Psychosomatic medicine

Psychosomatic medicine is an interdisciplinary medical subspecialty that examines how emotional and mental processes affect an individual’s physical health. The relationship between the mind and the body has piqued scholarly interest for centuries, but the connection was not given true credence until the late twentieth century. Modern medicine has grown increasingly aware of the mind-body connection in relation to illness. Issues stemming from stress, anxiety, paranoia, and other psychological disorders can greatly affect a person’s physical condition and recovery process. Physical problems can also contribute to worsening mental health conditions, promoting a vicious circle of deterioration. Psychosomatic medicine focuses on ensuring a patient’s physical and psychosocial processes are given equal attention when devising a treatment plan.

Background

The term psychosomatic derives from the Greek words psyche, which means “to breathe,” and soma, which means “body.” Early human beings believed disease was the product of an evil spirit entering the body. Medicine men and women of the ancient Egyptian and Babylonian civilizations were great believers in this concept. Treatment for disease often involved methods thought to rid the body of the spirit. This included practices such as exorcism and trepanation, or drilling a hole into the head. Religion greatly influenced how ancient peoples treated disease, and as a result, medicine was approached from a more holistic viewpoint as opposed to a separate body and mind approach.

In ancient Greece, views on medicine had begun to evolve. Greek medical thought was greatly advanced by Hippocrates, who stressed the importance of medical observation. By this point, most medical scholars believed disease originated inside the body as opposed to being the result of an outside force. Disease was believed to be caused by an imbalance of fluids within the body. Greek physicians questioned this theory. Although they accepted the body fluid imbalance theory, they believed external factors were also capable of causing this imbalance.

The Greeks argued that alongside body fluid imbalance, a person’s exposure to the external environment along with his or her own personal temperament related to the progression of disease. Greek philosopher Aristotle noted that emotions such as fear, anger, joy, and courage affected the body. Hippocrates also described what we now refer to as depression, anxiety, delirium, and dementia in relation to disease.

Although the Greeks emphasized the relation between the body and the mind in disease, many physicians gave greater weight to the body over the mind. It was Greek physician Galen who pushed ideas about the influence of emotion on health in later antiquity. A follower of traditional Greek theories on bodily fluids, he believed strong emotions readily affected physical health. He documented a number of cases in which a patient reported certain symptoms characteristic of disease, but when examined showed no biological markers for the disease. His studies came to dominate medical theory and became the foundation of European medicine over the next several centuries.

During the Renaissance and early modern period, ideas about the “passions of the psyche” gained ground in medical literature. The passions were thought to be instrumental in a number of medical ailments. Such ideas were made popular in The Anatomy of Melancholy, a book by English scholar Robert Burton published in 1621. Burton pushed the idea that unchecked emotions could lead to disastrous health consequences. This period also saw the emergence of a belief in the impact of the imagination on physical health. Multiple medical essays examined imagination’s role in health, particularly in regard to pregnant women. Some doctors believed a pregnant woman’s power of imagination could have dreadful effects on the fetus, and mainstream culture interpreted this to mean that women could give birth to “monstrous” babies simply by thinking too hard about something, such as a frog or a monkey.

Even with the growth of the Scientific Revolution, traditional medical practices continued to emphasize the connection between the mental and the physical as late as the seventeenth and eighteenth centuries. Numerous pieces of medical literature recurrently examined how emotional states influenced the development of disease. These beliefs persisted into the nineteenth century, but the Scientific Revolution eventually caught up with medicine during this period. Advances in the study of human anatomy made it possible to better understand the causes and effects of diseases, especially with the growth of postmortem autopsies and advances in the understanding of human cells and tissues. The growing reliance on observable pathology led to a gap in communication between patient and doctor. Physicians primarily looked to anatomy to understand disease, and emotions became progressively detached from disease.

Despite this move toward a more narrow view of pathology, a few physicians managed to maintain a grasp on the mind-body balance emphasized in traditional medicine. These physicians hoped to find a middle ground between anatomically based pathology and theories linking emotions and disease. Scholars looked to the nervous system for a connection, studying the health of patients with mental health disorders, primarily insanity. Insanity was normally marked by postmortem unveiling of lesions in the brain, but some patients diagnosed as insane did not have any of the classic markers upon posthumous dissection. This research incited further study into the nervous system and its effect on health, and soon researchers were identifying a number of functional disruptions to the nervous system that impacted the health of a patient. By the mid-nineteenth century, functional disorders of the nervous system were being referred to as neuroses and were the subject of extensive clinical study. These studies laid the groundwork for what would become the modern field of psychosomatic medicine.

Overview

Serious inquiries in psychosomatic medicine emerged out of the research conducted around one particular neurosis that afflicted women: hysteria. Hysteria had been a topic of medical conversation since the seventeenth century, but it was not until the dawn of the twentieth century that the condition was taken seriously. By the 1870s, clinicians were executing remarkably detailed studies aimed at identifying the condition’s precise symptomology and medical course. Within several decades, and with the advent of practices such as hypnosis, researchers were realizing the neurophysiological and psychological origins of hysteria. These studies piqued the interest of several notable medical and psychology scholars of the period, and soon the two fields began to intermingle.

The beginning of the 1900s saw a number of advances bolstering the connection between mind and body. Sigmund Freud introduced the world to psychoanalysis and later became largely interested in the way mental processes affected physical health, incorporating his studies into his practices. Following the end of World War I in 1918, returning soldiers experienced a number of psychological symptoms related to the traumas of war. Examinations of these men led to further progress in psychosomatic medicine. Publications detailing the tenets of psychosomatic medicine cropped up in the ensuing decades, and the term itself gained ground following the publication of Helen Flanders Dunbar’s Emotions and Bodily Changes in 1935. The American Psychosomatic Society was formed shortly after, and the journal Psychosomatic Medicine was founded in 1939. Interest in psychosomatic medicine continued to increase following the outbreak of World War II, and when the war ended in 1945, the American government was quick to provide psychiatric treatment to soldiers suffering from conditions such as shell shock.

Psychosomatic medicine took off after the war. Between the 1940s and 1950s, scientific literature related to psychosomatic medicine vastly increased, and soon medical schools were incorporating the field into school curriculums. Interest in psychosomatic medicine extended beyond the clinical setting and found its way into mainstream culture. Popular magazines such as Reader’s Digest regularly featured articles about psychosomatic topics, and psychosomatic jargon even found its way into entertainment such as Broadway shows.

Psychosomatic medicine made great leaps in the latter half of the twentieth century into the twenty-first century. Researchers linked mental and emotional processes to physical illness on a variety of levels, leading to the identification of psychosomatic disorders. On one end, psychosomatic disorders could include physical disease caused by or made worse by mental or emotional factors. On the other end, psychosomatic disorders could also refer to physical symptoms caused by mental factors without the presence of a specific disease. These types of disorders are often referred to as somatoform disorders.

Feelings of stress, anxiety, and depression as well as more severe degrees of mental illness were common markers of psychosomatic disorders in many patients. At the same time, physical illness was also capable of promoting the onset of such mental disorders. Scientists also identified several other common factors that affected the onset of psychosomatic disorders, such as genetic and environmental influences, personality traits, biological predispositions, and learned behavior. Psychosomatic medicine treated a wide range of diseases and conditions believed to be made worse by mental factors. These included skin disorders such as eczema and psoriasis, high blood pressure and heart problems, and gastrointestinal disorders. Treatment courses depended on the presentation of symptoms and could include medical and psychological therapies.

Although the status of psychosomatic medicine as its own specific subfield has been a subject of debate, related research and concepts are routinely incorporated into a variety of medical and psychological disciplines such as neurology, behavioral medicine, internal medicine, immunology, psychology, and psychiatry. Critics of psychosomatic research argue that not enough empirical research is available to substantiate the connection between a patient’s physical and mental states. Proponents argue that medical doctors need to be more attentive to the dynamic relationship between the psyche and overall health.

Bibliography

Blumenfield, Michael, and Maria Tiamson-Kassab, editors. Psychosomatic Medicine: A Practical Guide. Lippincott Williams & Wilkins, 2009.

“Emotions and Disease.” National Library of Medicine, www.nlm.nih.gov/exhibition/emotions/index.html. Accessed 7 Jan. 2019

Fritzsche, Kurt, et al., editors. Psychosomatic Medicine: An International Primer for the Primary Care Setting. Springer Science & Business Media, 2014.

Levenson, James L. Essentials of Psychosomatic Medicine. American Psychiatric Press, 2006.

Martin, M.J. “Psychosomatic Medicine: A Brief History.” Psychosomatics, vol. 19, no. 11, 1978, pp. 697–700.

Melmed, Raphael N. Mind, Body and Medicine: An Integrative Text. Oxford UP, 2001.

Philbrick, KemuelL. Clinical Manual of Psychosomatic Medicine. American Psychiatric Publishing, 2014.

“Psychosomatic Disorders.” Center for Anxiety Disorders, centerforanxietydisorders.com/treatment-programs/psychosomatic-disorders/. Accessed 8 Jan. 2019.

“Psychosomatic Medicine.” Encyclopedia of Health Psychology. Kluwer Academic/Plenum Publishers, 2004.