[Psychosomatic aspects of treated testicular neoplasm patients]

We examined 26 patients who were semicastrated, lymphadenectomied and cytostatic treated because of a maligne testicular tumor to find out the secondary psychic manifestation of this organic illness. Somatic caused consequences of operation were a unilateral loss of testis and a loss of ejaculation and therefore a generative impotency. We found no evidence for a primary psychic influence on the origin of tumor illness. We could subdivide the secondary psychic manifestation in two stages: 1. The psychodynamik at the time of diagnostic and operation, 2. the specific personal mechanism of conflictmanagement in the following time, the phase of rehabilitation. In the first stage we subdivided three different states during the acute crisis with regard to regression, to mobilisation of infantil drives and to defence: 1. Disavowal, 2. Helplessness, 3. Fight. We discussed the psychodynamic and the attachment of these affective states to the psychology of neurosis. In the second stage of the secondary psychic manifestation we could find different more or less durable strategies of conflictmanagement: So called normal conflictmanagement, conflictmanagement by disavowal, by different mechanism of compensation as oral symbiotic dependences, narcissistic increasing of potency, intensified productivity, forming of religious ideal and by secondary hypochondric processes. The sexual disorders which we could state in about 1/3 of the patients existed mostly in an avoid of sexual partnership because of anxiety concerning narcissistic grief and injury of selfesteem. In older patients with special liability to crisis we found also an erective impotency. All patients with sexual disorders showed also psychoneurotic and psychosocial disorders. We discussed the results with regard to forming of hypothesis in psychosomatics, to personal and interpersonal conflictmanagement and to supportive psychotherapeutic possibilities.