Psychosomatic medicine is an
interdisciplinary
Interdisciplinarity or interdisciplinary studies involves the combination of multiple academic disciplines into one activity (e.g., a research project). It draws knowledge from several other fields like sociology, anthropology, psychology, ec ...
medical field exploring the relationships among social, psychological, behavioral factors on bodily processes and
quality of life
Quality of life (QOL) is defined by the World Health Organization as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards ...
in humans and animals.
The academic forebear of the modern field of
behavioral medicine and a part of the practice of
consultation-liaison psychiatry, psychosomatic medicine integrates interdisciplinary evaluation and management involving diverse specialties including
psychiatry
Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related to mood, behaviour, cognition, and perceptions. See glossary of psychiatry.
Initial psych ...
,
psychology
Psychology is the scientific study of mind and behavior. Psychology includes the study of conscious and unconscious phenomena, including feelings and thoughts. It is an academic discipline of immense scope, crossing the boundaries betwe ...
,
neurology
Neurology (from el, wikt:νεῦρον, νεῦρον (neûron), "string, nerve" and the suffix wikt:-logia, -logia, "study of") is the branch of specialty (medicine), medicine dealing with the diagnosis and treatment of all categories of co ...
,
psychoanalysis
PsychoanalysisFrom Greek: + . is a set of theories and therapeutic techniques"What is psychoanalysis? Of course, one is supposed to answer that it is many things — a theory, a research method, a therapy, a body of knowledge. In what might b ...
,
internal medicine,
pediatrics
Pediatrics ( also spelled ''paediatrics'' or ''pædiatrics'') is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, paediatrics covers many of their youth until th ...
,
surgery
Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...
,
allergy
Allergies, also known as allergic diseases, refer a number of conditions caused by the hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include hay fever, food allergies, atopic derma ...
,
dermatology
Dermatology is the branch of medicine dealing with the skin.''Random House Webster's Unabridged Dictionary.'' Random House, Inc. 2001. Page 537. . It is a speciality with both medical and surgical aspects. A dermatologist is a specialist medical ...
, and
psychoneuroimmunology
Psychoneuroimmunology (PNI), also referred to as psychoendoneuroimmunology (PENI) or psychoneuroendocrinoimmunology (PNEI), is the study of the interaction between psychological processes and the nervous and immune systems of the human body. It is ...
. Clinical situations where mental processes act as a major factor affecting medical outcomes are areas where psychosomatic medicine has competence.
Psychosomatic disorders
Some physical diseases are believed to have a mental component derived from
stresses and strains of everyday living. This has been suggested, for example, of
lower back pain
Low back pain (LBP) or lumbago is a common disorder involving the muscles, nerves, and bones of the back, in between the lower edge of the ribs and the lower fold of the buttocks. Pain can vary from a dull constant ache to a sudden sharp feeli ...
and
high blood pressure
Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. Long-term high bl ...
, which some researchers have suggested may be related to
stresses in everyday life. The psychosomatic framework additionally sees mental and emotional states as capable of significantly influencing the course of any physical illness. Psychiatry traditionally distinguishes between psychosomatic disorders, disorders in which mental factors play a significant role in the development, expression, or resolution of a physical illness, and
somatoform disorders
A somatic symptom disorder, formerly known as a somatoform disorder,(2013) dsm5.org. Retrieved April 8, 2014. is any mental disorder that manifests as physical symptoms that suggest illness or injury, but cannot be explained fully by a general ...
, disorders in which mental factors are the sole cause of a physical illness.
It is difficult to establish for certain whether an illness has a psychosomatic component. A psychosomatic component is often inferred when there are some aspects of the patient's presentation that are unaccounted for by biological factors, or some cases where there is no biological explanation at all. For instance, ''
Helicobacter pylori'' causes 80% of
peptic ulcers. However, most people living with ''Helicobacter pylori'' do not develop ulcers, and 20% of patients with ulcers have no ''H. pylori'' infection. Therefore, in these cases, psychological factors could still play some role. Similarly, in
irritable bowel syndrome (IBS), there are abnormalities in the behavior of the gut. However, there are no actual structural changes in the gut, so stress and emotions might still play a role.
The strongest perspective on psychosomatic disorders is that attempting to distinguish between purely physical and mixed psychosomatic disorders is obsolete as almost all physical illness have mental factors that determine their onset, presentation, maintenance, susceptibility to treatment, and resolution. According to this view, even the course of serious illnesses, such as cancer, can potentially be influenced by a person's thoughts, feelings and general state of mental health.
Addressing such factors is the remit of the applied field of
behavioral medicine. In modern society, psychosomatic aspects of illness are often attributed to
stress making the remediation of stress one important factor in the development, treatment, and prevention of psychosomatic illness.
Connotations of the term "psychosomatic illness"
The term ''psychosomatic disease'' was most likely first used by Paul D. MacLean in his 1949 seminal paper ‘Psychosomatic disease and the “visceral brain”; recent developments bearing on the Papez theory of emotions.’ In the field of psychosomatic medicine, the phrase "psychosomatic illness" is used more narrowly than it is within the general population. For example, in lay language, the term often encompasses illnesses with no physical basis at all, and even illnesses that are faked (
malingering). In contrast, in contemporary psychosomatic medicine, the term is normally restricted to those illnesses that do have a clear physical basis, but where it is believed that psychological and mental factors also play a role. Some researchers within the field believe that this overly broad interpretation of the term may have caused the discipline to fall into disrepute clinically.
[{{cite book , last = Greco, first = Monica, title = Illness as a Work of Thought: Foucauldian Perspective on Psychosomatics, publisher = Routledge, year = 1998, pages = 1–3, 112–116, isbn = 978-0-415-17849-5] For this reason, among others, the field of behavioral medicine has taken over much of the remit of psychosomatic medicine in practice and there exist large areas of overlap in the scientific research.
Criticism
Studies have yielded mixed evidence regarding the impact of psychosomatic factors in illnesses. Early evidence suggested that patients with advanced-stage cancer may be able to survive longer if provided with psychotherapy to improve their social support and outlook. However, a major review published in 2007, which evaluated the evidence for these benefits, concluded that no studies meeting the minimum quality standards required in this field have demonstrated such a benefit. The review further argues that unsubstantiated claims that "positive outlook" or "fighting spirit" can help slow cancer may be harmful to the patients themselves if they come to believe that their poor progress results from "not having the right attitude".
In her book ''Authors of Our Own Misfortune'', Angela Kennedy argues that psychogenic explanations for physical illnesses are rooted in faulty logic and moralistic belief systems which situate patients with medically unexplained symptoms as deviant, bad and malingering. The diagnosis of a psychogenic disorder often has detrimental consequences for these patients as they are stigmatised and denied adequate support because of the contested nature of their condition and the value judgements attached to it.
On the other hand, psychosomatic medicine criticizes the current approach of medical doctors disregarding psychodynamic ideas in their daily practice. For example, it questions the broad acceptance of self-proclaimed diseases such as gluten-intolerance,
chronic Lyme disease and
Fibromyalgia
Fibromyalgia (FM) is a medical condition defined by the presence of chronic widespread pain, fatigue, waking unrefreshed, cognitive symptoms, lower abdominal pain or cramps, and depression. Other symptoms include insomnia and a general hyp ...
as a gain of illness for patients to avoid the underlying intra-psychic conflicts eliciting the disease, while at the same time, challenging the reasons for this neglect in the doctors’ own avoidance of their emotional intra-psychic conflict.{{Unreliable source?, date=September 2021
Treatment
While in the U.S., psychosomatic medicine is considered a subspecialty of the fields of psychiatry and neurology, in Germany and other European countries it is considered a subspecialty of internal medicine.
Thure von Uexküll and contemporary physicians following his thoughts regard the psychosomatic approach as a core attitude of medical doctors, thereby declaring it not as a subspecialty, but rather an integrated part of every specialty. Medical treatments and psychotherapy are used to treat illnesses believed to have a psychosomatic component.
History
In the
medieval Islamic world
The Islamic Golden Age was a period of cultural, economic, and scientific flourishing in the history of Islam, traditionally dated from the 8th century to the 14th century. This period is traditionally understood to have begun during the reign ...
the Persian psychologist-
physicians
A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...
Ahmed ibn Sahl al-Balkhi (d. 934) and
Haly Abbas (d. 994) developed an early model of illness that emphasized the interaction of the mind and the body. He proposed that a patient's
physiology
Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology, physiology focuses on how organisms, organ systems, individual organs, cells, and biomolecules carry out the chemical ...
and
psychology
Psychology is the scientific study of mind and behavior. Psychology includes the study of conscious and unconscious phenomena, including feelings and thoughts. It is an academic discipline of immense scope, crossing the boundaries betwe ...
can influence one another.
In the beginnings of the 20th century, there was a renewed interest in psychosomatic concepts. Psychoanalyst
Franz Alexander had a deep interest in understanding the dynamic interrelation between mind and body.
[{{cite book , last = Asaad, first = Ghazi , title = Psychosomatic Disorders: Theoretical and Clinical Aspects, publisher = Brunner-Mazel, year=1996, pages = X, 129–130 , isbn = 978-0-87630-803-5] Sigmund Freud
Sigmund Freud ( , ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical method for evaluating and treating psychopathology, pathologies explained as originatin ...
pursued a deep interest in psychosomatic illnesses following his correspondence with
Georg Groddeck
Georg Walther Groddeck (13 October 1866 in Bad Kösen – 10 June 1934 in Knonau, near Zurich) was a physician and writer regarded as a pioneer of psychosomatic medicine.
Early life
Groddeck was born in a Lutheran family. His works before Worl ...
who was, at the time, researching the possibility of treating physical disorders through psychological processes.
Hélène Michel-Wolfromm applied psychosomatic medicine to the field of gynecology and sexual problems experienced by women.
In the 1970s, Thure von Uexküll and his colleagues in
Germany
Germany,, officially the Federal Republic of Germany, is a country in Central Europe. It is the second most populous country in Europe after Russia, and the most populous member state of the European Union. Germany is situated betwe ...
and elsewhere proposed a
biosemiotic theory (the
umwelt concept) that was widely influential as a theoretical framework for conceptualizing mind-body relations.
Henri Laborit, one of the founders of modern neuropsychopharmacology, carried out experiments in the 1970s that showed that illness quickly occurred when there was inhibition of action in rats. Rats in exactly the same stressful situations but whom were not inhibited in their behavior (those who could flee or fight—even if fighting is completely ineffective) had no negative health consequences. He proposed that psychosomatic illnesses in humans largely have their source in the constraints that society puts on individuals in order to maintain hierarchical structures of dominance. The film ''
My American Uncle
''Mon oncle d'Amérique'' (English: ''My American Uncle'' or ''My Uncle from America'') is a 1980 French film directed by Alain Resnais with a screenplay by Jean Gruault. The film juxtaposes a comedy-drama narrative with the ideas of Henri Labori ...
'', directed by
Alain Resnais and influenced by Laborit, explores the relationship between self and society and the effects of the inhibition of action.
In February 2005, the Boston Syndromic Surveillance System detected an increase in young men seeking medical treatment for
stroke
A stroke is a medical condition in which poor blood flow to the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Both cause parts of the brain to stop functionin ...
. Most of them did not actually experience a stroke, but the largest number presented a day after
Tedy Bruschi
Tedy Lacap Bruschi (; born June 9, 1973) is a former professional American football player who was a linebacker in the National Football League (NFL) for 13 seasons, who currently serves as the senior advisor to the head coach at University of A ...
, a local sports figure, was hospitalized for a stroke. Presumably they began misinterpreting their own harmless symptoms, a group phenomenon now known as Tedy Bruschi syndrome.
Robert Adler is credited with coining the term Psychoneuroimmunology (PNI) to categorize a new field of study also known as mind-body medicine. The principles of mind-body medicine suggest that our mind and the emotional thoughts we produce have an incredible impact on our physiology, either positive or negative.
PNI integrates the mental/psychological, nervous, and immune system, and these systems are further linked together by ligands, which are hormones, neurotransmitters and peptides. PNI studies how every single cell in our body is in constant communication—how they are literally having a conversation and are responsible for 98% of all data transferred between the body and the brain.
Dr. Candace Pert, a professor and neuroscientist who discovered the opiate receptor, called this communication between our cells the ‘Molecules of Emotion' because they produce the feelings of bliss, hunger, anger, relaxation, or satiety. Dr. Pert maintains that our body is our subconscious mind, so what is going on in the subconscious mind is being played out by our body.
[{{Cite web, url=http://candacepert.com/, title=Explorer of the Brain, Bodymind & Beyond, website=Candace Pert, PhD, language=en-US, access-date=2020-01-24]
See also
{{col div, colwidth=40em
* ''
Healing Words: Poetry and Medicine'' (documentary film)
*
Medical students' disease
Medical students' disease (also known as second year syndrome or intern's syndrome) is a condition frequently reported in medical students, who perceive themselves to be experiencing the symptoms of a disease that they are studying.
The condition ...
*
Mirror box
*
Nocebo effect
A nocebo effect is said to occur when negative expectations of the patient regarding a treatment cause the treatment to have a more negative effect than it otherwise would have. For example, when a patient anticipates a side effect of a medicatio ...
*
Placebo effect
*
Placebo studies
A placebo ( ) is a substance or treatment which is designed to have no therapeutic value. Common placebos include inert tablets (like sugar pills), inert injections (like saline), sham surgery, and other procedures.
In general, placebos can aff ...
*
Psychoneuroimmunology
Psychoneuroimmunology (PNI), also referred to as psychoendoneuroimmunology (PENI) or psychoneuroendocrinoimmunology (PNEI), is the study of the interaction between psychological processes and the nervous and immune systems of the human body. It is ...
*
Psychotherapy
Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome pro ...
* ''
Psychosomatic Medicine (journal)''
*
Somatic symptom disorder also known as "somatoform disorder"
{{colend
References
{{Reflist
External links
Mind-Body Medicine: An Overview US National Institutes of Health, Center for Complementary and Integrative Health
Academy of Psychosomatic Medicine*
Psychosomatics journal of the Academy of Psychosomatic Medicine
American Psychosomatic Society*
Psychosomatic Medicine journal of the American Psychosomatic Society
{{Authority control
Medical specialties
Mind–body interventions
Stress (biological and psychological)
Anxiety disorder treatment
Immune system
Somatic psychology