Psychosomatic medicine

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Psychosomatic illness Classification and external resources
ICD-10	F40 - F48
ICD-9	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 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.^[1] A major European textbook on psychosomatic medicine (over 1000 pp, six German editions) is the one edited by Thure von Uexküll.^[2]

Contents 1 Psychosomatic disorders 2 History 3 Modern connotations 4 Psychosomatic disorders and aging 5 Treatment 6 Physiological Explanation 6.1 How orthodox neurophysiology may be misleading 6.2 The alternative basis: The "fixed action pattern" and its variants 6.3 Piaget's "scheme" as an elaborated equivalent 6.4 Early evidence that "schemes" may be RNA codings 6.5 The new surprise-findings about ncRNA 6.6 The two claimed roles for these "spare" elements 6.7 The likelihood of a sometimes-overlapping role 7 See also 8 References 9 External links

[edit] 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.^[3]

[edit] 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.^[4]

In the medieval Islamic world, the Muslim psychologist-physicians, Ahmed ibn Sahl al-Balkhi (d. 934) and 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 mentally healthy and those who were physically and mentally ill.^[5] 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.^[6]

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.^[7][8] In the 1870s, hysteria was also studied by Jean-Martin Charcot.^[9] 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.^[10]

Franz Alexander led in the beginnings of the 20th century, the movement looking for the dynamic interrelation between mind and body.^[3] 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.^[11]

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.^{[citation needed]}

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.^{[citation needed]}

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.^[12]

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.^{[citation needed]} 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^{[citation needed]}. Anthropologists have noted that culture plays an important role in which particular somatic expression results from a given internal psychological experience.^{[citation needed]}

Since 1970s, due to the work of Thure von Uexküll and his colleagues in Germany and elsewhere, 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.

[edit] 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.^[13]

In modern society, psychosomatic illness has been often attributed to a result from stress,^[14] making of stress management an important factor in the development, amelioration or avoidance of psychosomatic illness.^[13]

[edit] 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.^[15]

[edit] 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.

[edit] Physiological Explanation

[edit] How orthodox neurophysiology may be misleading

Within neurophysiology, it is usually assumed that the basic mental mechanisms are synapses with their neurotransmitter operation.^[16]   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:    

[edit] The alternative basis: The "fixed action pattern" and its variants

Ethologists such as Heinroth, Lorenz, and 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).^[17][18] —— 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).

[edit] Piaget's "scheme" as an elaborated equivalent

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 recursively into yet higher levels) — thus enabling advanced thought, including abstraction and symbolism. E.g.^{[19] [20][21]}

[edit] 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.^[22][23] 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.^[24]

[edit] 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^[25] — so the rest (the "Non-coding RNAs", i.e. "ncRNAs") were available for other tasks.

[edit] 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.   Meanwhile another obvious role was as the missing embodiment for the Piagetian scheme-elements,^[26] especially considering the abandoned evidence from the 1960s — so here one has a psycho- role.

[edit] 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)^[27] 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".

[edit] See also

• Conversion Disorder
• Illness as Metaphor
• Placebo
  • Nocebo
  • Placebo (origins of technical term)
• Psychoneuroimmunology
• Tension Myositis Syndrome

[edit] References

1. ^ Levenson, James L. (2006). Essentials of Psychosomatic Medicine. American Psychiatric Press Inc. ISBN 978-1585622467. 
2. ^ Uexküll, Thure von (ed.) (1997). Psychosomatic Medicine. Urban & Schwarzenberg, München. ISBN 3541135115. 
3. ^ ^{a b} Asaad, Ghazi (1996). Psychosomatic Disorders: Theoretical and Clinical Aspects. Brunner-Mazel, X, 129-130. ISBN 978-0876308035. 
4. ^ Elaine Showalter, Sander L. Gilman, Helen King, Roy Porter, G. S. Rousseau (1993). Hysteria Beyond Freud. University of California Press. ISBN 978-0520080645. 
5. ^ Nurdeen Deuraseh and Mansor Abu Talib (2005), "Mental health in Islamic medical tradition", The International Medical Journal 4 (2), p. 76-79.
6. ^ Ibrahim B. Syed PhD, "Islamic Medicine: 1000 years ahead of its times", Journal of the Islamic Medical Association, 2002 (2), p. 2-9 [7].
7. ^ Harold Merskey, Francois M. Mai and (1980), “Briquet's Treatise on Hysteria”, Archives of General Psychiatry 37: 1401-1405 .
8. ^ Harold Merskey, Francois M. Mai and (1981), “Briquet's Concept of Hysteria: An Historical Perspective”, Canadian Journal of Psychiatry 26: 5763 .
9. ^ Goetz, Christopher G. (1995). Charcot: Constructing Neurology. Oxford University Press. ISBN 978-0195076431. 
10. ^ Levin, Kenneth (1978). Freud's early psychology of the neuroses: A historical perspective. University of Pittsburgh Press. ISBN 978-0822933663. 
11. ^ Erwin, Edward (2002). The Freud Encyclopedia: Theory, Therapy and Culture. Routledge, 245-246. ISBN 978-0415936774. 
12. ^ Melmed, Raphael N. (2001). Mind, Body and Medicine: An Integrative Text. Oxford University Press Inc, USA, 191-192. ISBN 978-0195131642. 
13. ^ ^{a b} Greco, Monica (1998). Illness as a Work of Thought: Foucauldian Perspective on Psychosomatics. Routledge, 1-3, 112-116. ISBN 978-0415178495. 
14. ^ I. H. Treasaden, Basant K. Puri, P. J. Laking (2002). Textbook of Psychiatry. Churchill Livingstone, 7. ISBN 978-0443070167. 
15. ^ Donaldson, L.J. and R.J. (2003). Essential Public Health. Petroc Press - LibraPharm Limited, 352. ISBN 978-1900603874. 
16. ^ 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.
17. ^ 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 20, "My own contribution to an understanding of the instinctive motor pattern"
18. ^ Rose, S.P.R. (Ed.)(1972). Biological Bases of Behaviour — Unit 14: Ethology. Open University Press: Bletchley. SBN 335 04085 3
19. ^ Piaget, J. (1949). Traité de logique. Armand Collin: Paris. [Republished (1972) as Essai de Logique Operatoire, Dunod].
20. ^ Piaget, J. (1945/1951). La formation du symbole chez l'enfant / Play, Dreams and Imitation in Childhood.
21. ^ Traill, R.R. Molecular Explanation for Intelligence. Thesis, Brunel University. [1]
22. ^ 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.
23. ^ 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).
24. ^ Piaget, J. (1967/1971). Biologie et connaissance / Biology and Knowledge. Gallimard: Paris / Chicago University Press / Edinburgh University Press.
25. ^ Mattick, J.S. (2001) "Noncoding RNAs: the architects of eukaryotic complexity". EMBO Reports,2(11), 986-991. [2]
26. ^ Traill, R.R. (2005/2008). Thinking by molecule, synapse, or both? — From Piaget's schema, to the selecting/editing of ncRNA. Ondwelle: Melbourne. [3]
27. ^ ibidem

[edit] External links

• Mind-Body Medicine: An Overview, US National Institutes of Health, Center for Complementary and Alternative Medicine
• NIH
• American Psychosomatic Society
  • Psychosomatic Medicine, journal of the American Psychosomatic Society