• General
  • Psychosomatic Medicine: The Answer to Many Idiopathies
1+

‘When the last one falls, I must go too.’

-The last leaf, O. Henry

‘The Last leaf’ by O. Henry, is a classic representation of how the mind affects physical health. It is about a woman who is suffering from pneumonia and believes that when the ivy vine outside her window loses all its leaves, she would die too. So, to give her hope, her neighbour who is an artist, paints a real looking leaf on the wall, so the vine never loses all leaves and she eventually starts to recover. For ages, it has been observed that a mentally healthy person is more likely to recover from an illness than a person who has lost all hopes. This is what forms the basis of ‘Psychosomatic medicine’.

What is Psychosomatic Medicine?

‘Psychosomatic’ is a term used to indicate physical symptoms that are medically illegitimate. So, psychosomatic illnesses are those that do not have an organic cause of disease and have originated from psychological problems like stress, exaggerated emotions, emotional conflicts, etc. In simple terms, it’s a field that studies illnesses with no physical basis.

However, contemporary psychosomatic medicine studies illnesses that have a clear physical basis but might have been affected by psychological and mental factors. Although psychosomatic medicine is considered a relatively new field in terms of practice, the relationship between psychiatric illness and somatic organs was postulated a long time back.

Psychosomatic medicine is, infact, a multidisciplinary field that aims at combining or finding relations between all physical, psychological, and social factors behind the aetiology, prognosis and treatment of illness.

A Brief History of Psychosomatic Medicine

The earliest research that indicated the relation of mind and body was based on placebo groups. These groups were basically tricked into thinking that they were getting treatment but were actually put on medication that had no effect on their diseased state. The fact that many placebo groups showed positive benefits even without treatment indicated that there is a relation between your psychology and disease. Eventually, it led to many further pieces of research to find deeper relations.

Psychosomatic medicine is also known as consultation-liaison medicine because it aims at combining medicine with psychiatry. The term ‘Psychosomatic’ was first introduced in 1818 by Johann Christian Heinroth when discussing the causes of insomnia. The phrase ‘Psychosomatic Medicine’, on the other hand, was introduced nearly a century later in 1922 by Felix Deutsch. It was considered as a completely different field for a very long time and was studied separately until 2001 when The Academy of Psychosomatic Medicine (APM) and The Association of Medicine and Psychiatry applied to the American Board of Psychiatry and Neurology (ABPN) recognized “Psychosomatic Medicine” as a subspecialty field of psychiatry. It was officially recognised as a subspecialty of psychiatry in 2003.

Using Psychosomatic Medicine in Clinical Practice

Using psychosomatic medicine in clinical practice helps us understand the discipline a lot better. In a majority of cases, the manifestation of a particular disease or illness is attached to the meaning it has for the patient, and understanding it can help a doctor find a better treatment plan for them. While treating the patient, two points should be considered– first the significance of the disease or injury for the patient’s immediate or future circumstances and secondly, the meaning that each patient has, attached to the disease.

In the first case, it is possible that a medical procedure like an amputation to prevent the spread of infection gives one patient relief that his life is saved while for the other patient, it is more of distress as it is now going to affect their day to day life and might make them dependent on others.

In the latter case, even though the treatment plan is the best-suited one, there are going to be repercussions in various ways. The patient might lose all hope of living and it may become a reason for them developing post-procedure complications. For example, when you inform a patient they have liver failure, it is possible that they might begin to feel their vital organs are shutting down, despite knowing that their condition is treatable.

While few patients tend to attach their sufferings to religious causes and consider it as a consequence of their sins, others have a more scientific outlook. With the worldwide web at everyone’s fingertips these days, many patients are instantly exposed and tend to be affected by the extreme outcomes of a disease that they randomly read on the internet and lose hope.

So, most of the time what causes the disease can be a physical, biological, genetic or environmental cause but how the disease progresses (deteriorates or improves) is completely dependent on the psychological or mental status of the individual.

Keeping this in mind, the present medical practice aims at involving psychiatry and psychology at various steps to ensure that the patient can clarify emotional conflicts and their mental state does not affect their treatment and physical state.

Including Psychiatry in Medical Sciences Curriculum

The inclusion of psychiatry with general medical sciences in India began almost at the same time as in the Western countries. It was in 1933 that the first General Hospital Psychiatry Unit was started by Dr Girindra Shekhar at R. G. Kar Medical College and Hospital, Calcutta. This also marked the introduction of psychosomatic medicine in India although not much of a structured development has happened through the years.

In India, there has been no specific training programme in the field of consultation-liaison psychiatry except for the one-year postdoctoral fellowship program conducted at the National Institute of Mental Health and Neurosciences and postdoctoral fellowship programme at PGIMER, Chandigarh. This shows that psychosomatic medicine has still not received an accredited subspecialty status in our country while the conditions in American and European institutes are completely the opposite.

One of the national workshops on General Hospital Psychiatry stated that “A workable knowledge of psychiatry subspecialties like child psychiatry, mental retardation, psychotherapy, alcoholism, drug dependence, and psychogeriatric is advisable.”

Familiarity with psychosomatic medicine and liaison psychiatry is necessary for every medical practitioner. Infact, a survey stated that almost 91% of physicians and surgeons believe that if this unit is developed properly, it can improve the care of patients with psychiatric problems in non-psychiatric units of general hospitals. While there are many practitioners who think they lack the required psychiatric knowledge and are eager to learn more but there aren’t enough options to learn.

Takeaway!

With all this, it becomes very important to do something to popularise this field and make it more common in practice. If the concept of psychosomatic medicine is made common in normal practice then it would become very easy to solve a lot of questions of diagnosis and find reasons for the idiopathies, making treatment easier to a large extent.

References:

 

Featured Image Source: Photo by SHVETS production from Pexels
image_printPrint Post
A Peek into the World of Vision

Previous article

A Peek into the World of Vision

Next article

A Holy-Historical Soujourn to a Sri Lankan Temple
A Holy-Historical Soujourn to a Sri Lankan Temple

Tags

About the author

Shreya Singh

Shreya Singh

Dr Shreya Singh is an MBBS student at BJGMC, Pune. Being an introvert she likes spending much of her time with books and stories. She loves to write, read, draw, paint and everything that gives her a new perspective of the world and allows her to express herself.

JOIN THE DISCUSSION

Related

LifestyleSpecial
Compassion and Empathy towards your patients, how much?
LifestyleSpecial
INEMURI
LifestyleSpecial
Why are more doctor’s kids opting to choose non-medical careers?
BusinessGeneral
Crafting a patient-centered care model for exceptional service delivery.