Disability, psychosomatic disease, and psychoneurosis. The problem of differential vulnerability.

A pattern of cognitive and of affective development characterizing three classes of psychiatric patients is presented: (1) disabled persons, usually unskilled laborers showing a 'somatization reaction', are unable to form abstract categories and, as well, to describe the physiological correlates of 'inner' feelings; (2) psychosomatic patients may show highly developed cognitive skills, although they may not; but they uniformly show a similar inability to 'know' and describe inner feelings; (3) 'neurotic' patients, most dramatically in the phobic category, often show both well-developed cognitive skills and a high degree of sensitivity to, and ability to describe, the symptom complex of anxiety in physiologically relevant forms, with maintenance of meaningful relations with supportive (often 'overprotectively' supportive) family members. These three different states can be diagrammed as follows: (1) -, -; (2) +/-, -; (3) +, +. The suggestion appears that these differences have to do with vulnerability, and that there may be in the general population three separable populations at risk for the development of these three categories of psychiatric disorder. The vulnerability so identified seems to be inversely proportional to 'suitability for interpretative psychotherapy'.