Changing concepts in psychosomatic theory. I. Historical analysis

Psychosomatic medicine has utilized static, linear, two-dimensional models in attempting to identify a causative relationship between psychosocially conceptualized events and biologically conceptualized ones. This has led to inherent difficulties that are logistically unresolvable. For example, the different language systems lend themselves to overlap with the possibility of addressing themselves to describing manifestations of the same phenomenon from dissimilar conceptual orientations. The problem is further complicated by attempting to link these together in a temporal sequence suggesting a causal relationship. We have ignored both feedback processes in terms of a sequential process modifying a preceding one and the possibility that a reverse order of relationships might explain some processes. In our quest for specificity, we have ignored that disease states are not static ones any more than is life but change over time, suggesting that alterations will occur in the original relationships proposed among our different systems of conceptualization. Among the remedies suggested for a reordering of our thinking are: (a) a revision of linear unidirectional causative models to cyclical bidirectional models; (b) a reformulation of two-dimensional temporal linear relationships toward three-dimensional spherical ones which overlap in time; (c) the relating of these aspects not to each other but to a third factor, common to the three which remains to be identified; (d) the development of a language that bridges the psychological, social and biological.