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]

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, internal medicine, 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

Some physical diseases are believed to have a mental component derived from the 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] However, within a psychosomatic framework, mental and emotional states are seen 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.

Denotations 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

The idea that a person's mental state can influence the course and severity of even the most severe physical diseases has led to some very strong claims. For example, it has been suggested that patients with intractable cancer may be able to survive longer if provided with psychotherapy to improve their outlook. Early studies provided some support for this view.[10][11] 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.[12] The review further argues that these unsubstantiated claims that "positive outlook" or "fighting spirit" can help slow cancer may be harmful to the patients themselves. Patients may come to believe that their poor progress results from "not having the right attitude", when in fact it may be no fault of their own.

Treatment

Psychosomatic medicine is considered a subspecialty of the fields of psychiatry and neurology. Medical treatments and psychotherapy are used to treat illnesses believed to have a psychosomatic component.[13]

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. They proposed that a patient's physiology and psychology can influence one another.[14]

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.[15] 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.[16]

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.

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 0-06-085178-3.
  4. ↑ Fink, G. (February 2011). "Stress Controversies: Post-Traumatic Stress Disorder, Hippocampal Volume, Gastroduodenal Ulceration*". Journal of Neuroendocrinology. 23 (2): 107–117. PMID 20973838. doi:10.1111/j.1365-2826.2010.02089.x.
  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 Borderline mental disorders in chronic diseases of the digestive system in children and adolescents. Zhurnal nevropatologii i psikhiatrii imeni SS Korsakova Moscow Russia 1952 (1991), Volume: 91, Issue: 8, Pages: 81-84 PubMed: 1661526
  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. ↑ 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. PMID 8357293. doi:10.1001/archpsyc.1993.01820210015002.
  11. ↑ Spiegel, D; Bloom, JR; Kraemer, HC; Gottheil, E (14 October 1989). "Effect of psychosocial treatment on survival of patients with metastatic breast cancer.". Lancet (London, England). 2 (8668): 888–91. PMID 2571815.
  12. ↑ 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. PMID 17469983. doi:10.1037/0033-2909.133.3.367.
  13. ↑ Wise, Thomas N (March 2008). "Update on consultation-liaison psychiatry (psychosomatic medicine)". Curr Opin Psychiatry. 21 (2): 196–200. PMID 18332670. doi:10.1097/YCO.0b013e3282f393ae.
  14. ↑ Deuraseh Nurdeen, Abu Talib Mansor (2005). "Mental health in Islamic medical tradition". The International Medical Journal. 4 (2): 76–79.
  15. ↑ Asaad, Ghazi (1996). Psychosomatic Disorders: Theoretical and Clinical Aspects. Brunner-Mazel. pp. X, 129–130. ISBN 978-0-87630-803-5.
  16. ↑ Erwin, Edward (2002). The Freud Encyclopedia: Theory, Therapy and Culture. Routledge. pp. 245–246. ISBN 978-0-415-93677-4.
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