Psychosomatic medicine

Psychosomatic illness
Classification and external resources
ICD-10 F40 - F48
ICD-9 300-316

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.

Psychosomatic medicine integrates interdisciplinary evaluation and management involving diverse specialties, including but not limited to psychiatry, psychology, neurology; surgery; gynecology; pain management; pediatrics; dermatology; and psychoneuroimmunology. Clinical situations where psychological processes act as a major factor affecting medical outcome and affecting medical compliance and/or surgical results are areas where Psychosomatic medicine has competence.[1] A major European textbook on psychosomatic medicine (over 1000 pp, six German editions) is the one edited by Thure von Uexküll.[2]

Contents

Psychosomatic disorders

Sufferers of psychosomatic illness are experiencing pain, nausea, or other physically felt symptoms, but with no physical cause that can be diagnosed.

Physical complaints may have a defined psychological cause, including conversion disorder, somatization disorder, and tension myositis syndrome, while some physical conditions like vitamin deficiency or brain injury can cause major psychological symptoms. When the cause of a condition is uncertain, the possibility that it is psychosomatic is often considered. The support for such a view may be slow to entirely disappear when the physical nature of the disorder finds consensus, with residual controversies remaining, as is the case for peptic ulcers and chronic fatigue syndrome. A complicating factor is that there is a psychological influence on the risk and development of many physical conditions, such as heart disease.

History

Sigmund Freud

Until the seventeenth century, hysteria was regarded as of uterine origin (from the Greek "hustera" = uterus) in the Western world. The ancient Greeks believed that the uterus could detach itself and move about the body, and hysterical symptoms would emanate from the part of the body in which the wandering uterus lodged itself.[3]

In the medieval Islamic world, the Muslim psychologist-physicians, Ahmed ibn Sahl al-Balkhi (d. 934) and Haly Abbas (d. 994), developed an early understanding of psychosomatic disorders. They realized how a patient's physiology and psychology can have an effect on one another, and found a correlation between patients who were physically and mentally healthy and those who were physically and mentally ill.[4] Avicenna (980-1037) recognized 'physiological psychology' in the treatment of illnesses involving emotions, and developed a system for associating changes in the pulse rate with inner feelings, which is seen as an anticipation of the word association test later developed by Carl Jung.[5]

In the 1840s and 1850s, hysteria was already the subject in medical textbooks and specialized studies as i. e. the "Traité Clinique et Therapeutique de L'Hysterie" published in 1859 by Pierre Briquet.[6][7] In the 1870s, hysteria was also studied by Jean-Martin Charcot.[8] Charcot wanted to demonstrate recurrent clinical characteristics in hysterical symptoms, similarly to neuropathological disorders. Through observation and the use of a camera Charcot was able to record some recurrent clinical features of hysteria and with the use of hypnosis he researched into hysterical neurosis and its associated neurological mechanisms.[9]

Franz Alexander led in the beginnings of the 20th century, the movement looking for the dynamic interrelation between mind and body.[10] 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.[11]

Important distinctions were noted that led to the realization that hysterical disorders were different from the non-hysterical version of the same disorder. Patients were found who had a body part (i.e. a hand) that was paralyzed or numb; however the shape of the afflicted part did not match the shape of paralysis caused by disease or damage to specific nerves in the body. This was referred to as a "glove paralysis" since sometimes the afflicted area took the form of a glove. Similarly, some patients appeared to be blind, but they strangely did not seem to exhibit the limitations that persons with conventional, biologically-caused blindness would display. These anomalies tipped off researchers that the causal process for these diseases was different from conventional disease or injury.

Many identifiable illnesses have previously been thought of as 'hysterical' or 'psychosomatic', for example asthma, allergy, false pregnancy, coeliac disease, peptic ulcer and migraine. For some illnesses consensus has yet to be established, including multiple chemical sensitivity and Gulf War syndrome.

Some conditions and their manifestations make sometimes very difficult to classify a disorder as purely Psychosomatic. One example is Irritable Bowel Syndrome (IBS) that once was considered as having purely psychosomatic causes, but later research showed that defined functional responses in organ motility reflected structural changes involved in the causes and therefore IBS could no longer be defined solely as psychosomatically induced.[12]

Some modern diseases are believed to have a psychosomatic component derived from the stresses and strains of everyday living. This is the case, for example, of lower back pain and high blood pressure, that appears to be partly related to stresses in everyday life. The particular ways that the body converts psychological distress to physical symptoms, varies over time and differs across cultures. An example are the specific kinds of psychosomatic symptoms found among Victorian-era women in America and western Europe which have largely disappeared. Anthropologists have noted that culture plays an important role in which particular somatic expression results from a given internal psychological experience.

Since 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.

Modern connotations

The term "psychosomatic" has developed a negative connotation in popular health subjects, being erroneously associated with malingering, mental illness or delusion, adding further psychological injury to the sufferer.[13]

In modern society, psychosomatic illness has often been attributed to stress,[14] making stress management an important factor in the development, amelioration or avoidance of psychosomatic illness.[13]

Psychosomatic disorders and aging

The natural aging has a notable influence in the exacerbation or the development of psychosomatic disorders, most specifically in those generated by depression. This is caused by major life-events which usually happen more often when a person ages. Of particular influence are the loss of parents and other relatives, the loss of spouse, retirement and the onset of physical disorders characteristic of aging.[15]

Treatment

Psychosomatic medicine is considered a subspecialty of psychiatry and neurology. Medical settings including psychotherapy are used to treat psychosomatic disorders.[16]

See also

References

  1. ↑ Levenson, James L. (2006). Essentials of Psychosomatic Medicine. American Psychiatric Press Inc. ISBN 978-1585622467. 
  2. ↑ Uexküll, Thure von (ed.) (1997). Psychosomatic Medicine. Urban & Schwarzenberg, München. ISBN 3541135115. 
  3. ↑ Elaine Showalter, Sander L. Gilman, Helen King, Roy Porter, G. S. Rousseau (1993). Hysteria Beyond Freud. University of California Press. ISBN 978-0520080645. 
  4. ↑ Nurdeen Deuraseh and Mansor Abu Talib (2005), "Mental health in Islamic medical tradition", The International Medical Journal 4 (2), p. 76-79.
  5. ↑ Ibrahim B. Syed PhD, "Islamic Medicine: 1000 years ahead of its times", Journal of the Islamic Medical Association, 2002 (2), p. 2-9 [7].
  6. ↑ Harold Merskey, Francois M. Mai and (1980), "Briquet's Treatise on Hysteria", Archives of General Psychiatry 37: 1401-1405 .
  7. ↑ Harold Merskey, Francois M. Mai and (1981), "Briquet's Concept of Hysteria: An Historical Perspective", Canadian Journal of Psychiatry 26: 5763 .
  8. ↑ Goetz, Christopher G. (1995). Charcot: Constructing Neurology. Oxford University Press. ISBN 978-0195076431. 
  9. ↑ Levin, Kenneth (1978). Freud's early psychology of the neuroses: A historical perspective. University of Pittsburgh Press. ISBN 978-0822933663. 
  10. ↑ Asaad, Ghazi (1996). Psychosomatic Disorders: Theoretical and Clinical Aspects. Brunner-Mazel. pp. X, 129-130. ISBN 978-0876308035. 
  11. ↑ Erwin, Edward (2002). The Freud Encyclopedia: Theory, Therapy and Culture. Routledge. pp. 245-246. ISBN 978-0415936774. 
  12. ↑ Melmed, Raphael N. (2001). Mind, Body and Medicine: An Integrative Text. Oxford University Press Inc, USA. pp. 191-192. ISBN 978-0195131642. 
  13. ↑ 13.0 13.1 Greco, Monica (1998). Illness as a Work of Thought: Foucauldian Perspective on Psychosomatics. Routledge. pp. 1-3, 112-116. ISBN 978-0415178495. 
  14. ↑ I. H. Treasaden, Basant K. Puri, P. J. Laking (2002). Textbook of Psychiatry. Churchill Livingstone. pp. 7. ISBN 978-0443070167. 
  15. ↑ Donaldson, L.J. and R.J. (2003). Essential Public Health. Petroc Press - LibraPharm Limited. pp. 352. ISBN 978-1900603874. 
  16. ↑ Wise TN (March 2008). "Update on consultation-liaison psychiatry (psychosomatic medicine)". Curr Opin Psychiatry 21 (2): 196–200. doi:10.1097/YCO.0b013e3282f393ae. PMID 18332670. 

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