Psychosomatic medicine

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.[1]

For the medical journal, see Psychosomatic Medicine (journal).

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, psychoanalysis, internal medicine, pediatrics, 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.[2]

Psychosomatic disorders
Main article: Psychoneuroimmunology

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 and high blood pressure, which some researchers have suggested may be related to stresses in everyday life.[3] 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, 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.[4] 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.[5]

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.[6][7] 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[8] 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.[9] 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.[10][11][12] 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.[13] 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.[14]

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 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.[15]

Treatment

While in the US, 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.[16] Medical treatments and psychotherapy are used to treat illnesses believed to have a psychosomatic component.[17]

History

In the medieval Islamic world the Persian psychologist-physicians 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 and psychology can influence one another.[18]

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.[19] 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.[20]

In the 1970s, Thure von Uexküll and his colleagues in Germany 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.[21] 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, 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. Most of them did not actually experience a stroke, but the largest number presented a day after Tedy Bruschi, 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.[22]

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.[23]

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.[24]

Caroline Myss in her book, “Creation of health”, says that our life history and experiences, become intertwined with the cells of our physical body. She has stated that "Your biography becomes your biology."

See also

References
  1. Uexküll, Thure von (ed.), 1997. Psychosomatic Medicine. München: Urban & Schwarzenberg.
  2. Levenson, James L. (2006). Essentials of Psychosomatic Medicine. American Psychiatric Press Inc. ISBN 978-1-58562-246-7.
  3. Sarno, John (2006). The Divided Mind. ReganBooks. ISBN 978-0-06-085178-1.
  4. Fink, G. (February 2011). "Stress Controversies: Post-Traumatic Stress Disorder, Hippocampal Volume, Gastroduodenal Ulceration*". Journal of Neuroendocrinology. 23 (2): 107–117. doi:10.1111/j.1365-2826.2010.02089.x. PMID 20973838.
  5. Melmed, Raphael N. (2001). Mind, Body and Medicine: An Integrative Text. Oxford University Press Inc, USA. pp. 191–192. ISBN 978-0-19-513164-2.
  6. Skumin, V. A. (24 January 1991). "[Borderline mental disorders in chronic diseases of the digestive system in children and adolescents]". Zhurnal Nevropatologii Psikhiatrii Imeni S. S. Korsakova. 91 (8): 81–4. PMID 1661526. Archived from the original on 4 March 2016. Retrieved 2 March 2012.
  7. Skumin, VA (1982). Непсихотические нарушения психики у больных с приобретёнными пороками сердца до и после операции (обзор). [Nonpsychotic mental disorders in patients with acquired heart defects before and after surgery (review)]. Zhurnal Nevropatologii I Psikhiatrii Imeni S.S. Korsakova (in Russian). 82 (11): 130–5. PMID 6758444.
  8. I. H. Treasaden, Basant K. Puri, P. J. Laking (2002). Textbook of Psychiatry. Churchill Livingstone. p. 7. ISBN 978-0-443-07016-7.
  9. Greco, Monica (1998). Illness as a Work of Thought: Foucauldian Perspective on Psychosomatics. Routledge. pp. 1–3, 112–116. ISBN 978-0-415-17849-5.
  10. Helm Stierlin, Ronald Grossarth-Maticek: Krebsrisiken – Überlebenschancen: Wie Körper, Seele und soziale Umwelt zusammenwirken. 3rd edition, Carl-Auer-Verlag, Heidelberg 2006, ISBN 978-3896705341.
  11. Fawzy, FI; Fawzy, NW; Hyun, CS; Elashoff, R; Guthrie, D; Fahey, JL; Morton, DL (September 1993). "Malignant melanoma. Effects of an early structured psychiatric intervention, coping, and affective state on recurrence and survival 6 years later". Archives of General Psychiatry. 50 (9): 681–9. doi:10.1001/archpsyc.1993.01820210015002. PMID 8357293.
  12. Spiegel, D; Bloom, JR; Kraemer, HC; Gottheil, E (14 October 1989). "Effect of psychosocial treatment on survival of patients with metastatic breast cancer". Lancet. 2 (8668): 888–91. doi:10.1016/s0140-6736(89)91551-1. PMID 2571815. S2CID 8445427.
  13. Coyne, JC; Stefanek, M; Palmer, SC (May 2007). "Psychotherapy and survival in cancer: the conflict between hope and evidence". Psychological Bulletin. 133 (3): 367–94. doi:10.1037/0033-2909.133.3.367. PMID 17469983.
  14. Troke, Sarah (2017-07-03). "Authors of our own misfortune? The problems with psychogenic explanations for physical illnesses". Disability & Society. 32 (6): 931–933. doi:10.1080/09687599.2017.1321239. ISSN 0968-7599.
  15. Rueckert, Kamiar-K. (15 December 2017). "The Nameless Disease". in-training. Retrieved 5 February 2018.
  16. von Uexküll, Thure (2017). Psychosomatische Medizin. pp. 245–246. ISBN 978-3-437-21833-0.
  17. Wise, Thomas N (March 2008). "Update on consultation-liaison psychiatry (psychosomatic medicine)". Curr Opin Psychiatry. 21 (2): 196–200. doi:10.1097/YCO.0b013e3282f393ae. PMID 18332670. S2CID 40136135.
  18. Deuraseh Nurdeen, Abu Talib Mansor (2005). "Mental health in Islamic medical tradition". The International Medical Journal. 4 (2): 76–79.
  19. Asaad, Ghazi (1996). Psychosomatic Disorders: Theoretical and Clinical Aspects. Brunner-Mazel. pp. X, 129–130. ISBN 978-0-87630-803-5.
  20. Erwin, Edward (2002). The Freud Encyclopedia: Theory, Therapy and Culture. Routledge. pp. 245–246. ISBN 978-0-415-93677-4.
  21. Kunz, Edward (1 March 2014). "Henri Laborit and the inhibition of action". Dialogues in Clinical Neuroscience. 16 (1): 113–117. PMC 3984888. PMID 24733976.
  22. Why is it so hard to track the source of a food poisoning outbreak?
  23. "When your biography becomes your biology". Vesna Hrsto. 2014-09-16. Retrieved 2020-01-24.
  24. "Explorer of the Brain, Bodymind & Beyond". Candace Pert, PhD. Retrieved 2020-01-24.
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