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June 28, 1965


JAMA. 1965;192(13):1157-1158. doi:10.1001/jama.1965.03080260045016

Psychological distress, as well as severe physical stress, may be associated with increased adrenal steroid excretion. However, the relation between the degree of distress and the height of the steroid response is not simple. For example, some subgroups of clinically depressed patients have urinary 17-hydroxycorticosteroid (17-OHCS) levels as high as five times normal, whereas others, who appear equally depressed, may have normal levels. A number of severely depressed patients with normal levels show an intense denial of their illness,1 which has led to investigation of the hypothesis that urinary steroids reflect changes in psychological defense mechanisms. Inasmuch as the concept of defense mechanism is essential to the understanding of many psychological processes, a biochemical tool which would allow the development of a new perspective concerning defense mechanisms and psychological processes would have great theoretical and practical value.

Two communications in the June issue of the Archives of Psychiatry suggest