Psychosomatics

BIBLIOGRAPHY

The term psychosomatic relates primarily to a physical concern, symptom, or illness of the body originating from emotional and thinking processes. The psychosomatic is born from an appreciation that the mind influences the body and the body influences the mind, and that pathology is the multifactoral product of biological, psychological, and social processes.

Historically, psychosomatic referred to the adverse impact that psychic and hysterical struggles exerted onto physical functioning and illness. Many illnesses (asthma, tuberculosis, allergies, chronic headaches, epilepsy, fibromyalgia, hypertension, interstitial cystitis, irritable bowel syndrome, etc.) were initially, in a pejorative manner consistent with the zeitgeist of the times, conceptualized and evaluated as being hysterical reactions to psychic disturbances. In this mostly psychodynamic context promoted by Josef Breuer (1842-1925), Sigmund Freud (1856–1939), and other theorists, the term psychosomatic illness was used to describe physical symptoms and diseases whose primary etiologies were emotional and mental processes.

More recently, a psychosomatic illness is conceptualized as one whose etiology cannot be described by physical or organic causes or whose etiology is idiopathic. In cases of unknown or ambiguous onset, anger, hostility, repressed sexual tension, and guilt are often ascribed as etiological precipitants of disease. In other cases, even when significant biological factors clearly influence the onset and course of illness but psychic disturbance is saliently present (depression, anxiety, hostility, etc.), the term psychosomatic is also used to reference the interaction of psychiatric and biological processes on symptom and disease manifestation.

Consequently, psychosomatic illnesses refer to symptoms or diseases that have psychic onset or psychic influences on the course, duration, or resolution of symptoms. Notably, psychosomatic illnesses have real symptoms and are diseases with real physical manifestations. This distinction is important in comparison to disorders where motivational and conscious factors characteristic of the patient influence the reporting of feigned diseases. For example, as a psychosomatic manifestation, the gastrointestinal symptoms associated with irritable bowel syndrome (diarrhea, constipation, or abdominal pain and cramping) may increase during periods of prolonged or intense emotional stress. Similarly, the magnitude of an asthmatic onset may be reduced with relaxation, focused deep breathing, or other behavioral techniques that alter physiology.

As in the previous example, psychosomatic illnesses have brought about a focus on interventions that exploit the known relationship between the mind and body. The study of such interventions is known as psychosomatic medicine, and the journal that is most aligned with this pursuit is Psychosomatic Medicine, the official journal of the American Psychosomatic Society. In its basic conceptualization, psychosomatic medicine is the science of treating the mind and body toward the reduction of morbidity and mortality.

The methodology of inquiry, as well as the topics explored by clinicians and researchers who practice and study psychosomatic medicine, have evolved over many years. Most often, the scientific inquiry and reviewers’ and editors’ choices for published articles have been reflective of scientific and societal priorities at the time.

One of the best discussions of this evolution in methodologies and priorities for clinicians and researchers appears in a review article in Psychosomatic Medicine of papers published in the journal on the topic of pain from 1940 to the end of the 1990s (Keefe et al. 2002). The authors found that in the 1940s “case studies” were one of the major methodologies published on the topic. However, by the 1950s the number of such publications had decreased by more than 50 percent, and by the 1970s case studies were rarely published in the journal. In contrast, the number of published studies exploring the role of personality traits and individual differences on pain was relatively small in the 1940s, but it had increased more than 400 percent by the end of the 1990s.

More reflective of deeply rooted societal beliefs about race and ethnicity, there were no studies published on the impact of race, ethnicity, and culture on pain in the 1940s, 1950s, or 1960s in Psychosomatic Medicine. Two such studies appeared in the journal in the 1970s, and only one was published in the 1980s. Only four articles were published on racial and ethnic influences on pain in the 1990s, for a total of seven across sixty years. This lack of published studies is interpreted as demonstrative of the infancy of general interest, knowledge, and understanding of racial and ethnic influences on medical outcomes in society, medicine, and psychosomatic medicine.

Issues of gender differences in psychosomatic illnesses have a much more robust and long history within psychosomatic medicine. The first studies of gender on the prevalence and experiences of pain appeared in Psychosomatic Medicine in the 1950s. There was a steady number of publications on this topic throughout the 1950s, 1960s, and 1970s, with a rise in the 1980s and a fourfold increase in the 1990s. A similar pattern in the number of published articles after 1980 can be seen for pain induction studies and pain treatment studies.

The current state of psychosomatic medicine seems embedded in the historical roots of the discipline and is focused on such issues as coping and the impact of psychological constructs like depression and anxiety on biological, neurological, endocrine, and other symptom and disease-related outcomes. Although the horizon is bright with an increased number of studies that focus on individual differences and the impact of demographic factors like race, ethnicity, age, and geographic region on disease-related outcomes, there is still much work to be done.

As evidence of a new global environment and a terrorism-conscious world, experts in psychosomatic medicine are increasingly involved in the development of health policies and are advocates for the collaboration between medical practitioners and public health officials toward more effective responses to international and local threats. Many government officials have begun to recognize the unique skill sets that experts in the field possess and are utilizing these skills to more effectively implement public health policy. The use of advanced statistical methodologies by researchers in psychosomatic medicine allows for the development of more ecologically valid predictive models of human health and behavior. Journals such as Psychosomatic Medicine and Psychosomatics highlight the zeitgeist of the discipline and provide a forum for scientific communication among researchers.

SEE ALSO Disease; Medicine; Pathology, Social; Personality; Psychology; Psychopathology; Psychosomatics, Social; Psychotherapy; Public Health

BIBLIOGRAPHY

Blumenfield, Michael, and James J. Strain. 2006. Psychosomatic Medicine. Philadelphia: Lippincott.

Keefe, Francis J., Mark A. Lumley, Angela Buffington, et al. 2002. The Changing Face of Pain: Evolution of Pain Research in Psychosomatic Medicine. Psychosomatic Medicine 64: 921–938.

Kubo, Chiaru, and Tomifusa Kubok, eds. 2006. Psychosomatic Medicine: Proceedings of the 18th World Congress on Psychosomatic Medicine. New York: Elsevier.

Van Tilburg, Miranda, Cynthia C. McCaskill, James D. Lane, et al. 2001. Depressed Mood Is a Factor in Glycemic Control in Type 1 Diabetes. Psychosomatic Medicine 63: 551–555.

Christopher L. Edwards

Camela McDougald