[Theoretical viewpoints in psychosomatic medicine. The historical and current aspects]

Everyday cases, clinical experience, and some experimental data show that emotional life has significant and varied expressions in the body: behaviours expressed somatically, "functional" visceral disorders, and even "organic" diseases. To explain these findings, various theoretical concepts have been or are currently put forward. Taking the basic hypothesis of psychosomatics, i.e. the notion of a psyche-soma functional unit, as a starting point, the author considers these main concepts under three different lightings, which are related to the methodologic conditions under which facts are studied: 1) the physiologic approach, which underscores the significance of psychophysiologic interactions, emphasizes either the results of conditioning or those of emotions, according to the case; stress is considered under this angle; 2) the psychological approach, according to the point of view, emphasizes the following notions: life event, subjective experience, personality profile, specific conflict, conversion or regression, defective mentalization; 3) the sociologic and ecologic approach focuses on the relationships between the individual and his surroundings and gives predominance to the notion of environment factors. After a few considerations on the concept of disease and the notion of etiologic multideterminism it is recalled that therapeutic effectiveness stems from the ability to take into account both bodily and psychic distress.