Talk:Psychosomatic medicine

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Psychosomatic cf. Psychogenic[edit]

If anyone knows the difference between a psychosomatic illness and a psychogenic one, that would be a useful bit of information to throw into the article.

Just what I wanted to say ... and it has great importance. I believe this article and related articles about "psychosomatic" illness neeed to be placed into a proper linguistic and scientific/philosophical framework and currently are not.

OK HERE GOES >>>>> No one has responded at all regarding the material I have written below. I am going toplace it in the article as a BOLD piece of editing.

--Zigzagzen 09:45, 4 July 2007 (UTC)

I would like to see something along the lines of the following material added to the pages so that it is clear there is much debate about the reality of these "conditions". I would welcome other contributors thoughts on the material I have written below in this context. I have not edited the page as I realise the material here may be quite controversial.

This article and the science behind it are controversial on two grounds. The first is an etymological error that has crept into medicine. The second is the failure of medical practitioners to be realistic about the current limitations of medicine itself.

The Etymological Error

Psychosomatic means "relating to mind and body". This article and related articles on Somatization disorder and Conversion disorder actually relate to an entirely different class of problems that better labelled "psychogenetic". Psychogenetic means "originating in the mind", from the latin psychicus - meaning "belonging to the soul" and genesis - meaning "origin or source".

The Infallible Doctor Error

Doctors sometimes like to explain the things they can not explain by blaming the mind of their patients. If doctors said "we do not understand this" they would be showing themselves as limited humans - like the rest of us. This is an ego-centric disorder inherent in the minds of psychiatric and medical doctors and not in the minds of the patients concerned.

Instead of admitting their own - and western medicines' - limitations they have invented a whole raft of "psychosomatic" problems and disorders that might not exist, but actually confirm the current limitations of medical science.

--Zigzagzen 10:38, 20 June 2007 (UTC)


The article says that "There were times when almost any illnesses suffered by women were ascribed to hysteria, while anything men suffered from was not, since it was believed men did not suffer from hysteria. This view has changed since World War I, when men started to return from the front with what was called 'shell-shock syndrome'," this information seems a little more erudite than common knowledge and should be cited. It isn't very credible otherwise. Muggwort17 14:47, 6 November 2005 (UTC)

The article had a small chart or box overlying the text at the top right of the viewed page. It spelled out two classifications for this subject and stated links to classification charts. Those were "ICD-10 code F-45" and "ICD-9 code 306.9". Neither of those links mentioned anything about "psychosomatic illness" either in heading nor in item and I intend to remove those links. First they are in the wrong place, overlaying the text which introduces the subject. Second, they are not germane, they do not directly pertain to the subject of what psychosomatic illness is nor how it manifests. Terryeo 03:30, 12 December 2005 (UTC)

This article looks like it could have some good potential. In reference to the ICD box, it would seem that they do point to the same thing, however that is an underlying problem. Somatoform_disorders, Somatization_disorder, and Psychosomatic illness are all refering to the same basic condition. Something should be done to either remove, merge or clean up the articles. Tom Foolery 17:29, 13 December 2005 (UTC)

"soma" means body. "psyche" means mind or perhaps spirit." Psychosomatic means "the interplay of body and psyche" Perhaps "somatization disorder" and "somatoform disorders" might mean the same thing but that is not clearly splled out by those words, therefore if those words are introduced, referenced and linked as part of the Psychosomatic Illness article don't you think some introduction of meanings would be needed? Terryeo 20:46, 13 December 2005 (UTC)
After some further reasearch it would seem the difference can be broken down to this:
  • Psychosomatic Illness = Psychosomatic Disorder
  • Psychosomatic Disorders = Somatoform Disorders, the difference is that medically speaking, the term "psychosomatic" has fallen out of favor. This mainly can be seen by classification of "Somatoform Disorders" in both ICD-10 and DMS-IV. They can pretty much be used interchangeably as somatoform disorders are psychosomatic (interplay of the body and psyche).
  • Somatization Disorder, is a type of somatoform disorder, ICD defines it here, which should stay its own article. (duh)
So then where does this all lead? I think the easiest would be to turn Somatoform disorders into a redirect for psychosomatic illness, mainly because this article already has some good content, and Somatoform disorders is a one lined stub. With that out of the way, this article could be cleaned up, types of illnesses defined, etc, etc. =)
Tom Foolery 02:22, 14 December 2005 (UTC)
It is a difficult area to sort through, I think, because any mention of psycho- anything leads away from medical practice and to controversial psychiatry, eastern medicine, holostic healing and dianetics. Where does one turn for authority? Skin rashes might be psychosomatic or might be viruses treatable by medicine. Ulcers and other things too are recognized has having a psycho- component. Rather than attempt great specificity in an area modern medicine is uncertain of, might it be better to give a general outline along with possible areas to explore for treatment? Because some people might read wiki to find possible avenues of treatment. Terryeo 18:12, 17 December 2005 (UTC)
I thought it was horribly written, and as we help many people who suffered from psychosomatic disease, I cleaned it up some. But I lack my textbooks for authoratitive quotes and references. Soulwork 21:20, 31 December 2005 (UTC)
I too agree, the direction of the article should include links people can explore toward handling and informing themselves of treatments today. I'm not a medical doctor. But it is my limited understanding, there is no specific profession that treats psychosomatic illnesses, and so, no authority whom diagnoses such illnesses. It is on the fringe of medical doctors, on the fringe of almost everything. Yet some disciplines address it. My grandmother went to a Chinese medicine guy locally, he was helpful to her. Dianetics is the best shot, my opinion but this is one POV only. Terryeo 04:34, 1 January 2006 (UTC)
Nobody has ever considered that the factors most common in this illness type are are random as the weather:

Weatherlawyer (talk) 10:51, 27 September 2015 (UTC)

No, no, no... psychosomatic disorders are completely different from somatoform disorders. Psychosomatic disorders are physical illnesses that are caused in part by a psychological factor. Somatoform disorders are when there is nothing physically wrong with the patient. The reason psychosomatic is falling out of psychological grace is that doctors are realizing that more and more diseases are caused by psychological factors. For instance, stress lowers the immune systems ability to function, so a common cold has the potential to be psychosomatic. It may not be, but in many cases a cold is psychosomatic. Of course, the same holds true for blood pressure. When I'm less busy I'll try to update using an intro to psych book (all we really need for this sort of article). Werefrog 00:05, 28 November 2006 (UTC)

NO NON NON NO ..... see what I have written above .. you are discussing Pschogenetic/Psychogenic problems and using the Psychosomatic etymological error I have discussed.

At root here of all the psychological and philosophical discusions are two historical errors 1) Descartes error of separating mind and body into different universes and 2) Freud's error of changing his theory: he first said “my patients were sexually interfered with when they were children and show improved functioning when they talk about it”, but later said “my patients have really vivid imaginations and are kind of fu**ed up”. This was because the Vienniese Aristocracy who made up his clients just were not ready to deal with the demons of child abuse and the fact that it was rife in their society. If these guys had not made the errors they had psychology and medicine would not be in such a mess today over these issues.

--Zigzagzen 11:02, 20 June 2007 (UTC)

"O NON NON NO ..... see what I have written above .. you are discussing Pschogenetic/Psychogenic problems and using the Psychosomatic etymological error I have discussed." Here's the problem with that: this is the way psychologists use the word. It doesn't matter if it's an error in the etymology. We have to use the technical, scientific definition. You can put in a note saying that in the common vernacular use it differently. You can even mention the etymology. BUT the article has to be about the standard scientific definition.Werefrog 04:28, 13 October 2007 (UTC)

going to remove a nonesense paragraph[edit]

This paragraph: "Psychosomatic symptoms show that a human body can create physical symptoms that compensate for relationship deficiencies. (For example, hypnosis-induced allergic reactions indicate that a person's immune response can dramatically change during an intense relationship)." Makes a conclusion. It states that because symptoms manifest we can conclude the cause is "the human body has created physical symtoms." May I point out, this article is about psycho-somatic. A statement that says, "the human body injures itself" may be a perfectly fine, wonderful statement. But that statement is not cited, that statement is poorly worded and is difficult to glean meaning from and probably, that statement belongs deeper into the article under a subheading something like, "There are no psychosomantic illnesses, instead, the body hurts itself. So, I'm going to remove that portion to this page unless someone discusses and cites how "Body hurts itself" is germane to "psychosomatic". Terryeo 00:54, 14 January 2006 (UTC)

removed dianetics allegation[edit]

"They also claim to cure arthritis, radiation poisoning, cancer, [1] and, according to a 1995 brochure, "70 percent of Man's illnesses". [2]" is so completely untrue that it is laughable. To only quote a second party source which gives an opinion about what the source opinionates is laughable. I this case it is also untrue. Dianetics doesn't claim to cure physical ills. The Dianetics site takes particular care to be very sure they make no such claim or implication. The E-Meter court fiassco, years ago, made sure Dianetics makes no such public claims. Why not find a quote where they claim the moon is made of green cheese? heh !Terryeo 21:13, 8 February 2006 (UTC)


I've see several quotes in other sites that claim the the NIH has established that nine out of ten fatal diseases has a psychosomatic component and also that the NIH has established that two thirds of all ilnesses have a psychosomatic influence. Does anyone know of a reliable reference for these claims? Renaissance Healer

Definition of soma[edit]

I've been trying to find a definition of soma beyond the general definition that "soma" means body given in the discussion thread. The Wikipedia article on Soma makes no reference to this meaning as far as I can find. My sense is that Soma is an expanded sense of the body that includes energy systems, chakras, auras, etc. Does anyone have any suggestions about this?


Should we really mention Scientology in this page? It isn't necessary, none of the methods scientology use have any basis in science (ironic, considering their name) and they are actually opposed to psychiatry.

It is entertaining to watch two competing quackeries wrestle with each other. Nicmart (talk) 15:57, 6 February 2008 (UTC)

Refining the definition[edit]

Is it psychosomatic if it's caused entirely by one's thinking, attitude, or emotions? Or is the psychological aspect just one factor?

A disorder that involves both mind and body is called a psychosomatic illness. In other words, the illness may be emotional or mental in origin but have physical symptoms. Psychosomatic illnesses are not imaginary. They are physical disorders in which both emotions and thought patterns are believed to play a central role, and usually develop when a person's disease-fighting ability is weakened due to stress. After a particularly stressful event, like the loss of a loved one, for example, an individual might develop high blood pressure shortly afterward or even have a heart attack. In another person, the same situation might lead to a peptic ulcer or a series of asthma attacks. A third individual, equally as grief-stricken, might not get sick at all. For a psychosomatic illness to occur, a person must first be vulnerable in a particular body system. [3]

The above quote implies that a physical disorder can be caused in part by emotions and thought patterns. --Wing Nut 19:42, 5 July 2006 (UTC)

I understand the term psychosomatic has historically been used to mean that, but is presently construed as to indicate conditions that present physiological and psychological manifestations. On the other hand, physiological conditions caused (or at least triggered) by psychoemotional factors are referred to as psychogenous. This doesn't appear to be the same as somatoform, for on the current Wikipedia definition that only means a condition "for which no adequate medical explanation has been found", i.e., a relevant organic disorder hasn't been isolated. On the current wikipedia ref, functional symptoms are described as having "no current visible organic basis, e.g. if they are a result of psychological or perceptual dysfunction", but other circumstances could concur. S

Anorexia and Bulemia[edit]

I don't believe that these should be categorized as psychosomatic. I think they are better categorized as neuroses, but I expect that the psychologists have more specific, somewhat different categories for them. The reason I don't think they are psychosomatic is that, as I understand it, psychosomatic illnesses create symptoms of real degenerative processes in the body, whereas anorexia and bulemia create actions by the individual against their own body. The psychosomatic process is covert and the anorexic / bulemic actions are overt. The a / b patient overtly witholds food or induces regurgitation. 09:55, 10 July 2006 (UTC)

German article on psychosomatic disturbances[edit]

It may not be very helpful, but I want to draw peoples' attention to the German article which I find excellent; in accordance with the state of the art of medical science and psychotherapy. It's also critical enough towards popular "pseudo"-psychosomatic beliefs and ideology.

Friedhelm, Germany, 30 August 2006

It is helpful, but it would be even more helpful if you could translate something from the de page. This page badly needs some attention. Leibniz 12:29, 31 August 2006 (UTC)

Yes, it' true - a translation would be good. But I'm sorry, my English is not good enough for that, especially as adequate "scientific" vocabulary is necessary, and medical/psychotherapeutical knowledge in English as well. Psychosomatics is a complex field, and it needs well-founded differentiation of proved knowledge/facts, plausible theory on the one hand and beliefs, claims, ideology etc. on the other. Including a historical overview of the many different concepts and their development, and what can still be maintained as valid enough.
Friedhelm, Germany, 2 September 2006
Your English looks fine to me, better than the average on Wikipedia. You don't have to be an expert, just cite verifiable sources. I would encourage you to get an account and make some edits. Leibniz 12:14, 2 September 2006 (UTC)


The history section needs some serious attention. No mention of Freud, Neurasthenia, Charcot, or of doctors' views on the causes of psychosomatic illness (the uterus in hysteria, reflexology, magnetism, etc.) and the legion of quacks who tried (and succeeded) in curing psychosomatic patients from the 18th century to the present day. I don't have time to do this right now, but if anyone else wants to make some contributions please go ahead.

For anyone interested in the history of psychosomatic illness I would strongly recommend Shorter's "From Paralysis to Fatigue: a History of Psychosomatic Illness in the Modern Era". In fact, that is the only good book on psychsomatic illness that seems to be out there.

--Sciencewatcher 22:55, 22 February 2007 (UTC)

A more modern work that references and builds on Shorter's work is Dr. John E. Sarno's recent book (2006), "The Divided Mind: The Epidemic of Mindbody Disorders" [4]. Dr. Sarno is a pioneer at diagnosing and successfully treating many modern ills as psychosomatic or psychogenic, particularly chronic back pain, tendonitis, RSI, and fibromyalgia, in his more than three decades at the Rusk Institute of Rehabilitation Medicine, where he is still practicing at age 83. He is also a Professor of Rehabilitation Medicine at the NYU School of Medicine, and the author of other books, including "Healing Back Pain: The Mind-body Connection," (1991) [5], and "The Mindbody Prescription: Healing the Body Healing the Pain" (1998)[6]. Ralphyde 00:39, 23 February 2007 (UTC)

Definition a bit loose[edit]

Actually the psychosomatic disorders may be bidirectional, not only imposed by the mind on the body but also physical processes producing mental disorders may classify as psychosomatic as well even if there is not a consensus about that. For example hormonal disorders may have rebouncing effects and become psychosomatic I.e. hormonal imbalance>depression>anorexia I will see if I find citations that are solid because most are contradictory Librarian2 16:49, 16 August 2007 (UTC)

This is a term that I've heard batted about in pop culture. On a medical level, this article may be a candidate for redirect to somatoform disorder. It invokes ICD codes, but those talk about somatoform, not psychosomatic illness. Antelan talk 19:37, 20 August 2007 (UTC)

What about redirecting or linking to PNI ? What do you think? Can you anyhow put a template of WP:MED ? I cannot find it Librarian2 20:06, 20 August 2007 (UTC)

I disagree with any redirecting of psychosomatic, as it has an important history tracing back to Freud and Jung, and there are many links to it (317) in Wikipedia. It is also coming back as the basis for mindbody medicine.
In the introduction to his new book (2006), The Divided Mind: The Epidemic of Mindbody Disorders,[7] Dr. John E. Sarno of the Howard A. Rusk Institute of Rehabilitation Medicine says: "First I want to clear up any confusion surrounding the word psychosomatic. You may think it refers to something vaguely fraudulent, such as imaginary diseases dreamed up by people for their own selfish or confused reasons. That's simply not true. But even medical practitioners, doctors who might be expected to have a more accurate understanding of the term, sometimes make the mistake of assuming it refers to how stress makes disease worse, or the stressful consequences of living with a disease. Those are legitimate concerns and have been addressed in the medical literature, but they are not psychosomatic. Psychosomatic medicine specifically refers to physical disorders of the mindbody, disorders that may appear to be purely physical, but which have their origin in unconscious emotions, a very different and extremely important medical matter. Note that we will use the terms psychosomatic and mindbody interchangeably throughout the book, so don't let it throw you."
"There are literally hundreds of disorders and illnesses that have been identified as purely psychosomatic or having a psychosomatic component. We will explore many of them in the pages that follow. They can range from mildly bothersome back pain all the way to cancer, depending on the power and importance of unconscious emotional phenomena. Psychosomatic illnesses seem to be an inescapable part of the human condition. Yet amazingly, in spite of the nearly universal prevalence of such disorders, the practice of psychosomatic medicine is almost totally unknown within today's medical community, and plays virtually no part in contemporary medical study and research. Nowadays, when physicians and many psychiatrists are confronted with a psychosomatic disorder, they do not recognize it for what it is and almost invariably treat the symptom."
Dr. Sarno has been practicing medicine at the Rusk Institute since 1965, and has become world renowned for his success at treating mindbody pain disorders from back pain to fibromyalgia to carpal tunnel syndrome. He has written four books on his diagnosis and treatment methods. Ralphyde 22:15, 20 August 2007 (UTC)
Sorry, I think I wasn't clear. I agree that psychosomatic illnesses are very real indeed, but it was my understanding that they are so closely related to somatoform disorders as to merit a merge. If others feel that's not the case, I'm fine with that. The Merck Manual, for example, equivocates on this matter.[8] However, the ICD codes on this article are for somatoform disorder. Are there thoughts on that? Antelan talk 23:24, 20 August 2007 (UTC)
The Merck Manual you referenced also distinguishes between the two as follows in the section on Psychosomatic disorders: "Unlike somatoform disorders, psychosomatic disorders do not fit into specific diagnostic categories, and they manifest in a variety of ways. Social and psychologic stress can also aggravate a wide variety of physical diseases, including diabetes mellitus, coronary artery disease, and asthma."
"Stress can cause physical symptoms even when no physical disease is present. For example, hives can be brought on entirely by a psychologic reaction. In some cases, physical symptoms result from the body's automatic response to emotional stress, as when heart rate and blood pressure increase in response to fear. In other cases, psychologic symptoms become physical symptoms in an unconscious attempt to divert attention away from a troublesome emotional issue." Ralphyde 01:54, 21 August 2007 (UTC)
Yes, but it equivocates. As you noted, it says that psychosomatic disorders are distinct from somatoform disorders. At the same time, the very first sentence says, Somatoform disorder is a relatively new term for what many people used to refer to as psychosomatic disorder. In this way, the Merck Manual takes both sides of the issue (equivocates). Because of this, I dropped my suggestion to merge the two articles, and I'm now wondering what you think about the status of the ICD codes. Thanks, Antelan talk 19:51, 21 August 2007 (UTC)
The ones listed look pretty good to me. There may be others which might also fit within the broad definition of psychosomatic. But I can't get excited about the codes. Ralphyde 22:31, 21 August 2007 (UTC)
Because they refer to somatoform disorder, which you are distinguishing from psychosomatic illness, I plan on removing the ICD codes. Antelan talk 23:59, 21 August 2007 (UTC)

No mention of (Georg) Groddeck?[edit]

I've heard of him described as the "father of psychosomatic medicine"... Critic9328 21:13, 14 October 2007 (UTC)

National Library of Medicine[edit]

Much of the 'History' section of this article appears to have been taken, almost word for word, from this web page from the NLM titled: Psychosomatic Medicine: "The Puzzling Leap". That website requests that "National Library of Medicine (NLM) be given appropriate acknowledgement" if the text is used elsewhere. — BillC talk 21:20, 28 October 2007 (UTC)

Add: and some of the intro has come verbatim from this book review. — BillC talk 21:26, 28 October 2007 (UTC)

What a crock![edit]

Starting with this: "There is also a probable psychological influence in the development and outcome of conditions such as migraines." This is not only unproven but unaccepted by leading neurologists. While Wikipedia entries on physics and other hard sciences tend to be quite good, anything to do with psychiatry is a heap of conjecture and outright quackery. (talk) 15:05, 6 February 2008 (UTC)

Power of suggestion[edit]

Power of suggestion currently redirects here to psychosomatic medicine. While there is a brief mentioning of using suggestion by an authority figure to help alleviate psychosomatic symptoms, it would seem much more appropriate to redirect that to the general Suggestion page.Mmortal03 (talk) 04:19, 19 March 2008 (UTC)

M.E. (Chronic Fatigue Syndrome) is not psychosomatic.[edit]

Chronic Fatigue Syndrome is listed here as a psychosomatic illness. There is a growing mountain of evidence that it is purely physiological in cause and cure. It is possible that stress may contribute but that can be said of many illnesses.

Indeed, the suggestion by psychiatrists for the last 20 years that M.E. is psychological, may turn out to be one of the greatest malpractices of modern medicine. Where is the critical concession that many psychosomatic illness have turned out to be physiological ?

To keep a consistent tone, I invite one of the regular authors of this topic to make the corrections suggested by at least removing Chronic Fatigue Syndrome from the list.

--X86dude (talk) 06:25, 7 May 2008 (UTC)

Speaking of ME/CFS not being psychosomatic, check out this story -->

It is old news to anyone informed about ME/CFS, the gene expression findings have been around for a few years, they are just refining them until that magical diagnostic test appears and then ME/CFS will be viewed as legitimate as Multiple Sclerosis - rememeber the psychiatrists used to call MS "hysterical paralysis" before the MRI showed the lesions on the brain...

Also while I'm at it, the same can be said for Multiple Chemical Sensitivity -->

Hope someone corrects this article, I'm only new here so don't want to step on any toes.

Cheers Ash H —Preceding unsigned comment added by Ash H (talkcontribs) 01:54, 8 May 2008 (UTC)

Hypochondriasis is a psychosomatic disorder[edit]

Under the header Treatment, it reads: "Unlike hypochondria (which some mistakenly think is the same thing as psychosomatic illness), sufferers of a psychosomatic illness are experiencing real pain, real nausea, or other real physically felt symptoms, but with no cause that can be diagnosed."

According to the DSM-IV-TR, hypochondriasis is a somatoform disorder, which is itself a type of psychosomatic disorder. Therefore, hypochondriasis is a psychosomatic disorder. Since there's no source for the initial clause in the sentence quoted above, I'm removing it immediately. svadhisthana (talk) 18:16, 27 August 2008 (UTC)

P.S. Those with hypochondriasis do, in fact, experience real symptoms. However, they tend to psychologically exaggerate those symptoms, leading to a fixation that convinces them that they have a severe physical condition.


I have tagged this article as NPOV since it contains several tendentious, unsourced statements that suggest a number of organic diseases to be psychosomatic. Do not remove the template until this is resolved. Guido den Broeder (talk, visit) 00:04, 11 September 2008 (UTC)

Please discuss here exactly what is NPOV and we can resolve it. I'm removing the POV tag as it isn't appropriate. We can discuss any problems with the article here and then make the appropriate changes. --Sciencewatcher (talk) 00:08, 11 September 2008 (UTC)
I have already done so in my edit summaries and again above. Stop adding unsourced, tendentious statements and the issue is resolved. This is the entire problem, nothing more can be added to its description. While these statements are in the text, policy is clear that the template should remain. So please retag asap. Guido den Broeder (talk, visit) 00:16, 11 September 2008 (UTC)
As I said in the edit, the source for the statements are in the articles themselves, e.g. just click on "irritable bowel syndrome" link, etc. If there is any doubt about any of them, let me know which ones. --Sciencewatcher (talk) 00:25, 11 September 2008 (UTC)
Wikipedia articles are not reliable sources. Guido den Broeder (talk, visit) 00:28, 11 September 2008 (UTC)
As den Broeder says, Wikipedia articles may not be used as sources for other articles. If there are sourced statements in other articles that support statements in this one, then this article should directly reference those sources itself. Also, as the template itself says, it should not be removed until the dispute is resolved. — BillC talk 01:29, 11 September 2008 (UTC)
I agree with Guido and BillC: Wikipedia articles are not reliable sources, and not a good justification for disputed edits. Mangojuicetalk 13:42, 11 September 2008 (UTC)
Okay I'll add individual references. --Sciencewatcher (talk) 17:40, 11 September 2008 (UTC)
Not good enough. You can't just add any random reference. If you limit yourself to one reference, you must make sure that it represents the mainstream. Wessely, e.g., does not, since he uses a different disease definition altogether. And don't remove a template because you think you're done, you must check with the rest of us first. Guido den Broeder (talk, visit) 19:17, 11 September 2008 (UTC)
Now, increased risk by psychological factors and occurrences of comorbidities do not make a condition psychosomatic, as has been pointed out to you many times before. Most of the references you added are like this and are therefore completely irrelevant to the topic and misleading. They will have to go, and so have the statements you attached them to. The ulcer article you added is I think not mainstream. Guido den Broeder (talk, visit) 19:39, 11 September 2008 (UTC)
I agree. The article doesn't say these illnesses are psychosomatic, it says "There is also a probable psychological influence in the development and outcome ", which the references back up. And Wessely is about as mainstream as you can get. How is the ulcer article not mainstream? There is ample evidence that psychosocial stress plays a large factor in peptic ulcers - have a read through the article to see the evidence. The review states that "Psychosomatic factors in the aetiology of peptic ulcer have become unfashionable since the discovery of Helicobacter pylori" which I believe is the crux of the problem here. --Sciencewatcher (talk) 19:48, 11 September 2008 (UTC)
Excellent. Since this article is about psychosomatic medicine, we can simply remove all the off-topic comments about psychological influence. Guido den Broeder (talk, visit) 20:58, 11 September 2008 (UTC)
Are you just trying to be difficult or does it come naturally? Those comments are on-topic because psychosomatic medicine is about the psychological influence on physical illness. I know you personally don't like CFS being mentioned anywhere near the word "psychosomatic", but that is no reason to push your pov in the article. --Sciencewatcher (talk) 21:14, 11 September 2008 (UTC)

(unindent) Psychosomatic medicine is an interdisciplinary medical field studying psychosomatic illness, now more commonly referred to as psychophysiologic illness or disorder, whose symptoms are caused by mental processes of the sufferer rather than immediate physiological causes. These syndromes are classified as neurotic, stress-related and somatoform disorders by the World Health Organization in the International Statistical Classification of Diseases and Related Health Problems.

My pov does not go into any Wikipedia article. If I have one, it goes into an essay. Guido den Broeder (talk, visit) 21:22, 11 September 2008 (UTC)

So what exactly are you disputing here? The refs are all there. The CFS ref is the same one used in the CFS article itself, so if it's good enough for the CFS article, it's good enough for here. Just because you don't like Wessely isn't a good reason to remove it. --Sciencewatcher (talk) 13:59, 12 September 2008 (UTC)
In the CFS article, it gets due weight as a minority view. Guido den Broeder (talk, visit) 15:04, 12 September 2008 (UTC)
It's just your POV that it's a minority view. There is ample evidence to support the edits in this article. --Sciencewatcher (talk) 16:12, 12 September 2008 (UTC)
Well, provide it. I.e., evidence to the effect that yours is the mainstream view, in spite of what the CDC says. Not another random publication. Guido den Broeder (talk, visit) 16:20, 12 September 2008 (UTC)

(unindent) I have removed migraine from the list since the reference provided by SW was about comorbidity, not cause. Guido den Broeder (talk, visit) 18:03, 12 September 2008 (UTC)

I followed some links from the recent activity at the CFS pages and arrived here. Interesting discussion. The issue is obviously what illnesses/diseases qualify to be mentioned in this article. The way that the article currently phrases it ("There is also a probable psychological influence in the development and outcome of conditions such as ..."), you could include a whole bunch of illnesses and diseases that show any influence from psychological factors; I have looked into this before ([9]), however, this Wikipedia entry for psychosomatic medicine largely lists several controversial illnesses rather than a proper range; I'm guessing that this was done because these illnesses are in dispute and it's someone's opinion that they are therefore psychosomatic.
Psychosomatics is especially open to interpretation because the mind-body problem remains unsolved, and the history of psychiatry itself is particularly "colourful" to say the least. My impression is that there are two main interpretations for "psychosomatic": (1) The definition Guido gave, where physical symptoms are "caused by mental processes of the sufferer rather than immediate physiological causes", (2) any disease with primary physical symptoms in which psychological factors have any significant role in onset and/or prognosis (PMID 17385469 for example). Then there is a possible grey area, where significant psychological factors are resolved but this fails to resolve the physical symptoms. I remember reading somewhere that some people who are successfully treated for the psychological aspects of depression still experience physical symptoms. I'd also bet real money that many people with CFS fail to improve substantially despite resolving psychological factors.
This is what I suggest; either the wording of the paragraph must change to better reflect what it is describing (using definition #1, a "probable psychological influence in the development and outcome of a condition" doesn't automatically make it "psychosomatic"), or, depending on definition #2, a wider range of diseases should be included as examples (heart attacks, strokes, diabetes, asthma, ulcers, HIV/AIDS, multiple sclerosis, breast cancer, lupus erythematosus, rheumatoid arthritis, etc). As the WP article stands now, the sources (at least for CFS) fail to demonstrate why CFS is thought to be psychosomatic, and the wording of the WP article merely mentions something as vague as "probable psychological influence". At best you could probably use other references to demonstrate that some researchers believe CFS etc are psychosomatic, but selectively picking references which demonstrate a psychological risk factor isn't really good enough for demonstrating that something is psychosomatic in terms of definition #1. Let's not pretend that the mind-body connection is scientifically well-known or that psychiatry has been very accurate on the issue in the past.
_Tekaphor (TALK) 18:06, 12 September 2008 (UTC)

Guido: how is personality "co-morbid"? The article concluded that personality and psychosomatic factors were important in the development of migraines.

Tekaphor: if you want to take a go at improving the article, feel free. Certainly there are psychosomatic factors for many illnesses, and for some illnesses it plays a larger part than others. The difference is that for CFS many researchers believe that it is purely psychosomatic, so it should be included here. If you can suggest a better reference, great. --Sciencewatcher (talk) 18:14, 12 September 2008 (UTC)

Thanks Tekaphor, I guess we can reach consensus here now. My suggestion is to put in a general remark that psychological factors can influence risk and course of physical diseases, without mentioning any disorder in particular. Guido den Broeder (talk, visit) 18:22, 12 September 2008 (UTC)

It would seem sensible to discuss in the article the illnesses where psychosomatic factors are thought to play a large part. --Sciencewatcher (talk) 18:59, 12 September 2008 (UTC)
Possibly. They are classified as neurotic, stress-related and somatoform disorders as the article says, so they shouldn't be too hard to find. Guido den Broeder (talk, visit) 19:04, 12 September 2008 (UTC)

Is there any reason to still have the pov tag? I noticed Guido has added a cite-check tag too. --Sciencewatcher (talk) 22:00, 12 September 2008 (UTC)

If you stop editwarring and allow us to remove the pov it won't be needed anymore. Guido den Broeder (talk, visit) 22:09, 12 September 2008 (UTC)
Please discuss what you think is wrong, and preferably suggest an improvement. Originally it was the lack of references, which I fixed, and now I have no idea what you think is wrong with it. --Sciencewatcher (talk) 22:45, 12 September 2008 (UTC)
Guido says: "put in a general remark that psychological factors can influence risk and course of physical diseases, without mentioning any disorder in particular" and Sciencewatcher says "discuss in the article the illnesses where psychosomatic factors are thought to play a large part". Yes, it does make sense to mention examples, but "psychological influence" isn't really a good enough criterion, so on that basis I can understand Guido's criticism for the inclusion of CFS. What's wrong with the article now is that it mentions CFS as an example of psychosomatic illness without providing references that demonstrate it is psychosomatic. It simply mentions a psychological influence, which could be said for a range of diseases that people don't generally consider psychosomatic and are missing from the list of examples given here. The reference itself states "likely to have an aetiological role in some cases of CFS/ME", "some"? This article isn't a priority of mine, I'm just making suggestions, maybe I'll look at it later. - Tekaphor (TALK) 05:31, 13 September 2008 (UTC)
Ok, thanks Tekaphor. I mostly agree with you. The problem is that many people believe that CFS is purely psychosomatic. Perhaps it would be better mentioning the illnesses that have a large psychosomatic component, such as heart disease, but aren't purely psychosomatic. And maybe the same could be said for CFS. I'll have another look at the references to see if I can find references which say it is or isn't psychosomatic, although I think it's going to be difficult to pin down because there is no definitive etiology. --Sciencewatcher (talk) 14:20, 13 September 2008 (UTC)
Here's a few. PMID 18306098 is a review of "the relationship between psychosomatic disorders and interpersonal abuse" and one of the illnesses is "chronic fatigue". Also the institue of psychiatry in the UK had a research project underway that states "“Anorexia nervosa and chronic fatigue syndrome are classical psychosomatic disorders" here. What would be good would be if we could get a good reference which states which illnesses are believed to be psychosomatic by the medical profession. --Sciencewatcher (talk) 15:09, 13 September 2008 (UTC)
Chronic fatigue is a different diagnosis. Guido den Broeder (talk, visit) 17:22, 13 September 2008 (UTC)
Yes I realise that. The point is, there isn't a great deal of evidence either way as to whether CFS "is a purely psychosomatic illness". However there is enough evidence to say that psychosomatic factors play a large part, as is discussed in the CFS article itself, e.g. the evidence that stress prior to the illness is the most significant trigger. --Sciencewatcher (talk) 18:56, 13 September 2008 (UTC)
If you realise that, then why do you claim it supports your position? Where is that evidence? You have had plenty of time to provide it. And no, stress is neither psychosomatic nor a trigger of CFS. We have gone through full archives of that already. Guido den Broeder (talk, visit) 19:59, 13 September 2008 (UTC)
Sorry, but it was you who said that psychosomatic disorders are sometimes classed as "stress related". And we have gone through the stress-cfs debate before. The references are in the CFS article so you can look them up there. You just don't seem to be interested in discussing this reasonably. --Sciencewatcher (talk) 21:32, 13 September 2008 (UTC)
No, that was certainly not I. Yes, we have had this debate numerous times before, and you never backed up your claims as all the other editors have said multiple times. And no, there are no such references in the CFS article, nor has that anything to do with this article. Now, until you provide a source that contains your evidence, I will no longer respond. Guido den Broeder (talk, visit) 22:41, 13 September 2008 (UTC)

There is adequate evidence, which I have given and which is in the CFS article - you just choose not to look at it. And if you have a look above you'll see the comment from the WHO that you posted saying that psychosomatic illnesses are classed as stress-related. It seems that further discussion is pointless. --Sciencewatcher (talk) 23:00, 13 September 2008 (UTC)

Perhaps "some" researchers assume that CFS is purely psychosomatic, but that would be a minority view. My impression is that the overall consensus (if any) among researchers indicates a physiological dysfunction that goes beyond biological psychiatry and exists largely independent of current psychological factors (at the same time there is a significant but secondary degree of "inter-dependence" between the two). So, while most researchers and many organisations also tend to avoid a purely organic classification, they generally consider it to be a physiological problem more than a psychosomatic one. Allostatic load is another interesting concept to grasp.
Even if CFS turns out to be a "stress-disorder", the source of the stress perpetuation once CFS is acquired could largely be from the physiological dysfunction. To use an example you would be familiar with, David Smith claims that this perpetuating state is immune activation and generally cannot be turned off without the immunoregulatory effects of antidepressants. The above "stress is the most significant trigger" claim depends on how you classify infection. As for the stress studies used in the CFS article, I remember discussing them before and demonstrating that infection appears to be a greater risk factor than psychological stress, and the role of the latter isn't so clear cut either. Leonard Jason seriously questions the role of stress and somatisation in CFS, and he is not the only one.
As a comparison, the risk factor that psychological stress and psychiatric symptoms pose for heart attack and stroke in particular is rather high according to the studies I've come across, 2 to 3 times even; in one such study for heart disease (PMID 15381652), it even states that psychological factors appear to be more important than traditional risk factors. So is heart disease still mostly psychosomatic? Using the definition in this WP article (definition #1), I don't believe it is.
So what do we do in a situation where etiology is unknown? I consider psychosomatic medicine and the biopsychosocial model to be false middle-neutral ground because the former assumes psychological etiology and the latter when applied to CFS uses the "bio" prefix in the context of biological psychiatry. The problem with the term "functional somatic syndrome" is that the word "functional" is not used neutrally as it should be. This article, at most, should mention that some illnesses are under dispute and this has lead some to propose a psychosomatic mechanism, but it has to be more specific about who and why.
_Tekaphor (TALK) 04:21, 14 September 2008 (UTC)

I have tried to rewrite the disputed text to reflect all sides. CFS is still mentioned, but with a historical component rather than suggesting two equal camps in 2008. I hope this can satisfy everyone. Guido den Broeder (talk, visit) 07:50, 14 September 2008 (UTC)

Thanks. I think we're getting somewhere. Can we now resolve the disupted on the other pages too? --Sciencewatcher (talk) 14:51, 14 September 2008 (UTC)
I've changed "almost all" to "many". I think it's incorrect to say that psychological factors influence almost all illnesses. I also added heart disease as an example, as it is not controversial and is well established that stress is a significant cause. --Sciencewatcher (talk) 15:17, 14 September 2008 (UTC)

including, but not limited to[edit]

"Including, but not limited to" is lawyer-speak and is unnecessary since "including" implies additional items already. --Unimath (talk) 12:34, 2 September 2009 (UTC)

Stress / ulcers[edit]

Hi Sciencewatcher,

I'm the editor who reverted some of your recent changes to the Psychosomatic medicine page. I think you have a point about my wording, which wasn't great. But I'm concerned that the way you have re-expressed things implies the evidence for a role for stress in peptic ulcer is strong. I do not think this is the case. The article you cite by Fink as support for this claim presents the following evidence:

- the lack of 100% correspondence between presence of H pylori and peptic ulcer. This doesn't demonstrate a role of mental stress specifically, and it has already been mentioned earlier in the WP page

- the Hanshin-Awaji earthquake was followed by a significant increase in the number of people with peptic ulceration (doesn't demonstrate a mental stress link, could be a hygiene issue, or any number of things).

- the high rate of stomach ulcers amongst the physically injured and those with severe burns (independent of H pylori). This is very different from the idea of "mental stress" that is being claimed by the author. Its a huge stretch! 
- references to other people's opinions, arguments, conclusions (Creed, Levenstein). Just citing someone who agrees with the author is obviously not evidence.

None of these claims provides supporting evidence for the statement that stress plays a role in peptic ulcer. To state such a thing in WP, we need supporting evidence. Otherwise it must remain a "position" or a "view" as I was trying to empahsise (but perhaps not very prettily).

More generally, we need to find a way of presenting the views of the psychosomatic medicine which is fair to their perspective, but does not simply present their hypotheses as uncontroversial fact (their perspective has come under a lot of criticism of late, and some appears to be well justified in my view).

Your thoughts welcome on how to resolve.


--Wilshica (talk) 07:21, 21 November 2015 (UTC)

Both the Fink review and the original study say that emotional stress caused the ulcers. Wikipedia editors can't use their opinion to override a reliable source. Also, you can't put weasel words such as "proponents of a strong psychosomatic view". See WP:OR and WP:WEASEL.
Also, I would recommend adding some information to the article about the mechanisms for psychosomatic symptoms, e.g. stress causing stomach acid, stress causing immune system changes. Probably also worth mentioning that stress causes increased herpesvirus reactivation, and increased susceptibility to the common cold. --sciencewatcher (talk) 16:17, 21 November 2015 (UTC)

Okay, but then what you have in your supporting reference is essentially some person's opinion, this needs to made clear. I will have another go trying to avoid the weasel words, while still getting across the poor evidence and controversy regarding some of these claims.

--Wilshica (talk) 22:28, 21 November 2015 (UTC)

Your last edits are good, thanks. When we use reviews in wikipedia, we don't generally say that it's that person's opinion. Here is another review, but I don't have access to the fulltext: --sciencewatcher (talk) 23:27, 21 November 2015 (UTC)

Psychosomatic medicine as dismissal[edit]

I don't have any references for this issue, so I'm raising it on the talk page in the hope that some might be found.

The "it's all in your head" dismissal is very harmful because it is unfalsifiable. There are symptoms, the patient is told that they are lying, imagining it, or bringing it upon themselves with negative thoughts. There is no differential diagnosis, because the diagnosis of psychosomatic (or somatoform, or malingering...) is leapt to. Since the illness is not dealt with, the symptoms continue, which is taken as evidence that the patient has persisted in their pesky self-harm-via-thought.

I recall a time when I went to my GP with cramps. One would presume that he might start with the assumption that I had cramps, go through some sort of differential diagnosis to work out the cause and a sensible path forward. Instead, I made the mistake of suggesting what I thought the cause might be. His response was a cunty "I wonder whether you had them before you read about that." He wrote out my regular prescriptions, and the consultation ended. He didn't even check that I'd learnt that particular cause of low electrolytes before my cramps started or not. He just decided it was definitely psychosomatic, and abandoned me to my cramps --- which did actually continue until I removed that cause.

I'm pretty sure that's not a rare occurrence: the fact that a patient suggests a diagnosis is taken as evidence for an alternative diagnosis of "it's all in your head". This creates a perverse situation where an ignorant patient is treated properly, but a well-read patient is abandoned to their painful symptoms with no further investigation.

Hopefully someone has looked into this somewhere. Correctrix (talk) 04:54, 23 July 2016 (UTC)