[The future of psychosomatic medicine in West Germany--an illusion?]

Due to historical developments the structure and function of German Psychosomatics is unique in the world. Hence, to predict its future is difficult. There is the intimate conjunction of psycho-somatics with psychotherapy and the mandatory teaching of this combination to medical students, so that every medical school has to have a corresponding department and that most of these are psychoanalytically orientated. Medical care insurances finance psycho-therapy to a degree unknown in any other country. Then, in excess of the 700 beds for psychosomatics/psychotherapy in university and communal hospitals, the FRG provides another 4000 beds which are legally, financially and geographically separated from the former. Epidemiological data show that in spite of the above average out-patient financing many patients in need are not treated psychotherapeutically until their working capacity is reduced by which they become subject to another (and separate) legal system: The law of rehabilitation the measures of which are financed by the federal or state pension funds. At this late stage only in-patient psychosomatic treatment has some chance of rehabilitation. Hence, in cooperation with private entrepreneurs or non-profit organizations the above-mentioned over 4000 additional beds were provided. Two examples show that the effects of psychotherapy with somatic illness (myocardial infarction and metastatic cancer) are remarkable but discrete and their full impact can only been seen after several years. These features probably explain the habitual underestimation of psychotherapy in medicine.