이 치료의 과정이다. 이런 기법을 기초로 치료한 세 사람의 신체형장애 증례를 소개하였다. 첫 번째 소개한 히스테리성 실어증을 가진 H군은 억압된 분노가 역동적인 원인이었다. 유발인자와 관련지어 해석을 해주었고, 이차이득을 얻은 후에 회복되었다. 두 번째 소개한 심장노이로제에 빠진 치과의사의 경우는 아버지의 사랑을 잃을 것에 대한 불안이 역동적 원인이었다. 유발인자와 관련지어 증상을 해석하였고, 아버지의 사랑을 잃을까봐 두려워하는 마음속의 아이를 보여주었고, 이제는 어른이 되었으니 자신의 주인이 되어 살라고 교육적인 해석을 듣고 호전되었다. 세 번째 부인은 심한 흉통발작으로 내과에서 의뢰되어 왔는데 의존욕구의 좌절과 이로 인한 분노, 그리고 분리 불안이 역동적 원인이었다. 이 부인은 holter monitor를 메자 증상이 극적으로 사라졌는데 이것을 계기로 자신의 중상이 심인성이라는 것을 알고부터 치료동맹이 이루어졌고, 그 후 정기적인 정신치료 시간에는 증상과 유발인자들 사이의 관계를 해석해 주었다. 이를 통하여 분리불안이 증상과 관계되어 있다는 것을 이해하고 환자는 증상이 일어나도 덜 두려워하게 되었고, 해외여행이나 사회적인 활동이 가능해졌다.

흉통(胸痛)의 정신분석적(精神分析的) 고찰(考察) -두사람의 증례(症例)를 중심으로-

이무석,Lee, Moo-Suk 한국정신신체의학회 1995 정신신체의학 Vol.3 No.1

This study presents the cases of two patients suffering from chest pain as the chief complaint and refers to related literatures to reveal the psychoanalytic meaning of chest pain. In the first case, the patient who was balked of the desire to be loved complained of her pain in the chest She had been bereaved of her husband and felt deserted by someone on whom she depended, and these experiences caused the chest pain. The drive related to this chest pain in a dependent and aggressive one. The second case, the chest pain of a 28-year-old unmarried woman, resulted from Oedipal conflict Her Oedipal conflict did not resolve successfully for the exessive sexual stimulation in her childhood such as her experiences of witnessing the primal scenes sleeping with her parents in the same room, even under a same blanket In addition, there were some other traumas which prevented her from that conflict: Her father bathed her until her puberty: She saw her father's back view as he urinated in a jerry: She heard her parents' frequent quarrels. This patient felt guilty about desire of Oedipal incest, and chest pain seemed to occur as a kind of self-inflicted punishment.

비만의 정신분석적 고찰

이무석,Lee, Moo-Suk 한국정신신체의학회 1995 정신신체의학 Vol.3 No.2

비만환자들의 정신역동과 정신분석치료의 기법을 문헌 고찰하였다. 비만의 원인은 구강기 고착과 충동조절을 못하는, 자아와 초자아의 결함에 있었다. 비만환자들은 사랑의 상실에 의한 고통을 해결하는 방법으로 음식을 사용한다. 먹음으로 자신을 달래주고(self-soothing), 대리만족을 취한다. 부모의 양육태도가 문제인데, 비만아의 부모는 아이를 통하여 자신의 욕망을 이루려는 분들이어서 지배적이고 음식을 강요하며 어린이의 성취에 대한 기재가 높다. 어린이에게 따뜻한 보살핌이 필요할 때에도 부모의 목표가 더 우선되기 때문에 어린이는 늘 욕구불만에 빠지게 된다. 가정에서 어린이에게 사랑이 필요할 때마다 사랑 대신에 음식을 먹이는 부모였다. 그래서 성장후에 사회적 좌절을 당하면 음식에서 위로를 받고, 음식을 씹음으로 공격욕구도 발산한다(Stunkard, 1985). 또한 비만환자의 부모는 정상적인 부모역할을 전반적으로 소홀히 하는 편이었다. 절제를 가르치지 못하는 부모였다. 그것은 부모 자신의 초자아에 문제가 있어서 요구할 것을 요구하지 못하기 때문이기도 했고, 특별히 어떤 자식을 유난히 무관심 속에 방치해 두어서 비만을 만들기도 한다(Wilson, 1992). 이처럼 비만환자들은 전에디푸스기에 병의 원인(preoedipal pathology)을 가지고 있기 때문에 이런 갈등을 가지고 있는 환자들을 치료할 때는 언제나 그렇듯이 분석가는 좀더 적극적인 해석을 해주어야 한다. 또한 전이대상만으로는 안되고, 이에 추가하여 아이를 잘 키우는 새로운 대상(new and different object)이 되어 줘야한다(Wilson 1989). 비만환자들의 거구를 대하면서 치료자들은 위축되는 역전이에 빠질 수가 있다는 것도 염두에 두어야 한다. Author reviewed psychodynamics and psychoanalytic treatment of obesity. A variety of psychodynamics and unconscious conflicts have been described in obese patients : eating as a defense against depression, eating as a substitute for maternal love, obese body as a larger penis, and eating as a self-soothing. There was a gross neglect of certain normal parenting roles in obese family. The parenatal superego structure was not as perfectionistic. As with children and other patients with preoedipal pathology, in obese patients the analyst in addition to being transference object is a new and different object who promote healthy maturation. Because of obese parients, in there projective identification, can provoke intense countertransference, the analyst have to consider it. On the other hand, many analysts' countertransferences to superobese patients is that huge person recalls one's own childhood relationship with adults and bring forth a feeling of helplessness.

Gamma 보정을 위한 Digital Gamma Controller

이무석(Moo-Suk Lee),한재덕(Jaeduk Han) 대한전자공학회 2021 대한전자공학회 학술대회 Vol.2021 No.6

공황장애 환자의 스트레스 대처방식과 신체 증상 지각에 대한 인지적 특성

정해원,이무석,박우영,양종철,임은성,박태원,정영철,정상근,황익근,Jung, Hae-Won,Lee, Moo-Suk,Park, Woo-Young,Yang, Jong-Chul,Lim, Eun-Sung,Park, Tae-Won,Chung, Yong-Chul,Chung, Sang-Keun,Hwang, Ik-Keun 대한불안의학회 2007 대한불안의학회지 Vol.3 No.2

Objective : The purpose of this study was to investigate the strategies used to cope with stress and the cognitive characteristics of somatic symptom perception in patients with panic disorder. Methods : A total of 101 patients who met the DSM-IV criteria for panic disorder and 60 normal controls were recruited for participation in this study. We evaluated the subjects using The Way of Stress Coping Questionnaire (SCQ), Somato-Sensory Amplification Scale (SSAS), Symptom Interpretation Questionnaire (SIQ), and the Panic Disorder Severity Scale (PDSS). We analyzed the data using an independent t-test and Pearson correlation analysis (p<0.05). Results : The patients who used emotionally focused coping strategies scored significantly lower on the SCQ. The patients with panic disorder showed greater amplification of body sensations in the SSAS, a significantly higher score on the physical interpretation subset of the SIQ, and a lower score on the environmental interpretation subset of the SIQ than the normal controls. The PDSS scores were positively correlated with the SSAS score and physical interpretation score on the SIQ. Conclusion : These results show that patients with panic disorder have poor emotionally focused strategies for coping with stress, greater amplification of body sensations, and a tendency towards a physical interpretation of somatic symptoms.

쌍꺼풀성형술을 원하는 여성의 자아주체성

최영,이미숙,이무석,Choi, Young,Lee, Mi-Suk,Lee, Moo-Suk 한국정신신체의학회 1994 정신신체의학 Vol.2 No.1

Objective : Cosmetic surgery, as a psychosocial intervention, is unique in that its foundation rests solely on the individual motivations, internal or external, of the patient We investigated the ego-identity in women who seek double eyelid operation, to understand one aspect of internal motivation for cosmetic surgery. Methods : Subjects of this study were 47 young women, visited to plastic surgery clinics in Kwangju from June 1993 to October 1993, and 58 women who did not want double eyelid operation were chosen as controls. Each subject's ego-identity was scored using Dignan's ego-identity scale. Results : The total and stability subscale's scores of ego-identity of double eyelid operation group were significantly lower than those of control group. Conclusion : More psychosocial research on the ego-identify of patients seeking double eyelid operation is required to understand the psychological motives for requesting surgery.

콜라겐 젤과 성장인자 전처치 및 피복재료가 다공성안와삽입물의 섬유혈관증식에 미치는 효과

이준영,김석영,유창국,이무석,이상렬,오중협,김성주.Joon-Young Lee. M.D.. Suk-Young Kim. Ph.D.. Chang-Kook You. Moo-Seok Lee. Sang-Yeul Lee. M.D.. Ph.D.. Jung-Hyub Oh M.D.. Ph.D.. Sung-Joo Kim M.D.. Ph.D. 대한안과학회 2005 대한안과학회지 Vol.46 No.6

Purpose: To determine the effect of bFGF complexed collagen gel, which allows constant release of bFGF along with biodegradation of the collagen gel. The specific study purpose was to determine whether it can accelerate the fibrovascular ingrowth into wrapped HA-coated porous alumina and to verify the safety of new wrapping materials. Synthetic polyester-urethane (Neuropatch?) and lyophilized bovine pericardium (Lyoplant?) were compared to donor sclera for the fibrovascular ingrowth into HA-coated porous alumina. Methods: The experimental and control groups, each consisting of 9 rabbits were wrapped with each wrapping materials (3 rabbits per wrapping material). The experimental group underwent pretreatment of bFGF-collagen gel while the control group did not. The fibrovascular ingrowth was compared at 2 and 4 weeks after implantation. Western blot analysis was conducted at 4 weeks using antibodies against CD141 and laminin. The rate of fibrovascular ingrowth was fastest in orbital implant wrapped with Lyoplant?. Results: Histopathologic examinations at 2 weeks showed no differences in distance and percentage area of fibrovascular ingrowth. Histopathologic examinations at 4 weeks showed that pretreatment of bFGF-collagen gel increased the fibrovascular ingrowth in the experimental group. Western blot analysis on experimental group also showed that the expressions of CD141 and laminin were increased by bFGF-collagen gel, thereby indicating that the fibrovascular proliferations were accelerated by bFGF released from the complex. Conclusions: bFGF-collagen gel increased the rate and degree of fibrovascular growth into hydroxyapatite- coated porous alumina by releasing bFGF as the collagen gel biodegraded. Both Lyoplant? and Neuropatch? were evaluated as safe for substitution of the donor sclera.

엑시머 레이저 근시교정술후 PJ RGP 렌즈로 성공적인 시력교정을 한 2예

박경진(Kyung Jin Pak),이무석(Moo Suk Lee),주천기(Choun Ku Joo) 대한안과학회 1998 대한안과학회지 Vol.39 No.9

기억부하가 얼굴과 공간 작업기억의 유지에 미치는 효과 : 사건유관 fMRI 연구

김정희(Junghee Kim),정광우(Jeong Gwang-Woo),강형근(Heoung-KeunKang),이무석(Moo-Suk Lee),박태진(Taejin Park) 한국인지과학회 2010 인지과학 Vol.21 No.2

본 연구는 공간작업기억과 비공간작업기억의 유지 처리에 대한 영역특수모형과 처리특수모형을 검증하고자 수행한 사건유관 fMRI 연구이다. 지연반응과제에서 얼굴자극을 표적자극으로 사용하고 표적자극의 수를 달리하여 기억부하를 조작하였으며 일정한 지연기간 후 위치 및 얼굴 재인판단을 요구하였는데, 지연 동안 정보유형(위치와 얼굴)이 기억부하효과의 신경상관물에 미치는 영향을 뇌영상 처리로 분석하였다. 독립변인은 정보유형(자극영역)과 기억부하(표적자극의 수)로서, 정보유형변인은 얼굴작업기억(비공간작업기억) 및 공간작업기억의 두 수준, 기억부하변인은 표적자극이 1개인 조건(저부하)과 3개인 조건(고부하)이었다. 행동수행 분석 결과, 재인정확도에 있어 얼굴작업기억과 공간작업기억 간에는 차이가 없었으며 두 작업기억 모두에서 동등한 정도의 기억부하효과가 확인되었다. 뇌 영상분석 결과, 유지단계에서 전전두피질의 하측 및 중/상측영역이 모두 얼굴작업기억과 공간작업기억 양자와 관련되고 특히 VLPFC가 두 작업기억에 공통적으로 관련된다는 것이 밝혀졌는데, 이러한 결과는 처리성분에 따른 전전두피질의 기능적 전문화를 주장하는 처리특수모형에 더 잘 부합된다. In order to evaluate the domain-specific model and process-specific model of spatial and nonspatial working memory (WM), this study manipulated the memory load of the delayed response task and examined how the neural correlates of memory load effect was influenced by the stimulus domain (face and location) at the maintenance stage of WM using an event-related fMRI experiment. One or three face stimuli were presented as target stimuli and participants were asked to maintain the face itself (face WM) or the location of face stimuli (spatial WM). The results of recognition judgment accuracy showed no difference between face WM and spatial WM, and showed equivalent memory load effects of both WM. As a result of brian image analysis, memory load effect at maintenance stage showed that inferior, middle, and superior PFC were recruited by both face WM and spatial WM, and showed that VLPFC was the commonly activated area by both WM, supporting functional specialization of PFC by process components of WM. This study provides evidence for process-specific model in which maintenance of WM is associated with VLPFC.

지역갈등의 요인으로서 성격특성에 관한 연구

오수성(Oh Soo Sung),고형일(Koh Hyung Il),이무석(Lee Moo Suk) 성곡언론문화재단 1990 성곡논총 Vol.21 No.-