Methodology of Research in Psychosomatic Medicine

This paper reviews some problems in the methodology of clinical psychosomatic research. Its emphasis is on elucidation of symptoms rather than on aetiology of disease and on diagnosis and treatment of known psychopathology, particularly mood disturbance, rather than on underlying speculative mechanisms. Reliability, sensitivity, and validity of measurements are considered to be the keys to advance of knowledge in this field. Samples of patients studied must be representative of a disease, and not of other factors which contribute bias to the observations. Account must be taken of the wide variability found in most measures required in psychosomatic patients, and hence of their lack of specificity to an individual patient.     

The International College of Psychosomatic Medicine – a personal history

This is a history of the International College of Psychosomatic Medicine from 1970 to the present.     

Psychosomatic Principles

There are four lines of development that might be called psychosomatic principles. The first represents the work initiated by Claude Bernard, Cannon, and others, in neurophysiology and endocrinology in relationship to stress. The second is the application of psychoanalytic formulations to the understanding of illness. The third is in the development of the social sciences, particularly anthropology, social psychology and sociology with respect to the emotional life of man, and, fourth, there is an increased application of epidemiological techniques to the understanding and incidence of disease and its causes. These principles can be applied to the concepts of comprehensive medicine and they bid fair to be unifying and helpful in its study. This means that future practitioners, as well as those working in the field of psychosomatic medicine, are going to have to have a much more precise knowledge of the influence of emotions on bodily processes.     

The Psychosomatic Emergency

Many psychiatric problems present themselves under the guise of physical rather than mental symptoms.These occur in several categories: (1) Psychological problems which work in conjunction with definitive organic pathology, such as the fear of death. (2) Symptoms produced by altered physiology or biochemistry resultant from an acute orchronic stress state. (3) A combination of A and B above. (4) Patients with an intense disease, such as hypochondriasis. (5) Psychiatric symptoms, such as depression, anxiety or apathy which develop antecedent or subsequent to a fearfully anticipated illness or procedure.These patients have certain characteristics in common. (1) They manifest a disproportionate concern over symptoms. (2) The symptoms are inconsistent with the usual pattern of organic disease. (3) The onset is concurrent with states of conflict. (4) There is usually a personal and family history of psychic and psychosomatic disorders. (5) Other psychiatric disorders are usually present. (6) Secondary gain is usually evident.These patients can be successfully treated within the hospital setting and within the framework of psychiatric consultation and psychotherapy.