Psychosomatic medicine: some past and current concepts

Recognition of the body-mind dilemma goes back to antiquity. Growth in medical knowledge has produced an ever increasing emphasis on physiological deviations and somatic pathology--which too often is not accompanied by sufficient attention to the total patients. Psychosomatics is now the term often used by those who believe that illness in man is not usually caused by a single etiological agent. The American Psychosomatic Society succeeded in correlating biological processes with psychodynamics. The Academy of Psychosomatic Medicine had its roots in the belief that psychosomatic medicine belonged to all of medicine. Its goals were to close the gap between medicine and psychiatry. The Japanese Psychosomatic Society chose the best of both in setting its goals. Dunbar's personality profiles and Alexander's concept of specific conflicts are reviewed. Depression is seen to be a common core. Further correlations between depression and psychosomatic illness are evidenced by the work of Greene, Schmale and Engel. The contributions of Nemiah and Sifneos are reviewed. Many psychosomatic patients are noted to be incapable of expressing adequate feelings, which may account for the frequent failure of classical psychoanalytic techniques. The history of research is also reviewed. The role of biochemistry, neurophysiology and psychopharmacology in the understanding and management of psychosomatic problems is examined.