Summary
The introduction section first offers the chief reasons for the application of psychosomatic reasoning in medicine in general and orthopedics specifically (the intertwining of the somatic and the psychological, recognized in the dynamics of occurrence of somatic disease, i. e., injury, in the physician-patient relationship as well as in subjective phenomena accompanying physical illness and hospitalization). There follows an explanation of the role of stress, i. e., neuropsychological, behavioral and other aspects of organic response to physical injury as stress. Within three dominant theoretical approaches in psychology and psychotherapy - psychoanalysis in a narrow sense, theory of objective relationships and theory of learning - the relation between the orthopedic diseases, especially injuries, and a series of psychological factors in terms of personality development and characteristics of the injured and the circumstances of physical traumatization is explained. Insisting on the neglected psychotherapeutic attitude toward the injured in the clinical work, positive experiences resulting from such an attitude in the treatment of physically injured persons are presented.

The next, key section of the book presents the research objectives first. Then, it presents the sample consisting of 70 patients hospitalized because of severe physical injury at the University of Belgrade Orthopedics Clinic (26 fighters from Bosnia and Herzegovina and 44 Belgrade residents injured at their work, during leisure or in traffic accidents), who were the experimental group. The control group contained 105 subjects, 45 of whom had mental trauma experience and 60 had no trauma experience whatsoever.
The subjects were tested with the following instruments: Event Effect Scale, PTSS-10 Scale, Family Homogeneity Index (FHI), Brief Eysenck's Personality Inventory, Late Effects of Accidents Investigation Questionnaire (LEAIQ), General Health Questionnaire (GHQ-60), General Questionnaire for Accidents, and two instruments involving the subjects' history and way of responding to the accident effects. In the statistical data processing, Analysis of Variance (ANOVA), Pearson's chi-square test, discrimination analysis, and calculation of linear correlation were used.
As to the psychopathological characteristics of the physically injured, it was established that respondents over 30 years of age as well as married respondents responded considerably more frequently with cognitive neurotic symptoms (impaired memory and weak concentration). Unmarried respondents more often responded with PTSD symptoms while single people after physical trauma responded more neurotically according to Eysenck's personality inventory.
The highest degree of family cohesion was recorded in the group of the somatically traumatized in wartime. The persons with lower education degree responded with conversion neurotic disorders significantly more frequently.
The highest degree of neuroticism and proneness to PTSD responses, as well as an array of neurotic responses, were established in the group of somatically traumatized in wartime, then among the generally traumatized in peacetime, and, finally, among the somatically traumatized in peace time. This result was supported with a statistically significant relatedness of somatic traumatization in wartime with the experience of vital threat, loss of a close family member or home in the same trauma.
In a qualitative sense, there lead the symptoms of neurotic somatization (within those the feeling of being distracted) followed by insomnia and depression symptoms and, finally, anxiety. Respondents from the group of somatically traumatized in wartime responded mostly hysterically/neurotically (somatization), those from the group of somatically traumatized in peacetime by conversive and neurotically depressive disorders, and those from the group of generally traumatized in peacetime mostly by symptoms os PTSD.
'Nerve problems' before the trauma was found significantly most frequently in the respondents from the group of somatically traumatized in peacetime.
Subjects who were not prepared for the accident responded with a higher degree of depression and paranoia.

The most severely injured subjects in our research (those injured in wartime) showed and ambivalent attitude toward coping with accident effects as well as a tendency to consider someone other than themselves responsible for their accident.
It was determined that the outside circumstances of injury (in traffic accident, at leisure, at the workplace and in war) did not differentiate any of the psychological of psychopathological types of responses analyzed in the research. It was determined that a difficult surgery under general anaesthesia correlates significantly with PTSD Scale high values. It was also confirmed that the immobility of the patient significantly correlates with the general neuroticism and insomnia.

Other clinical features (part of the body injured in the trauma - trunk, arms, legs - amputation and acuteness of the injury) did not correlate significantly with either of the psychological or psychopathological features of the subjects.
As for immobile patients, a significantly higher level of family cohesiveness was determined, while the subjects with acute injury, although more extrovert, significantly more often took A passive attitude in coping with trauma consequences.

The next section presents the direct clinical experiences and observations of the authors on the psychological state of the physically injured, especially the wounded, depending on the severity of their injury, circumstances of injury and the stage of their treatment or rehabilitation.

The last chapter consists of 7 case histories of hospitalized patients i. e. respondents. In a qualitative way they to a great extent illustrate the results we obtained thorough quantitative methods.

Further informations available from Petar Opalic. He will be glad to give more detailed information about the study.

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