What is Psychosomatics?

Psychosomatics is a scholarly discipline of medicine with a rich history. The term psychosomatic was coined in 1818 by Johan Heinroth, and the words psychosomatic medicine is known to be used around 1912; the term being a combination of psychological and body function. Contributing to the development of psychosomatic medicine are the fields of psychoanalysis and psycho-physiologists that work with the mind-body interaction (Levenson, 2005).

As one looks towards the other non-medical and non-therapeutic fields, one also stumbles upon the philosophers like Maurice Merleau-Ponty, who had taken the non-dualistic view that that the ideological separation of mind and body is erroneous. In Phenomenology of Perception originally published in 1945, Merleau-Ponty explains that the body is consciousness, and not separate from the mind: “Bodily experience forces us to acknowledge an imposition of meaning, which is not the work of a universal-constituting consciousness, a meaning which clings to certain contents. My body is the meaningful core which behaves like a general function, and which, nevertheless, exists and is susceptible to disease” (Merleau-Ponty, 2004).

Levenson (2005), in citing three general groups of patients— i.e. “those with comorbid psychiatric and general medical illnesses complicating each other’s management, those with somatoform and functional disorders, and those with psychiatric disorders that are the direct consequence of a primary medical condition or treatment”— gives us an idea of how psychosomatic disorder is considered by the medical profession; that medical and psychological are linked in a way that one is a cause of the other. The perspective of Merleau-Ponty’s writings—and psychotherapists from modalities that are founded on the phenomenological experience— begs to differ from this point-of-view. They consider both medical and psychological ailments are one and the same thing.

A Holistic Point of View

This phenomenological viewpoint marks the movement towards holistic recognition of the connection between what we perceive as mental and physical cause-and-effects of illnesses and the respective treatment of symptoms. This attitude makes psychosomatics stand out from other disciplines of medicine. There is also the implicit recognition that patients suffering from organic diseases recover better with integration of medial and psychological therapy than with just medicine alone.

Historical Concepts of Psychosomatic Medicine

That psychosomatic medicine is considered a new discipline in the medical profession is paradoxical to the history of medicine itself.  Millennia before construct of physics, primitive man understood phenomenologically how his own psyche affected his physical actions, in so doing, attributed the forces of nature to human-like emotional states as well (Alexander, 1962).  This natural sensitivity of human beings to perceive mind and body as inseparable concepts is evident in traditional and folk medicine. Traditional Chinese medicine (TCM) is a good example since it developed independently and possesses written records dating back to 1500 BC (Tseng, 1973).

TCM is based primarily on the idea of correspondence between organism (microcosm) and its environment (macrocosm). Like the “primitive man” idea described by Alexander (1962), this is a belief in the conceptual connection between the body and nature. TCM considers human emotions the “vital air” in the body, which has its equivalence in nature. The body is characterized by its visceral organs. Patients frequently describe their psychiatric problems in terms of organs, like “exercised heart” to give meaning to apprehension, “injured heart” to mean sadness, and “elevated liver fire” to mean agitation and tension (Tseng, 1973). Since psychological problems are deemed somatic and organ-based, ancient Chinese did not separate psychiatric disorders from other medical illness.

Attempts at explanation of natural phenomena is a preoccupation of western civilization, commonly traced to Greek cosmologists of the pre-Socratic era at around 600 BC- 400 BC. Substances like water, air and fire were used – almost metaphorically— to give material foundation for explaining illnesses. Similar ideas were also seen in the medicine of other cultures like those in the Islamic world, Tibet and India (Sabernig, 2016).  This materialist way of understanding disease afflictions can be extrapolated to the modern-day reductionist scientific thinking. The milestone of this idea is popularly traced to Hippocrates in 400 BC, who declared the cause of epilepsy to be material in nature with nothing to do with the “sacred” (Alexander, 1962).

Interestingly enough, when one traces the roots of dynamic psychiatry, one is led to the very concept that Hippocrates disproved in the early days: the idea that demonology has anything to do with the physical condition. In almost every culture, there existed faith healing. Medical anthropologists like Forest E. Clement and Erwin H. Ackerknecht in his early 20^th century attempted to systematize primitive medical beliefs and practices. Clement categorized disease theory of the ancient healers into 5 main forms: disease-object intrusion, loss of the soul, spirit intrusion, breach of taboo, and sorcery. For each of these theory there existed corresponding therapeutic methods. These methods included extraction of diseased object, to resort lost soul, exorcism, transference of the foreign spirit to another living being, confession and counter magic.

Ackerknecht showed that the true ancestors of the modern physician are the lay healers, that is, those men to whom the medicine man left the empirical and physical care of the patients), whereas “the medicine man is rather the ancestor of the priest, the physician’s antagonist for centuries” (Ellenberger, 2008, S. 5-48). By taking us through the the era of faith healing to the discovery of the unconscious Ellenberger can help us make sense of how the idea of demonology could have existed as explanation for psychological afflictions during the period of the Dark Ages. The psyche— and consciousness in itself— is, after all, a concept that has been illusive to human awareness, until the 18^th Century.

The 20^th century saw the movement towards re-integration of this medical field through the development of psychoanalysis and the use of psychotherapeutic methods including hypnosis in dealing with physical healing, as well as the work on the body to aid psychological problems. With the advancement of new technology like neuroscience, we can expect to see the move towards integration and separation of handling of what is deemed psychological and what is deemed somatic issues again and again; this happens as long as mind and body cannot be understood or accepted as one whole which is more than the sum of its parts.  Holism, as with phenomenology, are philosophical foundation in some psychotherapeutic methods that deals with symptoms suffered by individuals in an integrated manner.

 

Categorization of Psychosomatic Disturbances

Given the broad understanding of psychosomatics, one may create categorization of the specific disorders in a number of ways (Mörtl, 2016). In the medical profession, the categorization may be done according to the anatomical location, i.e. the skin, the musculoskeletal, cardiovascular, lymphatic, gastrointestinal genito-urinary, endocrine and nervous systems and specific organ reactions. Another classification system is one based upon the dynamic in which the disorders evolve. They could be:

• psychological afflictions caused by bodily symptoms, otherwise known as psychophysiologic, psychosomatic or somatoform disorders. These disorders do not present in itself organic causes, which often lead the sufferer to seek multiple medical consultations without result. These symptoms can be observed physiologically on the patient, and a description of the affliction can be made. The nosology— that which describes the underlying psychological causes of the condition— is much more complicated, and would require deeper understanding of the patient’s psychosocial situation as well. This category encompasses an array of somatic syndromes, those which maybe related to mood (affective) disorders, neurotic and stress-related disorders, behavioral syndromes, personality disorders, mental retardation and disorders in psychological development.
• Physiological problems that cause psychological disturbances, otherwise known as somatopsychic disorders. These disorders have organic causes, and include (but not exclusively) degenerative brain disorders like Dementia, disorders caused by lesions to the brain either caused by disease, damage or dysfunction. The causes of brain dysfunction may be also attributed to intoxication. Symptoms that afflict other parts of the body that also lead to the need for psychological care would be psychosocial influences that affect physical health. These broadly include addictions, poor nutrition and aging. Many physical diseases cause psychological stress, like chronic ailments and terminal conditions. Psychological help is needed to help patients cope with their symptoms, and the consequences of disease.

 

Classification of psychosomatic symptoms

Contemporary textbooks and diagnostic manuals commonly classify psychosomatic disorders as:

• Somatoform: Physical disturbances caused by somatization of psychological problems. This includes somatoform-autonomous symptoms— like tinnitus, irritable bowel syndrome, and cardiovascular heart disease— non-organic sleep disorder, non-organic sexual disorders, conversion disorder and non-organic migraine.
• Eating disorders: Behavioral conditions as result of psycho-social problems resulting in Anorexia Nervosa, Bulimia Nervosa and Binge Eating disorder.
• Potential psychosocial factors in organic disorders in organic disorders like Hypertonia, bronchial Asthma, Colitis Ulcerosa, and Neurodermatitis.
• Somatopsychic disorders: characterized by psychological symptoms with organic origins like brain lesions, strokes and tumors that cause structural damage and/or biochemical, dysfunction, adversely affecting normal brain activity. This also includes psychological problems in dealing with pain, chronic illnesses, and consequences of surgeries and injuries.

Conclusion

When we consider Merleau-Ponty and the holistic philosophers, it should be a given that the condition of the physical body is one and the same with the mind. In the western world of knowledge politics, this basic wisdom is somewhat put aside in favor of reductionist thinking.  The idea that “psychosomatics” be a discipline rather than a standard form of looking at symptoms is proof of this. The classification in psychosomatic medicine is helpful for practitioners and patients alike to discover which came first— the psychological problems or the physical ones. That, however, cannot really tell much else, since every single client is a unique case study in him/herself in relation to his/her own environment. Non-holistic observing of the client could be the reason that many in the medical and psychotherapeutic professions alike find difficulty working with psychosomatic problems and keeping the clients in therapy.

Development in psychosomatics and psychotherapy may lead to greater arguments among psychotherapy modalities as well as fields of medicine. These studies may also bring the modalities in a common agreement as well. It would be interesting to realize, perhaps, how almost every person suffers from some kind of psychosomatic issue, and how their personality, muscularity, adiposity or aging are linked. The term “psychosomatics” alone conjures a whole philosophical understanding of what it means to have mind and body.

Bibliography

Alexander, F. (1962). The development of psychosomatic medicine. Psychosomatic medicine, 24(1), 13-24.

Ellenberger, H. F. (2008). The discovery of the unconscious: The history and evolution of dynamic psychiatry. Basic Books.

Levenson, J. L. (2005). Textbook of psychosomatic medicine. (J. L. Levenson, Ed.) VA: The American Psychiatric Publishing.

Merleau-Ponty, M. (2004). Maurice Merleau-Ponty: Basic writings. (T. Baldwin, Ed.) NY: Psychology Press.

Tseng, W. S. (1973). The development of psychiatric concepts in traditional medicine. Archives of General Psychiatry, 29, 569-575.