Psychosomatic medicine

Psychosomatic medicine is an interdisciplinary medical field studying psychosomatic illness, now more commonly referred to as psychophysiologic illness, disorders whose symptoms are caused by mental processes of the sufferer rather than immediate physiological causes. These syndromes are classified as neurotic, stress-related and somatoform disorders by the World Health Organisation in the International Statistical Classification of Diseases and Related Health Problems.

Psychosomatic medicine integrates interdisciplinary evaluation and management involving diverse specialties, including but not limited to psychiatry, psychology, neurology; surgery; gynecology; pain management; pediatrics; dermatology; and psychoneuroimmunology. Clinical situations where psychological processes act as a major factor affecting medical outcome and affecting medical compliance and/or surgical results are areas where Psychosomatic medicine has competence.

Psychosomatic disorders
Some physical disorders may have a psychological cause as in the case of hysterical paralysis and somatization disorder, while some physical conditions like vitamin deficiency or brain injury can cause psychological symptoms. There is also a probable psychological influence in the development and outcome of conditions such as migraines. Peptic ulcers were once thought to be the result of stress, but have been proven to have a connection to the H-Pylori bacteria. Various studies in neuropsychiatry, immunology and endocrinology among other fields, have led to various theories and explanations.

History


Until the seventeenth century, hysteria was regarded as of uterine origin (from the Greek "hustera" = uterus) in the Western world. The ancient Greeks believed that the uterus could detach itself and move about the body, and hysterical symptoms would emanate from the part of the body in which the wandering uterus lodged itself.

In the medieval Islamic world, the Muslim psychologist-physicians, Ahmed ibn Sahl al-Balkhi (d. 934) and Ali ibn Abbas al-Majusi (d. 994), developed an early understanding of psychosomatic disorders. They realized how a patient's physiology and psychology can have an affect on one another, and found a correlation between patients who were physically and mentally healthy and those who were physically and mentally ill. Avicenna (980-1037) recognized 'physiological psychology' in the treatment of illnesses involving emotions, and developed a system for associating changes in the pulse rate with inner feelings, which is seen as an anticipation of the word association test later developed by Carl Jung.

In the 1840s and 1850s, hysteria was already the subject in medical textbooks and specialized studies as i. e. the "Traité Clinique et Therapeutique de L'Hysterie" published in 1859 by Pierre Briquet. In the 1870s, hysteria was also studied by Jean-Martin Charcot. Charcot wanted to demonstrate recurrent clinical characteristics in hysterical symptoms, similarly to neuropathological disorders. Through observation and the use of a camera Charcot was able to record some recurrent clinical features of hysteria and with the use of hypnosis he researched into hysterical neurosis and its associated neurological mechanisms.

Franz Alexander led in the beginnings of the 20th century, the movement looking for the dynamic interrelation between mind and body. Sigmund Freud pursued a deep interest in psychosomatic illnesses following his correspondence with Georg Groddeck who was, at the time, researching the possibility of treating physical disorders through psychological processes. Important distinctions were noted that led to the realization that hysterical disorders were different from the biologically-caused version of the same disorder. Patients were found who had a body part (i.e. a hand) that was paralyzed or numb; however the shape of the afflicted part did not match the shape of paralysis caused by disease or damage to specific nerves in the body. This was referred to as a "glove paralysis" since sometimes the afflicted area took the form of a glove. Similarly, some patients appeared to be blind, but they strangely did not seem to exhibit the limitations that persons with conventional, biologically-caused blindness would display. These anomalies tipped off researchers that the causal process for these diseases was different from conventional disease or injury.

Many identifiable illnesses have previously been labeled as 'hysterical' or 'psychosomatic', for example asthma, allergies, false pregnancy, Coeliac disease, Peptic ulcers and migraines. Some illnesses are under debate, including multiple chemical sensitivity, Gulf War syndrome, and chronic fatigue syndrome.

Some conditions and their manifestations make sometimes very difficult to classify a disorder as purely Psychosomatic. One example is Irritable Bowel Syndrome (IBS) that once was considered as having purely psychosomatic causes, but later research showed that defined functional responses in organ motility reflected structural changes involved in the causes and therefore IBS could no longer be defined solely as psychosomatically induced.

Some modern diseases are believed to have a psychosomatic component derived from the stresses and strains of everyday living. This is the case, for example, of lower back pain and high blood pressure, that appears to be partly related to stresses in everyday life. The particular ways that the body converts psychological distress to physical symptoms, varies over time and differs across cultures. An example are the specific kinds of psychosomatic symptoms found among Victorian-era women in America and western Europe which have largely disappeared. Anthropologists have noted that culture plays an important role in which particular somatic expression results from a given internal psychological experience.

Modern connotations
The term "psychosomatic" has developed a negative connotation in popular health subjects, being erroneously associated with malingering, mental illness or delusion, adding further psychological injury to the sufferer.

In modern society, psychosomatic illness has been often attributed to a result from stress, making of stress management an important factor in the development, amelioration or avoidance of psychosomatic illness.

Psychosomatic disorders and aging
The natural aging has a notable influence in the exacerbation or the development of psychosomatic disorders, most specifically in those generated by depression. This is caused by major life-events which are usually happening by first time or happen more often when a person ages. Of particular influence are the loss of parents and other relatives, the loss of spouse, retirement and the onset of physical disorders characteristic of aging.

Treatment
Various types of psychotherapy and alternative therapies are used to treat psychosomatic disorders. In some cases, psychosomatic problems may improve or disappear following suggestion by a recognized authority.

Treatment is typically anti-anxiety medications and/or anti-depressants in conjunction with therapy of some kind. Unlike hypochondria (which some mistakenly think is the same thing as psychosomatic illness), sufferers of a psychosomatic illness are experiencing real pain, real nausea, or other real physically felt symptoms, but with no cause that can be diagnosed.