[From body to mind: the psychoanalytic approach to patients with chronic pain]

Psychosomatic Medicine in Germany is a very sophisticated and elaborated disciplin in the health care system. The system of psychosomatic care in Germany is organized from the basic care of the general practitioner to the integrated multimodal psychosomatic inpatient treatment. This development is due to a big growth of psychosomatic need of treatment in the society. So the introduction of a new specialist of Psychosomatic medicine and psychotherapy in 1993 was a logical consequence of this development. Moreover it is the intention of this article to look for some historical explanations for the fact that this development of psychosomatic medicine was especially in Germany after the second world war. Chronic somatoform pain patients are suffering from pain as if the pain was caused by an injury of tissue. In this article is shown how and why the pain that is caused by deep powerlessness, lost of objects, traumatization can by turned from psychic to physical pain. The role of childhood experiences and the lack of mentalization and symbolization capacity is discussed. As the pain is felt as a somatic pain by the patients it needs a special attitude and psychoanalytic technique to treat this patient successfully. Therefore we need additional methods like art therapy and concentrative movement therapy to involve these patients. For this treatment we need a special setting by integrative multimodal psychosomatic inpatient or day clinic treatment. This way that is very developed in Germany is discussed and shown.