psychosomatic: Definition from Answers.com

It is difficult to provide an exact definition of psychosomatics. To some extent the term itself already indicates a theoretical bias. It joins together the normal or pathological dynamics of both mental and somatic structures and assumes their close interaction. According to Pierre Marty, psychosomatics is the clinical observation of individual mental or somatic organization, disorganization, and reorganization, the attempt to draw from those observations theoretical findings, and the practical application of those findings to the therapeutic situation. If considerably broadened, psychosomatics would involve a global understanding of what it is to be human.

The term psychosomatics appeared in 1818 in the work of J. C. H. Heinroth, a German psychiatrist, and reflects a naturalist and vitalist approach to medicine. The context was formalized in 1945 by British psychologist James L. Halliday. The word has been in use since then among a wide range of practitioners, often with different interests. In the United States it is often referred to as psychosomatic medicine.

Prior to these developments, the interaction of psyché and soma, both within and beyond the context of philosophy and religion, reflected a vague association of the term with organic disease. It has been said (Kamieniecki) that "the history of medicine has written the prehistory of psychosomatics." This prehistory has gradually distinguished psychosomatic medicine, in various socio-cultural contexts, from its philosophical, mystical, and religious corollaries, the Corpus Hippocraticum being a good example. Since then there has been a continued effort to identify the links between "the ontological unity of being and the phenomenological duality of its operation."

This project, which has become for some researchers an original and fundamental discipline, can be considered part of a psychoanalytic framework, for it "consists in subjecting the somatic to the same dynamic and the energic considerations that govern the life of individuals undergoing analysis," according to the authors of L'investigation psychosomatique (Psychosomatic investigations; Marty, M'Uzan, and David). It must be noted that this project has generated no consensus, since it is a matter of applying these principles to the field of organic disease from the standpoint of psychoanalysis, a concept that has its detractors. Psychosomatics relates to the human individual in its concrete being, living and sexual, acting through its own body and mental organization—including the conflict within the individual movements between life and death (Marty)—and where illness is an incarnation of the logic governing the living being.

In the area of organic disease, where research in psychosomatics has been directed, what has been referred to as the "psychosomatic phenomenon," the interaction of psyché and soma, remains problematic and has led to numerous claims that have further confused the concept: psychogenesis, generalized conversion, somatization, and so on, not all of which have the same heuristic value. Somatization, seen as the result of a process in which mental causality (in the broad sense) plays a role, has become a doctrine for some. However, the real problem and focus of interest for the psychosomatic psychoanalyst, aside from any reactive mental disturbances, remains the discovery of a process for understanding and interpreting the reality of the disease, any possible exacerbation, and its resurgence in times of crisis. This entails the question of causal factors, while at the same time giving medical factors their due. It therefore includes the notion of a possible psychic causality that would interweave two histories of pathological alteration that belong to different orders but whose interactions are not purely random. When the two fields do not interact, there is no psychosomatic phenomenon, only the evolution of somatic morbidity along biological lines. The possible psychic causes remain an open question; these may be neither necessary nor sufficient but cannot be overlooked, even if we do not believe in psychogenesis or a limited determinism, and even if we feel that the "constructed meaning" of a symptom is not the cause or the origin of the disturbance.

Freud was not overly concerned with a strictly psychosomatic approach to disease, but in 1923 he wrote, "According to the indications of some analysts, the psychoanalytic treatment of obvious organic disturbances is not without a future, since it is not unusual for a psychic factor to play a role in the genesis and persistence of these affections" (1923a [1922]). The libidinal organization points to the somatic as a source; the description of actual neurosis and its underlying hypotheses (for some this is related to the so-called process of somatization); the idea of libidinal stasis identified in the organic disease; and the emergence of the id (the term originates with Groddeck, a precursor of psychosomatics according to some authors)—all these theoretical hypotheses, after being reworked, have led to the conclusion that Freud was also a pioneer in this field.

More recent interest in psychosomatics can be traced to the investigations of the American researchers Helen Flanders Dunbar and especially Franz Alexander during the 1940s. Their work helped develop later research and elements of it can be found, in modified form, among psychosomaticians and clinical psychologists. The so-called New York School (Dunbar) was associated with the culturalist movement of the time. They related organic pathology to pre-morbid "personality profiles," specific to certain clinical symptoms: the structure of the personality would expose a specific part of the organism to external aggression and would prepare the way for somatization. Dunbar also hypothesized an emotional dynamic, derived from Darwin, who assigned a defensive goal to the emotions, coupled with the affective repercussions within the body itself. Dunbar was one of the first to take a neovitalist approach—the degradation of vital energy—to developing an understanding of psychosomatics. For him, the exclusion of conflict outside consciousness would result from a short-circuiting of the mental (though he does not use this word), through subcortical mechanisms. This school of thinking concluded that psychoanalysis alone would provide a deeper understanding of the processes in question.

Franz Alexander believed that the personality profile alone was not sufficient to determine causality. He centered his hypotheses on the notion of a "specific psychodynamic constellation." This constellation was based on basic reactions that ensued following an increase in tension within the psychic apparatus, reactions that encompassed the autonomic nervous system and the subcortical stem, along with basic dispositional characteristics. The idea of psychosomatic medicine (the title of his first book) was both established and subject to criticism because of its over-reliance on biology. But internal conflicts and emotional reactions culminating in physical changes also played a role. This sequence led to the concept of "organ neurosis," corresponding to the abnormal stagnation of a quantity of energy in an organ or system. These connections between affective states and somatic behaviors resulted in "psychosomatic patterns" that, from functional disturbances, could produce organic symptoms. One finds in his work profound intuitions that have contributed to contemporary theory in spite of his overly biological approach and pertinent suspicion about the concept of organodynamics, a concept picked up by Henri Ey.

During the 1960s, two approaches to psychosomatics appeared in France. These were the sources of a number of subsequent developments that altered, weakened, and expanded certain hypotheses, and modified the clinical and therapeutic approach to the field. Jean-Paul Valabrega promoted an approach to somatic symptoms through a model of generalized conversion isolation, whose rediscovered source in fantasy would give meaning to the symptom. For Valabrega the isolation of the conversion phenomenon from its source and its specifically hysterical environment resulted in the development of manifestly visceral symbolizations, which originated in conversion phenomena and were unexplained by reference to a hysterical kernel common to all neuroses. In this context of "psychosomatic conversion," Valabrega insisted on the resurgence of the fantasy at the very site from which it had been expelled, a hypothesis associated with the general problem of the accessibility of the symptom to symbolization and meaning. The psychosomatic symptom was said to constitute a physical barrier that had to be crossed by separating it from its hidden fantasy elements, which had been kept in check. "In other words, according to the hierarchical etiology, the specificity is defined less by physiopathological or psychopathological mechanisms than by the singular mode of organization which underlies both mechanisms" (1966/1974).

In 1963, the so-called psychosomatic school of Paris (Pierre Marty, Michel de M'Uzan, Christian David, Michel Fain) formalized its approach, based on the notion of deficit, where a mental loss (fantasy, oneiric, associative, the loss of mental defenses) was seen as paradigmatic. This concept meshed satisfactorily with the findings of psychoanalysis, especially in the area of psychic economy, where the somatic symptom is asymbolic and does not produce meaning. Their approach gave rise to a number of developments. After Pierre Marty introduced the concept of operative thought, other clinical concepts emerged, such as essential depression and chronic disorganization, and Marty insisted on the reorganizing value of the regression/fixation system. The process of disorganization, triggered by trauma and incapable of stopping the regression/fixation system, became the crux of the "somatization process." However, regression can also be pathogenic and reversible illnesses are conceivable, in terms of points where disorganization is halted at various stages of somatic fixation. This model, based on monist, evolutionist, and neovitalist principles, and extensively described in Marty's writings, presents an internal coherence that has made it a classic, although not always accepted, reference in the field.

Bibliography

Alexander, Franz. (1950). Psychosomatic medicine, its principles and applications. New York: Norton.

Kamieniecki, Hannah. (1994). Histoire de la psychosomatique. Paris: Presses Universitaires de France.

Marty, Pierre. (1990). La psychosomatique de l'adulte. Paris: Presses Universitaires de France.

Marty, Pierre, M'Uzan, Michel de, and David, Christian. (1963). L'Investigation psychosomatique. Paris: Presses Universitaires de France.

Valabrega, Jean-Paul. (1974). Problèmes de théorie psychosomatique. In Encyclopédie médico-chirurgicale: Psychiatrie. Paris: E.M.-C. (Original work published 1966)

		Dictionary. The American Heritage® Dictionary of the English Language, Fourth Edition Copyright © 2007, 2000 by Houghton Mifflin Company. Updated in 2009. Published by Houghton Mifflin Company. All rights reserved. Read more
		Dental Dictionary. Mosby's Dental Dictionary. Copyright © 2004 by Elsevier, Inc. All rights reserved. Read more
		Psychoanalysis. International Dictionary of Psychoanalysis. Copyright © 2005 by The Gale Group, Inc. All rights reserved. Read more
		Health Dictionary. The New Dictionary of Cultural Literacy, Third Edition Edited by E.D. Hirsch, Jr., Joseph F. Kett, and James Trefil. Copyright © 2002 by Houghton Mifflin Company. Published by Houghton Mifflin. All rights reserved. Read more
		Veterinary Dictionary. Saunders Comprehensive Veterinary Dictionary 3rd Edition. Copyright © 2007 by D.C. Blood, V.P. Studdert and C.C. Gay, Elsevier. All rights reserved. Read more
		Translations. Copyright © 2007, WizCom Technologies Ltd. All rights reserved. Read more

	Actual Neurosis/Defense Neurosis
	Alexander, Franz Gabriel
	Groddeck, Georg Walther

	What is the difference between psychosomatic and somatization? Read answer...
	Is insomnia a psychosomatic disease? Read answer...
	Does Homoeopathy has a role in Psychosomatic ailments? Read answer...

	How likely is it to have psychosomatic pregnancy symptoms?
	Journals of psychosomatic disorder?
	Psychosomatic implies means?