I had a bad night, I can’t write well or look up much so I’ll have to rely on rough notes, but Engel was a psychosomatic ideologists to his core and he followed (and taught) the classical, typical beliefs from the American psychosomatic movement. First and foremost that physical illness was the result of psychological processes (in his case particularly patriarchally/conservatively flavoured), but also e.g. what basically boils down to the doctrine of signatures for bodies (conversion of emotions to matching physical symptoms, e.g he taught that people become blind because they do not want someone else to see something, or get pain in a body part because that is where they unconsciously wanted to hit someone else – “Character structure also figures importantly in determining the form that an illness may take.”), the inferior role of pathogens and physical processes as driver of ill health, and antagonism towards medicine as “the biomedical approach” that is regarded inferior and limited compared to their superior and more insightful psychosomatic one.
Engel believed for example that “the tubercle bacillus is a necessary but not sufficient condition for tuberculosis”, and that “the immediate effects of the viable tubercle bacillus account for only a few, not all the clinical manifestations of tuberculosis.” His elaboration on it is very underwhelming, he’s clearly trying to make it fit his preference that pathogens are not the ultimate cause of illness presentation
[1], that there must be personal factors involved, in accordance with his psychosomatic and health supremacy views - his ableist personal preference where psychological factors and behaviour are the decisive factor in getting ill .
According to Engel (in 1967, when discussing how to incorporate the psychosomatic approach into medical education): “the role of mind and brain in the regulation of somatic processes and organismal adjustment will prove to be the most important basic discipline to emerge in the second half of the 20th century.” [edited as I first used a slightly different worded 1968 quote by a UK admirer]
A piece from my (still very crude!) draft notes on how illness developed according to Engel:
<<Under the header "patterns of response to psychological stress as factors in determining the manifestations of illness.”, he uses an arsenal of mental gymnastics to make his basically disableist health supremacy notion fit. According to his views, certain people just can’t handle anger, shame, guilt, helplessness & hopelessness like other people can, which, he theorizes, leads to physical changes. Then, in an effort to make the unpleasantness go away, it leads to behaviour exemplary of neuroses (hysteria, hypochondria), perversions (homosexuality, transgenderism, oral and anal sex, frigidity, etc, especially anything that deviated from the patriarchal view of only heterosexual penetrating sex being “normal”) and character disorders. This then “may directly or indirectly expose or predispose the person to other varieties of environmental stress, such as injury, poisons, drugs, dietary deficiency, etc., with all the consequences already mentioned. In other words, the inadequacies or inappropriateness of the person's attempt to deal with this intrapsychic distress may include behaviour which does not properly evaluate or avoid the stresses of the external environment or renders the person incapable to do so.”
So, in your effort and inferior ability to deal with emotions you found unpleasant, you gave into being gay, having oral sex, or being a sick woman etc -the
behaviour patriarchal and conservative societies don’t like - or are having a character defect, and these things would then theoretically lead to more risk of exposure to “environmental stress” (injury, poisons, drugs, dietary deficiency etc.), leading to móre hypothesised and undetermined physical changes and “unwanted/inappropriate/deviant behaviour”
And then, “in susceptible individuals”, Engel knits on in his little knitwork of mays, “the biochemical and physiological concomitants of sustained or intense effects may ….directly or indirectly put an already defective system under strain. (e.g., the effect of anxiety or rage on a damaged heart) or accelerate, precipitate, enhance or uncover preexisting, sometimes latent, pathological processes at a biochemical organ or system level (e.g., an infection, neoplasia, diabetes, peptic ulceration, etc.).”
According to Engel’s pet theory, you’re either sick because your (perverted, neurotic) behaviour and emotions in an unspecified way exacerbate physical problems, or because those same things (your defective-deemed “behaviour” and your inferiority to other people in how to handle unpleasant feelings without them causing non-defined physical changes) somehow bippedy bopped boop-cycled you into being more vulnerable to infections, tumor growth, diabetes, ulcers and the whole range of etcetera’s one is willing to apply it to.
This is historically interesting as an example of psychosomatic fantasy-knitting or of how psychiatry is used to spin and push discriminating and harmful narratives about people who do not “behave” according to the wishes of conservative ideology and patriarchy, but it has zero value as a scientific and substantiated distribution of facts, reality and knowledge.>>
He had bizarre views on homosexuality and girls and young women (Heavily based on Freud. Including (and especially) boys-want-to-shag-their-mum, girls-their-dad stuff. And it might just be the Freudian enthusiasm, but when reading I found Engel’s elaborate description of, and obsession with, the supposed sexuality of children not only bad in content but at times even downright creepy.) He confidently taught that “the vagina must eventually replace the clitoris as the primary erotogenic zone”, that when girls discover the anatomical difference between them and males “the first impulse is to want to repudiate the difference and to attempt a masculine identification”, and that “the fantasy of having been deprived of a penis (i.e. castrated) by the mother may occur” which “may engender antagonism toward or fear of the mother” (This was the point where I exclaimed to my partner, “Jeez, has this dude actually ever talked to women, or even
met one?” He speaks of them like the Vegetable Lamb of Tartary.)
And I’m just scratching the surface here. An absolutely inappropriate source for medical views.
[1] I have come across this same view in eugenic writing of the 1920s, where it was insinuated that the tuberculosis bacteria was not the sole cause of tuberculosis and the physicians with their bug theory where smirked at as missing the obvious psychiatric influence. Similar in the writings of the psychosomatic movement of the 20’s, 30’s and 1940’s, just before treatment became available.
