Historical Perspective of Contemporary Psychosomatic Medicine

The great triumphs of 19th century scientific medicine in the fields of morbid anatomy, microbiology and biochemistry resulted also in a narrowly organic orientation which fostered increasing specialization and a neglect of the psychological aspects of medicine. Freud, Pavlov and Cannon paved the way for the introduction of the psychosomatic approach to medical practice and research. Their methods and theories offered potential tools for the measurement of emotions and access to repressed, unconscious, psychological content. The psychosomatic movement which started in Germany and Austria was further elaborated through the psychosomatic research of American psychiatrists and particularly psychoanalysts, with psychologists increasingly entering the field. Gradually, interest in the psychodynamics and psychoanalytic treatment of patients with psychosomatic disorders yielded to a growing exploration of the place of environmental stress, consultation psychiatry and pharmacotherapy in psychosomatic disorders. As laboratory studies have burgeoned, occasional rifts have occurred between those in basic psychosomatic research and those in applied psychosomatic medicine. The numerous conceptual models of mind-body relationships in general and psychosomatic diseases in particular are summarized and discussed. While uncertainty abounds and initial hopes of finding an exclusive psychogenic explanation for puzzling diseases and methods of treating them easily by psychotherapy have not materialized, the psychosomatic approach has nonetheless had a profound impact on medicine.