Psychosomatic medicine is an interdisciplinary medical field exploring the relationships among social, psychological, and behavioral factors on bodily processes and quality of life 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, psychology, neurology, internal medicine, surgery, allergy, dermatology and psychoneuroimmunology. Clinical situations where mental processes act as a major factor affecting medical outcomes are areas where psychosomatic medicine has competence.
History of psychosomatics
In the medieval Islamic world the Persian psychologist-physicians Ahmed ibn Sahl al-Balkhi (d. 934) and Haly Abbas (d. 994) developed an early understanding of illness that was due to the interaction of the mind and the body. They realized how a patient's physiology and psychology can have an effect on one another. They found correlations between patients who were physically and mentally healthy and between those who were physically and mentally ill.
In the beginnings of the 20th century, Franz Alexander led the movement looking for the dynamic interrelation between mind and body. Sigmund Freud pursued a deep interest in psychosomatic illnesses following his correspondence with Georg Groddeck who was, at the time, researching the possibility of treating physical disorders through psychological processes.
Since the 1970s, due to the work of Thure von Uexküll and his colleagues in Germany and elsewhere, biosemiotic theory has been used as a theoretical basis for psychosomatic medicine. Particularly, the umwelt concept and the theory of organism by Jakob von Uexküll has been found useful as an approach to describe psychosomatic phenomena.
Some physical diseases are believed to have a mental component derived from the stresses and strains of everyday living. This has been suggested, for example, of lower back pain and high blood pressure, which some researchers have suggested may be related to stresses in everyday life. However, within a psychosomatic framework, mental and emotional states are seen 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, disorders in which mental factors are the sole cause of a physical illness.
It is sometimes difficult to establish whether an illness causation is primarily physical, mental, or whether it has a psychosomatic component. For instance, while peptic ulcer was once thought of as being purely caused by stress, later research revealed that Helicobacter pylori caused 80% of ulcers. Nevertheless, most people living with Helicobacter pylori do not develop ulcers, and 30% of patients with ulcers have no H. pylori infection. Therefore, mental stress could still play some role. Similarly, in irritable bowel syndrome (IBS), recent research has shown significant differences in the behavior of the gut in IBS patients. On the other hand, there are no actual structural changes in the gut. Again, 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 increasingly 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"
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. 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.
The idea that a person's mental state can influence the course and severity of even the most severe physical diseases has led to some very strong claims. For example, it has been suggested that patients with intractable cancer may be able to survive longer if provided with psychotherapy to improve their outlook. Early studies provided some support for this view. 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 these unsubstantiated claims that "positive outlook" or "fighting spirit" can help slow cancer may be harmful to the patients themselves. Patients may come to believe that their poor progress results from "not having the right attitude", when in fact it may be no fault of their own.
- Behavioral medicine
- Conversion disorder
- Healing Words: Poetry and Medicine (documentary film)
- Placebo effect
- Psychosomatic Medicine (journal)
- Somatoform disorder (or somatic symptom disorder)
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- 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