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108 PSYCHOSOMATICS A Note on Psychosomatic Medicine H. KEITH FISCHER, M.D. MARCH-APRIL Psychosomatic medicine is a term im- plying the effective integration of good psychiatry and good medicine. It evolves from the classical organic, physiologic and pathologic concepts of disease, but special problems occur when the increas- ing body of knowledge of modern dynamic psychiatry is added. Scientific psychiatry has developed parallel to unscientific in- dividuals and groups through the areas of witchcraft, demonology, magicians, soothsayers, ecclesiastical authorities, the charlatans, the Mary Baker Eddy's, the bartenders, the individuals with the "pla- cebo personalities" and the "glib-talking spellbinders." The latter have their suc- cesses too. The basic problem has been to determine the standards and controls to keep this at a constructive and therapeu- tic level. This problem is unique. It will be resolved by the integrity of the indi- vidual physician plus taking out the magic and replacing it with scientific knowledge. The emotion and personality of the phy- sician enters this far more than in other areas of medicine where rational intellect and manual dexterity are usually suffi- cient. This problem is difficult and will be an everlasting one. In this regard I must propose several general principles. First, that the basic science is the hu- man individual with his tissue pathology and his psychopathology. All begins here and all returns to here. Thus psychi- atry must be based at a medical biologi- cal level. Secondly, the basic integrative princi- ples would have to apply and have ap- propriate meaning to both physiology and psychology. Let me mention a few. First, Cannon's principle of homeostasis-the tendency for both the psyche and the phys- Presented at the Seventh Annual Meeting of the Academy of Psychosomatic Medicine, Phila- delphia, Pa., October 13, 1960. iology seek a steady state. The steady state may be at a level which is destruc- tive to the organism, or destructive to so- ciety, or it may be at a healthy or con- structive level. Therefore, Fechner's prin- ciple, number two on my list, calls atten- tion to the tendency of the organism to keep tensions at the lowest level. This means that psychologically and physiolog- ically, homeostatic levels which are de- structive become the focus of a variety of efforts to replace them with more healthy and comfortable levels. If this is accomplished, my third basic principle would involve Alexander's theories con- cerning the priorities of energy invest- ment. The basic priority is existence. If this is adequately taken care of the ex- cess energy goes to creativity and if this in turn is satisfied, any left over energy would go into play. The definition of "play" would be anything done simply for the pleasure of it. The tools for making these clinical and therapeutic involves knowledge of the unconscious, as defined by FreUd, as the conditioning center in which sensitivities from the past child- hood experiences, the outside environment and the present come together with the activity of the ego to handle it. If these principles are basic pillars which can be accepted as applying both to the body psychology and the body phys- iology, the applications, both in under- standing disease and planning therapy, can be put on an acceptable and rational basis and the integration becomes opera- tionally, theoretically and rationally sound. In doing this the re-emphasis on clinical research and the re-writing of a physiology with the intact mind is an im- portant goal. When the growth and ma- turity of the physician accompanies the success of this effort medicine will be closer to its greatest contribution in pre- vention of disease and suffering.

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Page 1: A Note on Psychosomatic Medicine

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.