Psychosomatic medicine

Another particularly influential field that arose alongside the biomedical model was psychosomatic medicine. This came to prominence in the early twentieth century in response to psychoanalytic theories such as those of Sigmund Freud on the relationship between mind and physical illness. Freud examined patients coming to him experiencing loss of mobility in their limbs but was unable to identify any anatomical reason for this paralysis. Instead, he hypothesized that such paralysis was caused by hysteria set in motion by repressed experiences and feelings.(14) This not only suggested that the mind and body interacted, but that the mind could actually cause illness.

Interestingly, this idea was not new. Indeed, the genesis of theories on this combined mind-body approach to medicine can be traced through every major ancient tradition of medicine. One example lies in the Islamic tradition, made famous by the Persian physician Abu Sayd Ahmed ibn Sahl Balkhi (Al-Balkhi). Born in Khorasan (modern-day northern Afghanistan) in ad 850, Al-Balkhi became renowned for criticizing the medical doctors of his day for concentrating solely on physical illnesses and neglecting the psychological and mental health of their patients. He developed the concept of ‘mental hygiene, coining the phrases ‘al-Tibb al-Ruhani’ (spiritual and psychological health) and ‘Tibb al-Qalb’ (mental medicine), and in his famous book Masalih al-Abdan wa al-Anfus (Sustenance for Body and Soul), he argued that the two concepts were interwoven.(15) Far from claiming that this was a new concept, he traced his own ideas on mental health to verses of the Qur’an and hadiths attributed to the prophet Muhammad. Al-Balkhi’s ideas were echoed in the work of other esteemed Islamic scientists, including Yaqoob al-Kindi (801-873) and Acivenna (Ibn Sina) (980-1037).

However, despite this and other traditions of a combined mind and body approach to medicine, in the seventeenth century, philosopher Rene Descartes proposed that in fact the mind and body were different substances, with the mind existing outside the body. Although this idea had been considered before and can be traced back to the Ancient Greeks, it gained particular ground following the writings of Descartes and came to be known as Cartesian dualism (‘Cartesian’ meaning ‘pertaining to Descartes’). Descartes’ theories had immediate opponents: Dutch philosopher Baruch Spinoza, for example, responded by hypothesizing that the mind and body were in fact identical, with events in one mirrored by events in the other; a concept he referred to as psychophysiological parallelism. And in the eighteenth and nineteenth centuries these opponents gained in force, supported by the developing interest in mental illness and mat- eralist models of the mind. For example, eighteenth-century German reformer Johann Christian Reil argued that psychiatry (a term he is credited with being the to use) and the study of the brain and psyche should be a mainstream part of medicine. In 1812, Benjamin Rush’s Medical Inquiries and Observations Upon the Diseases of the Mind further helped to define psychiatry as a medical discipline. And in 1818, the medical term ‘psychosomatic’ (referring to the interaction of mind and body) was first used in conjunction with mind-body medicine by the German physician Johann Christian Heinroth.(16)

The work of Freud and his colleagues mentioned above meant that the early approaches in psychosomatic medicine were predominantly psychoanalytic and psychodynamic. However, through the influence of other individuals, the field broadened. Psychosomatic medicine now explores a range of topics, including the potential psychiatric contributions to medically unexplained symptoms, functional disorders, diseases, and pain management. It also focuses on the psychological implications of chronic conditions, including identifying predictors of mental health conditions. The psychological focus is not just on the individual but also on the social aspects of disease, such as social support networks and social resilience. Other major strands of research include psychophysiological manifestations and consequences of acute and chronic stress, the role of placebo, and the effects of complementary and alternative medicines. This psychosocial focus in many ways marked a theoretical challenge to the biomedical model by broadening considerations away from pure laboratory science and surgical techniques and demonstrating the role of the mind and social environment in both the development and treatment of illness.

For more information, the book Psychosomatic Medicine by Michael Blumenfield and James J Strain covers the history alongside core research findings that have helped to define the field.(16)

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