Psychosomatic and Obsolete Idea
The whole enterprise of psychosomatic thinking is misleading and distracts
from the practical and important pursuit of healthy environments and
constructive action to alter disease-causing conditions. Physicians and patients
are often in conflict because they occupy opposite sides of the same irrational
psychosomatic belief system. The physicians believe that the mind can invent
disease without outside help and their patients believe the mind can cure
disease without outside help. Physicians tend to divide illness into two broad
categories, the organic and the non-organic. The distinction is used by
physicians when they talk to one another but there is no biology to support the
irrational belief in "non-organic illness." In dismissing a patient's symptoms,
a physician will remark to a colleague, for example, that the origin of the
abdominal pain is "supratentorial." This is a neuroanatomical remark without
much understanding. The tentorium is a membrane that forms a floor for the
cerebral hemispheres inside the skull. A supratentorial event would involve any
part of the brain above the midbrain and for many physicians, brain function at
this level is indeed a mystery.
Medical lists of the causes of disease continue to include the term
"psychogenic" and it is common to hear or read a physician claiming that
symptoms are "psychological." Although in most respects medicine has become
scientific, the area of psychogenic medicine remains primitive. The term
psychogenic is associated with fuzzy thinking and superstitions still prevail.
Psychiatry has several labels that suggest that patients make themselves ill but
there is little or no biological justification for the belief in psychogenic
causation. These are issues in patient-physician relationships mostly that go
unexamined and ignorance of these issues often shows up as belief in psychogenic
Physicians continue to rely on patients stories and medical students are
still taught to take a history as an essential part of their examination of the
patient. However, all story telling is imperfect, patients lie, both
deliberately and inadvertently. Physicians tend to be impatient and biased
listeners who want to hear a simplified story that fits their preconceptions of
The physician's tendency to dismiss descriptions that he or she does not
understand leaves many patients frustrated and angry. They feel patronized,
misunderstood and abandoned. Often, this perennial miscommunication allows
irrational and superstitious beliefs to persist on both sides.
Psychosomatic thinking often assumes that each person has control over his or
her behavior and mental states. This leads to the moralistic and punitive
aspects of psychosomatic thinking. I have observed that physicians tend toward
the punitive version of psychosomatics, blaming patients for dysfunction and
disease. Patients tend toward the wish-fulfilling aspect, hoping that good
intentions and mental trickery will assist them to recover from serious illness,
especially when the physician is powerless to help. Many have suggested that
psychosomatic notions are obsolete.
Psychiatrist, Lipovski, stated: "...the concept of psychogenesis of organic
disease is as reductionistic as the germ theory of it, against which pioneers in
psychosomatic medicine inveighed...To distinguish a class of diseases as
`psychosomatic disorders' and to propound generalizations about `psychosomatic
patients' is misleading and redundant. Concepts of single causes and of
unilinear causal sequences - for example, from psyche to soma and visa versa -
are simplistic and obsolete."
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