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Introducing a New Special Series

Clinical Applications in Psychosomatic Medicine

Boland, Robert J., MD; Weihs, Karen L., MD; Gündel, Harald, MD

doi: 10.1097/PSY.0000000000000657
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From the Department of Psychiatry (Boland), Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts; Department of Psychiatry (Weihs), Cancer Prevention and Control Program, University of Arizona Cancer Center, University of Arizona, Tucson, Arizona; and Klinik und Poliklinik fuer Psychosomatische Medizin und Psychotherapie (Gündel), Universitaetsklinikum Ulm, Ulm, Germany.

Address correspondence to Robert J. Boland, MD, Department of Psychiatry, Brigham and Women's Hospital, 60 Fenwood Rd, Boston MA 02115. E-mail: rjboland@bwh.harvard.edu

Received for publication September 13, 2018.

With this issue, Psychosomatic Medicine is beginning a special series on “Clinical Applications in Psychosomatic Medicine.” Articles in this series will emphasize a specific clinical topic with an eye toward demonstrating how the empirical evidence is organized and used to provide effective behavioral and psychological interventions in the setting of psychosomatic medicine. This series is a substantial departure from the usual format in this journal because it will consist of narrative reviews that are directly useful and applicable for practicing clinicians and scientist-practitioners. The articles aim to organize practical information about treatments and their empirical basis to demonstrate how they are used in clinical settings. They are aimed at medical practitioners, as well as mental health and behavioral health practitioners working in clinical settings. Primary care and specialist physicians are responsible for the assessment of symptoms arising from the undifferentiated functions of the body-brain organism, communicated to the physician from a person's unique family, social, and cultural perspective at a particular stage of development. This series aims to provide these clinicians and other members of the healthcare team with cutting-edge, integrated knowledge to better address this complex task. We also hope that it will inform basic researchers interested in investigating real-world problems, as well as clinical researchers seeking to more fully integrate biological and psychological knowledge in their work.

Overall, the series should clearly demonstrate how clinical treatment and psychosomatic psychotherapies are organized and realized practically; we hope that this can provide some useful and stimulating instructions for colleagues who wish to start a similar treatment scheme at their institution. Moreover, within the current process of globalization and all its consequences on society and individual health, psychosomatic medicine may consider developing an additional preventive approach on the background of its ample clinical and scientific experiences, especially in the field of stress-associated disorders.

To increase the practical value of these articles, they are organized around a case. An example of a disorder found in the psychosomatic setting is presented, followed by a brief review of what is known about that disorder, leading to a discussion of the evidence for various treatment approaches. Articles in this special series will typically have the following sections: (1) Case Report; (2) Clinical Features; (3) Assessment Tools; (4) Epidemiology; (5) Biological and Behavioral Mechanisms Regarding Etiology and Clinical Consequences; (6) Evidence-Based Interventions, (7) Author's Perspective; and (8) Conclusions. The first article in this Special Series, published in this issue of Psychosomatic Medicine, focuses on chronic pain, and future subjects will include depression in patients with medical conditions, illness anxiety, and a wide range of other clinical applications. These articles expand the journal's typical focus on biobehavioral research. Our goal is to help reduce the sometimes perplexing divide between psychosomatic medicine in the clinical versus research setting.

Psychiatrists and other mental health providers involved in the treatment of patients often work in departmental divisions set apart from their research counterparts. This separation of clinical practice and research occurs in many medical specialties but is of particular relevance to the field of psychosomatic medicine. In the United States, the recent change in medical subspecialty name from psychosomatic medicine to consultation-liaison psychiatry (1) reflects this divide. Consultation-liaison psychiatry is often taken to be the clinical application of the psychosomatic approach. This simple formulation obscures the tenuous link between the disciplines.

The term psychosomatic was first used by Heinroth in 1818 (2) to describe the interrelationship between body and soul and developed by pioneers such as Uexküll (3) in the middle of the 20th century, but the concept goes back thousands of years as exemplified by Plato's lament that “this … is the great error of our day in the treatment of the human body, that physicians separate the soul from the body (4).” Consultation-liaison psychiatry grew out of the practical needs of psychiatrists in the 20th century as mental health care gradually moved from the asylum to the general hospital (5); the discipline began to flourish in the United States through grants from the Rockefeller Foundation and then the National Institute of Mental Health, which, in the mid-1970s, made it a priority to foster the growth of consultation-liaison psychiatry (6). Thus, psychiatry and psychosomatic medicine, although theoretically entwined, in practice developed separately, involved different people and, in some countries, existed in different university departments (7). In Europe, particularly Germany, the field of psychosomatic medicine is more embedded in internal medicine, and clinical care of patients with nonpsychiatric medical disorders often includes active participation of experts in psychosomatic medicine. In other parts of the world, the clinical implementation of psychosomatic medicine varies substantially. Regardless of the country and sociocultural context, there is often a divide between practice and basic or clinical research in this context.

Such divides substantially impede progress in mental health and general medical care. Indeed, although a divide between basic neuroscience research and clinical practice still exists, multiple lines of research into the mechanisms of psychiatric disorders demonstrate what Plato and the pioneers of psychosomatic medicine already knew—that the historic Cartesian divide between mind and body is a false conflict (8). Research into neuroimmunology (9), gastroenterology and the “brain-gut axis” (10) or cardiac disease (11) are just a few of the many examples of the complex and bidirectional relationships between psychiatric disorders, psychological distress, and medical illness. To emphasize the importance of biological and behavioral processes in the bidirectional association between psychosocial factors with health and disease, this journal added a subtitle to its name: “Journal of Biobehavioral Medicine” (12). The goal of adding this subtitle was to increase awareness that the field of psychosomatic medicine is fueled by the systematic investigation of basic and clinical science. With the new series “Clinical Issues in Psychosomatic Medicine,” we want to highlight how this research is useful to clinical practice and how clinical practice can further inspire and shape biobehavioral research. The more one is familiar with this literature the more one becomes convinced that sequestering psychiatric disorders as purely “mental diseases” impedes the field and that the major mental disorders are better conceptualized as systemic illnesses (13). Hence, one could argue that the psychosomatic approach to mental illness is the only approach having an empirical basis. As the recent World Psychiatric Association–Lancet Psychiatry Commission on the Future of Psychiatry suggested, a necessary priority for the 21st century is that “mental health professionals need to be well trained in integration of biological, psychological, social, and spiritual factors in the care that they provide (14).”

We intend for these articles to model such integration and anticipate that they will be of use to the practitioner and investigator alike.

Sources of Funding and Conflicts of Interest: The authors report no conflicts of interest.

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REFERENCES

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Keywords:

psychosomatic medicine; consultation-liaison psychiatry; clinical

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