Semantics and history of psychosomatic medicine are not popular topics nowadays, if they ever were; yet both of them constitute indispensable facets of any discipline that lays claim to a separate identity, as psychosomatics does. The latter, being an inchoate and inherently complex field of study, is especially in need of repeated efforts to clarify the meaning of its key terms, to delineate its scope, and to chart its development over time. Such efforts should pay off in improved teaching of this subject and in more effective communication with workers in other disciplines and with the general public. I have tried in this paper to sketch the historic development of psychosomatic conceptions and address some relevant semantic issues. It appears that early in this century, the convergence of two ancient conceptions, the holistic and the psychogenic, prepared the ground for the emergence in the 1930s of psychosomatic medicine as an organized scientific discipline and a counterreformation against the mechanistic view of man and medicine. Those two conceptions came to be subsumed by the word "psychosomatic" and thus contributed its two distinct connotations. The latter have not usually been clearly distinguished; hence, the ambiguity of the term. I have argued that only the holistic connotation should be retained, as it properly conveys the contemporary viewpoint. It is unfortunate that the word "holistic" has been appropriated recently by an anti-scientific and antiintellectual so-called "holistic health movement" (67), with resulting increment in semantic confusion and, in the eyes of many, loss of credibility for the misappropriated term. However, to retain it has merit as it is short, simple, and derived from the Greek - as were the very conceptions it has come to connote. Moreover, "holistic" has been part of the basic vocabulary of psychosomatic medicine from the beginning and conveys its core premises and purpose faithfully. As a historian aptly put it, the historic function of the psychosomatic movement has been to "vitalize the whole of medicine, psychiatry no less . . . with the holistic and ecologic viewpoint" (59, p. 9).(ABSTRACT TRUNCATED AT 400 WORDS)
After a period marked by one-sided emphasis on psychodynamics and social issues, or what could be called "brainless" psychiatry on account of its relative neglect of cerebral processes, we are witnessing an opposite trend towards extreme biologism or "mindless" psychiatry. The pendulum has swung periodically from one to the other of these reductionistic positions throughout the history of psychiatry. The author argues that neither brainless nor mindless psychiatry can do justice to the complexity of mental illness and to the treatment of patients. Psychiatry's distinguishing feature as a clinical discipline is its equal concern with subjective experience, or the mind, and with the body, including brain function, which together constitute a person, a psychiatrist's proper focus of inquiry and intervention. Moreover, a person, viewed as a mindbody complex, is in constant interaction with the environment. It follows that both study of mental illness and clinical practice need to take into account the psychological, the biological and the social aspects. These three aspects are not mutually reducible and are indispensable for the understanding and treatment of the individual patient. Such a comprehensive, biopsychosocial approach provides an antithesis to the reductionistic viewpoints and, in the writer's opinion, is both practically and theoretically most satisfying.
The writer discusses the relationship between physical illness and psychiatric disorders. He points out the relativity of the “psychosomatic” and “somatopsychic” concepts and the dynamic interaction between biological, psychological and social factors in initiating, predisposing to and influencing the course and outcome of all organic diseases. Psychiatric disorders causally related to physical illness include organic brain syndromes, reactive psychoses, neuroses and personality disorders, and deviant illness behavior. Some of the pathogenic mechanisms are discussed and the clinical importance of this area of psychosomatic medicine is stressed.
The first historical phase of psychosomatic medicine was largely dominated by the psychoanalytic approach to research and theory. The current phase has shown a radical shift away from that approach. It has focused on the study of the physiological mechanisms mediating between psychological states and body functions in health and disease, and on the role of personally meaningful life events and psychophysiological responses to them in the etiology, course, and outcome of a wide range of physical illnesses. The concepts of psychosocial stress, psychophysiological response specificity, coping, adaptation, and social supports predominate in psychosomatic theory. Research has grown in scope, diversity, and methodological sophistication. Concurrently, clinical application and the psychosomatic approach to patient care has expanded in the form of consultation-liaison psychiatry and behavioural medicine. The author reviews the current state of the field in its scientific and clinical aspects, and offers definitions delineating its scope.
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