The Funkenstein Test of Autonomic Function J.
THURLOW '61
INI'RODUCI'ION AI; might be expected in any relatively new field of investigation, the area of
psychosomatic medicine suffers from a lack of basic research . . . from a scarcity of general established relationships between emotional reactivity and physiology. The investigations of Daniel Funkenstein and his co-workers at Harvard Medical School offer one such relationship. This paper is intended neither as a critical review of the literature nor as an evaluation of this research, but rather as a general' explanation of the Funkenstein test and some of its implications.
BIOLOGICAL CONSIDERATIONS The role of the autonomic nervous system (A.N .S.) is an important one in the genesis of psychosomatic disorders; in fact, some psychiatrists would restrict the use of the term "psychosomatic" to disorders mediated largely by the A.N.S. (e.g. essential hypertension, migraine, etc.). In this sense "psychosomatic" would not include the hysterical disorders functioning through the central nervous system, as described by Freud, or the "diseases of adaption" mediated through the pituitaryadrenal axis, as described by Selye. It is the role of the autonomic system, and the sympathetic division in particular, that is to be considered here. In contrast to the sympathetic autonomic system, the parasympathetic division has long been considered as an executor of "repose and repair", replenishing rather than expending body energy, with particular emphasis on the intake and absorbtion of food through the gastro-intestinal tract. With its anabolic type of function, and lack of preparation for external action, the parasympathetic system at a physiological level is somewhat analagous to "passivedependency" at a psychological level. The sympathetic division, on the other hand, comes into increased activity in situations demanding either attack or active flight. Cannon originally conceived of the NOVEMBER,
1960
sympathetic system as an executor of both fight and flight, with little distinction between these two reactions as far as autonomic reactivity is concerned. In keeping with the discovery by Tuller and Thinter in 1948 of two sympathetic mediators, adrenalin and noradrenalin, these two functions have become separated in current thinking. Some reactions call forth a predominantly adrenalin response, whereas different reactions call forth a predominantly noradrenalin reaction. The differential actions of these two hormones on the maintenance of blood pressure is of some interest in this regard. Noradrenalin has a relatively specific action, namely peripheral arteriolar vasoconstriction. Adrenalin, on the other hand, shows widespread effects on the body, only one of which is a direct action on the heaJ:\t producing increased cardiac output. Thus noradrenalin increases blood pressure by increasing the total peripheral resistance, whereas adrenalin accomplishes the same effect by increasing cardiac output. The adrenal medulla is capable of secreting both substances, each apparently controlled by a different area of the posterior hypothalamus.
PSYCHOLOGICAL CONSIDERATIONS In contrast to Freud's early emphasis on sexual or erotic feelings as determinants
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