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PSYCHOSOMATIC MEDICINE
Editorial PSYCHOSOMATIC MEDICINE Dr. Arnold S. Anderson presents a very interesting and unique article in this issue. In his treatment of psychogenic factors in chest disease he emphasizes two important points. First, that there is abundant evidence of psychogenic factors in chest disease, and second, the human attributes with which a physician should be endowed if he is to successfully deal with the many psychogenic problems of the chronic invalid. I am sure that most any psychiatrist and internist will agree with Dunbar's statement "we know now that todily changes may be brought about by mental stimuli, by emotion, just as effectively as by bacteria and toxins, and that psychological changes accompanying emotion may disturb the function of any organ in the body." Since most acute infectious diseases are now practically controlled by the use of vaccines, antibiotics, and public health measures, together with increased longevity, we are of necessity more concerned with chronic and degenerative diseases. We are forced to recognize the urgent need to study and deal with the ever increasing number of patients whose complaints and invalidism are brought about by emotional distress. It is also important to understand that one etiological factor is the imbalance of the internal environment as well as the physical environment. In chronic diseases of the chest, especially in pulmonary tuberculosis, more and more studies are being made from the psychogenic angle. It is believed that anxiety with all its implications is the one factor present in every patient with chronic chest disease. In the case of pulmonary tuberculosis it has recently been shown that anxiety in varying degrees is also found in all arrested cases of tuberculosis. Therefore, psychosomatic approaches must be made in the rehabilitation of these patients. From observations that have been made by internists and by foremost psychiatrists it is becoming more generally recognized by the medical profession that mental therapy is nearly as essential as physical and medical treatment in the curing of pulmonary tuberculosis. Untrained in dynamic psycho-pathology and the techniques of investigating and treating problems and interpersonal relationships, the internist has found an ally in the psychiatrist. Psychiatry at the same time has stopped being preoccupied with a 603
604
EDITORIAL
May, 1951
search for physiological causes for emotional imbalance and has become intensely interested in the psychological concomitants of emotional maladjustment. It was the common scientific pursuit, as well as the old interest in the patient as a person, which led to coordination of interests. Dr. Anderson describes his ideal physician who would become an ideal psychosomatist. All of the traits he mentions are valuable, and I would add that the physician of the future be trained in the psychosomatic approach. The development of psychosomatic medicine and the organization of programs in comprehensive medicine in the liawn relationships between the department of psychiatry and the department of medicine have created problems concerning instruction in the use of the psychosomatic approach. There are two groups who should receive such instruction, the physician already in practice and the medical students. There are now institute courses in psychosomatic medicine available for the general practitioner, Armed Forces medical officers, and Public Health officers at the University of Minnesota, University of Cincinnati, Fitzsimmons, Letterman, Walter Reed General Hospital, and the California Institute on Mental and Public Health. The Duke University School of Medicine has made some studies concerning the methods to be used in teaching psychosomatic medicine to house officers. It would seem that the ideal instructor for the medical student would be a highly trained internist who later has become a psychiatrist in the final stages of his medical training. The problem of organizing methods of instruction in this all important subject is still in the trial and error stage. In due time, however, we can be sure a complete renovation of the curriculi in our medical schools will bring about a more comprehensive integration of psychiatry with other departments in medicine. C. M.Hendricks, M.D., F.C.C.P.
604
EDITORIAL
May, 1951
search for physiological causes for emotional imbalance and has become intensely interested in the psychological concomitants of emotional maladjustment. It was the common scientific pursuit, as well as the old interest in the patient as a person, which led to coordination of interests. Dr. Anderson describes his ideal physician who would become an ideal psychosomatist. All of the traits he mentions are valuable, and I would add that the physician of the future be trained in the psychosomatic approach. The development of psychosomatic medicine and the organization of programs in comprehensive medicine in the liawn relationships between the department of psychiatry and the department of medicine have created problems concerning instruction in the use of the psychosomatic approach. There are two groups who should receive such instruction, the physician already in practice and the medical students. There are now institute courses in psychosomatic medicine available for the general practitioner, Armed Forces medical officers, and Public Health officers at the University of Minnesota, University of Cincinnati, Fitzsimmons, Letterman, Walter Reed General Hospital, and the California Institute on Mental and Public Health. The Duke University School of Medicine has made some studies concerning the methods to be used in teaching psychosomatic medicine to house officers. It would seem that the ideal instructor for the medical student would be a highly trained internist who later has become a psychiatrist in the final stages of his medical training. The problem of organizing methods of instruction in this all important subject is still in the trial and error stage. In due time, however, we can be sure a complete renovation of the curriculi in our medical schools will bring about a more comprehensive integration of psychiatry with other departments in medicine. C. M.Hendricks, M.D., F.C.C.P.