Psychosomatic medicine 52671 225754806 2008-07-15T06:52:03Z 137.215.6.50 {{DiseaseDisorder infobox | Name = Psychosomatic illness | ICD10 = F40 - F48 | ICD9 = 300-316| }} '''Psychosomatic medicine''' is an interdisciplinary medical field studying '''psychosomatic illness''', now more commonly referred to as '''psychophysiologic illness''' or disorder, whose symptoms are caused by mental processes of the sufferer rather than immediate physiological causes. These syndromes are classified as [[ICD-10 Chapter V: Mental and behavioural disorders#.28F40-F48.29 Neurotic.2C stress-related and somatoform disorders|neurotic, stress-related and somatoform disorders]] by the [[World Health Organization]] 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.<ref>{{cite book | last = Levenson| first = James L. | title = Essentials of Psychosomatic Medicine| publisher = American Psychiatric Press Inc|date=2006| isbn = 978-1585622467}}</ref> A major European textbook on psychosomatic medicine (over 1000 pp, six German editions) is the one edited by [[Thure von Uexküll]].<ref>{{cite book | last = Uexküll| first = Thure von (ed.) | title = Psychosomatic Medicine| publisher = Urban & Schwarzenberg, München|date=1997| isbn = 3541135115}}</ref> __TOC__ ==Psychosomatic disorders. Some physical disorders may have a psychological cause as in the case of [[hysterical paralysis]], [[somatization disorder]], and [[tension myositis syndrome]], 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 [[migraine]]s. [[Peptic ulcer]]s were once thought to be the result of stress, but have been proven to have a connection to the [[Helicobacter pylori|H-Pylori]] bacteria. Various studies in neuropsychiatry, immunology and endocrinology among other fields, have led to various theories and explanations.<ref name= "psydis">{{cite book | last = Asaad| first = Ghazi | title = Psychosomatic Disorders: Theoretical and Clinical Aspects| publisher = Brunner-Mazel|date=1996| pages = X, 129-130 | isbn = 978-0876308035}}</ref> ==History== [[Image:Sigmund Freud-loc.jpg|thumb|Sigmund Freud]] 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.<ref>{{cite book | last = Elaine Showalter| first = Sander L. Gilman, Helen King, Roy Porter, G. S. Rousseau| title = Hysteria Beyond Freud | publisher = University of California Press|date=1993| isbn = 978-0520080645}}</ref> In the [[Islamic Golden Age|medieval Islamic world]], the [[Islamic psychology|Muslim psychologist]]-[[Islamic medicine|physicians]], [[Ahmed ibn Sahl al-Balkhi]] (d. 934) and [[Ali ibn Abbas al-Majusi|Haly Abbas]] (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 [[Mental health|mentally healthy]] and those who were physically and [[Mental disorder|mentally ill]].<ref>Nurdeen Deuraseh and Mansor Abu Talib (2005), "Mental health in Islamic medical tradition", ''The International Medical Journal'' '''4''' (2), p. 76-79.</ref> [[Avicenna]] (980-1037) recognized '[[Psychophysiology|physiological psychology]]' in the treatment of illnesses involving [[emotion]]s, 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]].<ref name=Syed-7>Ibrahim B. Syed PhD, "Islamic Medicine: 1000 years ahead of its times", ''[[The Islamic Medical Association of North America|Journal of the Islamic Medical Association]]'', 2002 (2), p. 2-9 [7].</ref> 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.<ref>{{Citation | last= Harold Merskey| first= Francois M. Mai and| year= 1980| title= Briquet's Treatise on Hysteria| periodical= Archives of General Psychiatry| volume= 37| pages= 1401-1405}}.</ref><ref>{{Citation | last= Harold Merskey| first= Francois M. Mai and| year= 1981| title= Briquet's Concept of Hysteria: An Historical Perspective| periodical= Canadian Journal of Psychiatry| volume= 26| pages= 5763}}.</ref> In the 1870s, hysteria was also studied by Jean-Martin Charcot.<ref>{{cite book | last = Goetz| first = Christopher G. | title = Charcot: Constructing Neurology| publisher = Oxford University Press|date=1995| isbn = 978-0195076431}}</ref> 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.<ref>{{cite book | last = Levin| first = Kenneth | title = Freud's early psychology of the neuroses: A historical perspective| publisher = University of Pittsburgh Press|date=1978| isbn = 978-0822933663}}</ref> [[Franz Alexander]] led in the beginnings of the 20th century, the movement looking for the dynamic interrelation between mind and body.<ref name= "psydis"/> [[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.<ref>{{cite book | last = Erwin| first = Edward | title = The Freud Encyclopedia: Theory, Therapy and Culture| publisher = Routledge|date=2002| pages = 245-246 | isbn = 978-0415936774}}</ref> Important distinctions were noted that led to the realization that hysterical disorders were different from the non-hysterical 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.{{Fact|date=October 2007}} Many identifiable illnesses have previously been labeled as '[[hysteria|hysterical]]' or 'psychosomatic', for example [[asthma]], [[allergies]], [[false pregnancy]], [[Coeliac disease]], [[Peptic ulcer]]s and [[migraine]]s. Some illnesses are under debate, including [[multiple chemical sensitivity]], [[Gulf War syndrome]], and [[chronic fatigue syndrome]]. {{Fact|date=October 2007}} 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.<ref>{{cite book | last =Melmed| first = Raphael N. | title = Mind, Body and Medicine: An Integrative Text| publisher = Oxford University Press Inc, USA| date = 2001| pages = 191-192 | isbn = 978-0195131642}}</ref> 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.{{Fact|date=October 2007}} 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{{Fact|date=October 2007}}. Anthropologists have noted that culture plays an important role in which particular somatic expression results from a given internal psychological experience. {{Fact|date=October 2007}} Since 1970s, due to the work of [[Thure von Uexküll]] and his colleagues in Germany and elsewhere, [[biosemiotics|biosemiotic]] theory has been used as a theoretical basis for psychosomatic medicine. Particularly, the [[umwelt]] concept and the theory of organism by [[Jakob von Uexküll]] has been found useful as an approach to describe psychosomatic phenomena. ==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.<ref name= "greco">{{cite book | last = Greco| first = Monica| title = Illness as a Work of Thought: Foucauldian Perspective on Psychosomatics| publisher = Routledge| date = 1998| pages = 1-3, 112-116| isbn = 978-0415178495}}</ref> In modern society, psychosomatic illness has been often attributed to a result from [[stress (medicine)|stress]],<ref>{{cite book | last = I. H. Treasaden| first = Basant K. Puri, P. J. Laking| title = Textbook of Psychiatry| publisher = Churchill Livingstone| date = 2002| pages = 7| isbn = 978-0443070167}}</ref> making stress management an important factor in the development, amelioration or avoidance of psychosomatic illness.<ref name= "greco"/> ==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.<ref>{{cite book | last = Donaldson| first =L.J. and R.J. | title = Essential Public Health| publisher = Petroc Press - LibraPharm Limited| date = 2003| pages = 352| isbn = 978-1900603874}}</ref> ==Treatment== Various types of [[psychotherapy]] and [[alternative medicine|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. ==Physiological explanation== ===How orthodox neurophysiology may be misleading=== Within neurophysiology, it is usually assumed that the ''basic mental mechanisms'' are [[synapses]] with their [[neurotransmitter]] operation.<ref>There is now a vast body of literature on this topic. Perhaps the most advanced relevant attempt to make sense of it all is the book by Edelman, but also see Crick's critique of it: *Edelman, G.M. (1987). ''Neural Darwinism'', Basic Books: New York. *Crick, F. (1989, July). "Neural Edelmanism", ''Trends in Neurosciences''.</ref> &nbsp; Important though these may be, they seem ill-suited ''on their own'' to explain anything involving accurate sequencing such as advanced thought — and that implies that there must also be some alternative mechanism available. Of course these synaptic mechanisms might nevertheless be a factor in psychosomtic effects, but that case has yet to be argued; and meanwhile the alternative may seem more attractive there too. The case for the physical connection between "psycho" and "somatic", depends on explaining how they may both be ''sharing the same submechanisms'' to some extent. Some preliminary background is needed: &nbsp; &nbsp; ===The alternative basis: The "fixed action pattern" and its variants=== [[Ethology|Ethologists]] such as [[Oskar Heinroth|Heinroth]], [[Konrad Lorenz|Lorenz]], and [[Nikolaas Tinbergen|Tinbergen]] promoted the idea of the "[[fixed action pattern]]" (a stereotyped sequence-or-coordination of actions, ''as output''), and likewise the "[[innate releasing mechanism]]" (a comparable coordination of cues which would act as a stimulus, ''as input'').<ref>Lorenz, K. (1948/1996). ''The Natural Science of the Human Species: an introduction to comparative behavioral research: The "Russian Manuscript" (1944-1948)''. MIT Press: London.[[ISBN 0-262-12190-5]] — Chapter&nbsp;20, "My own contribution to an understanding of the instinctive motor pattern"</ref><ref>Rose, S.P.R. (Ed.)(1972). ''Biological Bases of Behaviour — Unit 14: Ethology''. Open University Press: Bletchley. [[SBN 335 04085 3]]</ref> —— While such patterns would not necessarily consist of one strict linear sequence, they might nevertheless be interpreted as a coordination of such "lists", (and hence comparable to a subroutine of a computer program). ===Piaget's "scheme" as an elaborated equivalent=== [[Jean Piaget|Piaget]]'s "scheme" concept is virtually equivalent, but he extended the idea further: not just for input and output patterns, but also for internal thought, with higher schemes acting upon lower ones (and doing so [[recursion|recursively]] into yet higher levels) — thus enabling advanced thought, including abstraction and symbolism. E.g.<ref>Piaget, J. (1949). ''Traité de logique''. Armand Collin: Paris. [Republished (1972) as ''Essai de Logique Operatoire'', Dunod].</ref> <ref>Piaget, J. (1945/1951). ''La formation du symbole chez l'enfant / Play, Dreams and Imitation in Childhood''.</ref><ref>Traill, R.R. ''Molecular Explanation for Intelligence''. Thesis, [[Brunel University]]. [http://hdl.handle.net/2438/729]</ref> ===Early evidence that "schemes" may be RNA codings=== In the 1960s there was much discussion about the observed correlation between learning and the appearance of RNA, apparently as a consequence. — See especially the work of Holger Hydén, e.g.<ref>Hydén, H. and E.Egyházi (1962). "Nuclear RNA changes of nerve cells during a learning experiment in rats". ''Proceedings of the National Academy of Sciences''. '''48''', 1366-1373.</ref><ref>Hydén, H. (1967). In G.C.Quarton, T.Melnechuk, and F.O.Schmitt (Eds.) ''The Neuroscience: a study program''. Rockefeller University Press: New York. — Pages 248-266 (refs.857-859), and 765-771 (refs.913-914).</ref> However it was assumed that this RNA must be using its code to manipulate the synapses (an obvious irrelevance in the present context if one considers the RNA coding in its own right), and the idea was dropped when the supposed synaptic mechanism failed to gain support. Meanwhile Piaget himself did briefly consider the RNA possibility.<ref>Piaget, J. (1967/1971). ''Biologie et connaissance / Biology and Knowledge''. Gallimard: Paris / Chicago University Press / Edinburgh University Press.</ref> ===The new surprise-findings about ncRNA=== It was formerly believed that most RNA coded for protein production (or served special roles as mRNA or tRNA). It thus came as a great surprise to find out that only about 3% of the RNA served in those roles<ref>Mattick, J.S. (2001) "Noncoding RNAs: the architects of eukaryotic complexity". ''EMBO Reports'','''2'''(11), 986-991. [http://emboreports.npgjournals.com/cgi/content/full/2/11/986]</ref> — so the rest (the "[[Non-coding RNA]]s", i.e. "ncRNA''s''") were available for other tasks. ===The two claimed roles for these "spare" elements=== Geneticists were quick to see a role for some of these ncRNAs as "regulators" of genes at other sites — and one may interpret that as a ''somatic'' role. &nbsp; Meanwhile another obvious role was as the missing embodiment for the Piagetian scheme-elements,<ref>Traill, R.R. (2005/2008). ''Thinking by molecule, synapse, or both? — From Piaget's schema, to the selecting/editing of ncRNA''. Ondwelle: Melbourne. [http://www.ondwelle.com/OSM02.pdf]</ref> especially considering the abandoned evidence from the 1960s — so here one has a ''psycho-'' role. ===The likelihood of a sometimes-overlapping role=== In view of Piaget's account of schemes acting internally on other schemes, there is a plausible similarity to the Geneticists' model. Thus Traill (2005, p.3)<ref>''ibidem''</ref> has suggested that "indeed we might see thought as just another form of regulation", and (p.21) that "'psycho-' and 'somatic' can often be closely related, and even share some of the same basic mechanisms". ==See also== * [[Conversion Disorder]] * [[Illness as Metaphor]] * [[Placebo]] ** [[Nocebo]] ** [[Placebo (origins of technical term)]] * [[Psychoneuroimmunology]] * [[Tension Myositis Syndrome]] ==References== <references /> {{ reflist}} ==External links== * [http://nccam.nih.gov/health/backgrounds/mindbody.htm Mind-Body Medicine: An Overview], US National Institutes of Health, Center for Complementary and Alternative Medicine * [http://www.nlm.nih.gov/hmd/emotions/psychosomatic.html NIH] * [http://www.psychosomatic.org/ American Psychosomatic Society] ** [http://www.psychosomaticmedicine.org/ Psychosomatic Medicine], journal of the American Psychosomatic Society [[Category:Medical specialties]] [[Category:Mind-body interventions]] [[ar:الأمراض النفسية الجسمية]] [[cs:Psychosomatika]] [[de:Psychosomatik]] [[es:Afecciones psicosomáticas]] [[eo:Psikosomatiko]] [[fr:Psychosomatique]] [[it:Psicosomatica]] [[he:מחלה פסיכוסומטית]] [[lt:Psichosomatika]] [[nl:Psychosomatiek]] [[no:Psykosomatikk]] [[pl:Choroba psychosomatyczna]] [[pt:Psicossomática]] [[ru:Психосоматика]] [[sk:Psychosomatika]] [[fi:Psykosomatiikka]] [[sv:Psykosomatisk]] [[zh:心身疾病]]