Conceptual Developments in Psychosomatic Medicine: 1939-1969

The term psychosomatic medicine has undergone theoretical shifts during the last 30 years. After Cannon's initial observations of specific physiological changes accompanying specific emotions, Dunbar emphasized the relation of specific diseases to personality and life styles. Alexander introduced the ideas of illness-onset situation in terms of conflict specificity and organ vulnerability. Wolff elaborated sophisticated experimental design to investigate the relations of environment, psychological stress, and bodily reaction. Mason and others used new techniques of hormonal research to study end-organ reaction to stress. Others are focusing on intracerebral processes by which endocrine function is triggered. Miller has shown that autonomic responsivity can be conditioned. Engel and the Rochester school have emphasized illness-onset in terms of loss and development of the giving-up-given-up state with affects of displeasure, helplessness, hopelessness. Psychosomatic medicine has come to embrace all illnesses rather than 'Alexander's Holy Seven." Its preoccupation has shifted from concern with intrapsychic events and disease to emphasis on the environments in which illness occurs. A linear model of causality has given way to a cyclical model in which illness is viewed as behavior representing the final common pathway resulting from interrelated factors within the frameworks of psychology, physiology, and environment for each individual.