Psychosomatic Medicine

The term psychosomatic is derived by combining two Greek roots, psyche (“mind”) and soma (“body”). Psychosomatic medicine refers both to a scientific paradigm and medical institutions (journals, textbooks, learned societies, medical schools) that are premised on the inextricable physiological relationship between mind and body. The psychosomatic approach to research, education, and treatment acknowledges the potential contributions of emotions and psychological states to the onset, exacerbation, course, and recurrence of disease. Psychosomatic medicine can be contrasted to health psychology or medical sociology in its relative emphasis on physiological processes as opposed to psychological (social-cognitive, behavioral) processes or socioeconomic conditions.

History of Psychosomatic Medicine

Psychosomatic concepts have been discussed for millennia. The term psychosomatic medicine was used more frequently after the 1935 publication of Helen Flanders Dunbar’s Emotions and Bodily Changes. The formation of the American Psychosomatic Society and the creation of its influential flagship journal Psychosomatic Medicinein 1939 were other defining events.

Psychosomatic medicine insinuated itself into American culture by the late 1940s. Popular magazines such as Readers Digest featured articles on psychosomatic topics. Not coincidentally, psychoanalysis also gained popularity at that time. In 1950, Franz Alexander likened psychosomatic specificity to microbial specificity in his attempt to reconcile psychoanalytic theory with mainstream medicine. His approach provided a stark contrast to the psychoanalysis of the 1920s, when Georg Groddeck, a self-proclaimed “wild” analyst, maintained that all physical conditions, including myopia, represented unconscious conflicts. (After hearing Groddeck deliver a presentation, Sigmund Freud asked him whether he meant to be taken seriously; Freud supported him nonetheless.)

From Alexander’s perspective, diseases such as asthma or ulcers resulted from unresolved needs and intrapsychic conflicts. Alexander’s bold but unsuccessful attempt to appeal to his physician colleagues may have contributed to the marginalization of psychosomatics within internal medicine. Still, psychosomatics gained momentum in psychiatry. The Academy of Psychosomatic Medicine, an organization of psychiatrists, was founded in 1954. Its official journal, Psychosomatics, was launched in 1960.

While Alexander and other psychoanalytic investigators pursued creative if occasionally strange ideas with dubious validity, the 1950s and 1960s saw a dramatic increase in research on the health consequences of stress. Devoid of psychoanalytic content, these studies ushered in a new era in psychosomatics. The endocrinologist Hans Selye examined the deleterious effects of an overactive hypothalamic-pituitary-adrenal axis, Hinkle and Wolff conducted groundbreaking research in social epidemiology, and experiments demonstrated that animals subjected to stress show greater susceptibility to infection. A multidisciplinary, empirically driven psychosomatic medicine emerged from the shadow of psychoanalysis. Stress, not intrapsychic conflict or unconscious motivation, took center stage in this new paradigm.

Is Psychosomatic Medicine Merely a Historical Novelty?

The institution of psychosomatic medicine has not been particularly successful. Witness its peripheral role in the curriculum of most medical schools, the long-term trend toward reductionism in internal medicine and even in psychiatry, and the failure of the label “psychosomatic medicine” to appear anywhere on the organizational chart of the National Institutes of Health. Still, the ascendancy of new journals, societies, and textbooks in the 1980s and 1990s devoted to psychyoneuroimmunology and psychoneuroendocrinology testifies to the power, validity, and heuristic value of the fundamental premise of the psychosomatic paradigm, the inextricable physiological relationship between mind and body.