The Good, the Bad and the Ugly Sides of "Psychosomatic"

Riccardo Torta MD, & Rossana Botto PsyD
Clinical Psychology and Psycho-Oncology Unit, Department of Neuroscience, University of Turin, Turin, Italy

The presentation proposes to summarize the evolution of the concept of "Psychosomatic" and the approach to it. The Mind-body problem is a philosophical matter of concern to science since its inception. In ancient Greece, Hippocrates, proposing the humoral theory, tried to provide a unitary conception of human being, in which the body, the mind and the environment were strictly interconnected. According to his theory, four humors, blood, yellow bile, black bile, and phlegm combine in the human body, and manifest in the form of temperaments. A few centuries later, in the modern age, Descartes replaced this perspective with his reflections on res extensa versus res cogitans. It distinguished between psychic and physic reality, contemplating the existence of two distinct domains, i.e. that of thinking (cogito) and that of the material world (sum). The introduction of such dichotomy, known as Cartesian dualism, had a protracted harmful impact on science. The term "Psychosomatic" has been introduced at the beginning of the 19th century, and the first phase of development of the modern psychosomatic medicine started in the early 1900s. Originally, due to the strong influence of psychoanalysis, the nucleus of psychosomatic diseases were the individual intrapsychic conflicts. It was thought that such unconscious instincts and drives generated emotional states that could determine pathological modifications in tissues and organs, and had a direct causal relationship with somatic diseases. For example, in the hysterical conversion, neurological deficits, such as paralysis or somatosensory alterations, were considered as caused by psychogenic stressors. In this way, the physical symptoms that could not be explained by organic reasons, were the resulting effects of psychic issues. Subsequently, thanks to the scientific advances especially in genetics and neurobiology, these first theories were questioned, and the mind and the body started to be considered as interconnected and exerting reciprocal influences. Multi-factorial circular models replaced the causal-linear ones, and the study of other individual aspects, such as attachment, subjective development and cognitive domain became salient. Furthermore, Psychosomatic received a fundamental support from the bio-psycho-social model and the concept of heterogeneity of diseases, according to which psychosomatic diseases do not exist, but psychosomatic factors could be central in some diseases.  Therefore, the actual hypothesis is that multiple aspects, such as bio-chemical, psycho-social and environmental contribute to the manifestation of a certain clinical condition. This is sustained also by neuroscientific evidences, that are demonstrating how neurobiological processes can impact on both soma and psyche. For example, it has been shown the double role of oxytocin that, on the one hand, stimulates uterine contractions during delivery and milk secretion and, on the other, promotes maternal care and attachment. Also the function of proinflammatory cytokines both on mood and physical disease well represents this new actual psychosomatic perspective.
Paradigmatic in this context is the problem of fibromyalgia syndrome (FMS) in which both biological and psychosocial factors play significant roles in his pathogenesis. In FMS there is a greater presence of psychological distress and psychosomatic syndromes than in rheumatoid arthritis (RA) patients (Ghiggia et al., 2017). A better understanding of the psychosomatic manifestations of FM syndrome could allow clinicians to structure tailored interventions that take more account of the emotional distress associated with the physical complaints. Also the current evidence strengthens the relevance about the management of FMS from a psychosomatic perspective (Sancassiani et al., 2017). In agreement with these considerations an integrated model of Psychosomatic Medicine could help the approach to FMS in clinical practice (Deter, 2018).

Deter HC. Bio-psycho-socio or psychotherapeutic medicine - actual development of psychosomatics in clinical practice. Wien Med Wochenschr. 2018: 168(3-4):52-61.
Ghiggia A, Torta R, Tesio V, et al. Psychosomatic syndromes in fibromyalgia. Clin Exp Rheumatol. 2017;35 Suppl 105(3):106-111. 
Sancassiani F, Machado S, Ruggiero V, et al. The management of fibromyalgia from a psychosomatic perspective: an overview. Int Rev Psychiatry. 2017;29(5):473-488.