Upload
keith-h
View
215
Download
2
Embed Size (px)
Citation preview
108 PSYCHOSOMATICS
A Note on Psychosomatic MedicineH. KEITH FISCHER, M.D.
MARCH-APRIL
Psychosomatic medicine is a term implying the effective integration of goodpsychiatry and good medicine. It evolvesfrom the classical organic, physiologicand pathologic concepts of disease, butspecial problems occur when the increasing body of knowledge of modern dynamicpsychiatry is added. Scientific psychiatryhas developed parallel to unscientific individuals and groups through the areasof witchcraft, demonology, magicians,soothsayers, ecclesiastical authorities, thecharlatans, the Mary Baker Eddy's, thebartenders, the individuals with the "placebo personalities" and the "glib-talkingspellbinders." The latter have their successes too. The basic problem has been todetermine the standards and controls tokeep this at a constructive and therapeutic level. This problem is unique. It willbe resolved by the integrity of the individual physician plus taking out the magicand replacing it with scientific knowledge.The emotion and personality of the physician enters this far more than in otherareas of medicine where rational intellectand manual dexterity are usually sufficient. This problem is difficult and willbe an everlasting one. In this regard Imust propose several general principles.
First, that the basic science is the human individual with his tissue pathologyand his psychopathology. All beginshere and all returns to here. Thus psychiatry must be based at a medical biological level.
Secondly, the basic integrative principles would have to apply and have appropriate meaning to both physiology andpsychology. Let me mention a few. First,Cannon's principle of homeostasis-thetendency for both the psyche and the phys-
Presented at the Seventh Annual Meeting ofthe Academy of Psychosomatic Medicine, Philadelphia, Pa., October 13, 1960.
iology seek a steady state. The steadystate may be at a level which is destructive to the organism, or destructive to society, or it may be at a healthy or constructive level. Therefore, Fechner's principle, number two on my list, calls attention to the tendency of the organism tokeep tensions at the lowest level. Thismeans that psychologically and physiologically, homeostatic levels which are destructive become the focus of a varietyof efforts to replace them with morehealthy and comfortable levels. If this isaccomplished, my third basic principlewould involve Alexander's theories concerning the priorities of energy investment. The basic priority is existence. Ifthis is adequately taken care of the excess energy goes to creativity and if thisin turn is satisfied, any left over energywould go into play. The definition of"play" would be anything done simply forthe pleasure of it. The tools for makingthese clinical and therapeutic involvesknowledge of the unconscious, as definedby FreUd, as the conditioning center inwhich sensitivities from the past childhood experiences, the outside environmentand the present come together with theactivity of the ego to handle it.
If these principles are basic pillarswhich can be accepted as applying bothto the body psychology and the body physiology, the applications, both in understanding disease and planning therapy,can be put on an acceptable and rationalbasis and the integration becomes operationally, theoretically and rationallysound. In doing this the re-emphasis onclinical research and the re-writing of aphysiology with the intact mind is an important goal. When the growth and maturity of the physician accompanies thesuccess of this effort medicine will becloser to its greatest contribution in prevention of disease and suffering.