Psychosomatic Medicine: Past and Present
Part I. Historical Background*
Z.J. LIPOWSKI, M.D., F.R.C.P.(C)1
Psychosomatic Medicine as an organizedfield of'scien-
tific inquiry and a mode ofapproach to patient care has
existed for 50 years. It has focused on the study of the
interaction of psychosocial and biological factors in
health and disease. Despite its relatively recent origin,
this field continues a long tradition in Western thought
and medicine, one concerned with the reciprocal rela-
tionship ofmind and body as two integral aspects ofthe
human organism. That tradition goes back to ancient
Greeceand represents a counterpoint to the dualistic and
reductionistic conceptions. Psychosomatic medicine
merged as a reaction against them and as an organized
attempt to subject various aspects ofmind-body relation-
ship in health and disease to scientific inquiry. Three
major methodological approaches to such inquiry have
been employed: the psychoanalytic, the psychophysio-
logical, and the psychobiological. The author discusses
the relative contributions ofthese approaches in thefirst
phase in the development ofpsychosomatic medicine, i.e.
between circa 1930 and 1960.
P sychosomatic medicine as an organized field of
scientific inquiry and a method of approach to the
practice of medicine and psychiatry has existed for half a
century. Despite this fact, confusion and misconceptions
regarding its definition, scope, key assumptions, and cur-
rent state continue (I). The very term "psychosomatic"
implies different things to different people, and has been
used in a variety of contexts such as psychosomatic medi-
cine, movement, disorders, symptoms and patients.
These terms are seldom defined by those using them. This
perpetuates their ambiguity. The teaching of psychoso-
matic medicine has often been less than adequate and has
lagged behind the developments, both conceptual and
investigative, in this field over the past two decades or so.
Yet advances in this area are highly relevant to both
medicine and psychiatry as they are concerned with mat-
ters of health and disease, mind-body relationship, and
the conduct of medical practice.
Hopefully, to correct widespread misconceptions
about psychosomatic medicine and to achieve better
communication and teaching, this three-part article will
*Manuscript received June 1985; revised August 1985.
'Professor of Psychiatry, University of Toronto; Psychiatrist- in-Chief,
Psychosomatic Medicine Unit, Clarke Institute of Psychiatry, Toronto,
Ontario.
Address reprint requests to: Dr. Z.J. Lipowski, Clarke Institute of
Psychiatry, 250 College Street, Toronto, Ontario M5T I R8
Can. J. Psychiatry Vol. 31, February 1986
2
focus on the historical derivation of the core psychoso-
matic concepts, define the key terms, examine the current
state scope of this field in its clinical and scientific aspects.
Historical Antecedents
The term "psychosomatic" was introduced by Hein-
roth in 1818, but modern psychosomatic medicine was
founded only in the early 1930's, and reflected the conflu-
ence oftwo concepts having an ancient tradition in West-
ern thought and medicine: those of psychogenesis of
disease and of holism (I). Both of these concepts were
formulated in a rudimentary form in ancient Greece
nearly 2,500 years ago and have had changing fortunes
and influence since. Moreover, their flowing together to
form the conceptual foundations of psychosomatic med-
icine in-this century has resulted in two distinct connota-
tions of the word "psychosomatic" which have been sel-
dom explicitly recognized, and thus contributed to the
ambiguity which continues to bedevil it as well as the
terms derived from it (I). To understand why psychoso-
matic medicine emerged when it did, what its founders set
out to investigate, and how it came to be plagued by
semantic confusion, one needs to trace the historical
roots of the two concepts which that field has embraced.
The Concept of Psychogenesis
The psychogenic concept implies the belief that psy-
chological factors may cause bodily disease. In other
words, its occurrence may be adequately accounted for
by invoking psychological concepts, states and processes.
From Hippocrates on, countless writers, medical and
non-medical, have asserted that emotions, or passions as
they were called initially, could not only influence all
functions of the body but also cause disease (2). Galen,
one of the most influential medical writers of all time,
whose teachings had been followed until the 19th cen-
tury, wrote in the 2nd century A. D. that passions such as
grief, anger, lust and fear constituted a class of causes of
disease and ought to be diagnosed and treated (2). As a
result of his influence, medical writers had, until the
mid-nineteenth century, devoted a great deal of attention
to the role of emotions as putative pathogenic factors
(1,2). A typical and most explicit example of that notion
may be found in a book by Archer, a 17th century English
physician: "The observation I have made in practice of
physick these several years hath confirmed me in this
opinion, that the original, or cause, of most mens and
womens sickness, disease and death is first, some great
discontent which brings a habit of sadness of mind ..." (3,
p. 121).
February, 1986 PSYCHOSOMATIC MEDICINE: PART I
Similar, if far less sweeping, views on the role of emo-
tions in bodily disease were expressed by practically all
the leading medical writers of the 17th and 18th centuries,
including such founders of modern medicine as Syden-
ham, Willis, Whytt, Harvey, and Gaub. As a historian' of
medicine has recently observed, "for seventeen hundred
years there has been a continuous tradition of psychoso-
matics under the label of 'passions"'(2, p. 18). Whole
treatises were devoted to the discussion of the influence of
emotions on the body's health and disease (4-6). Ben-
jamin Rush (1745-1813), the foremost American physi-
cian and medical educator of his times, and the man who
wrote the first American textbook of psychiatry (1812),
asserted that the "actions of the mind" were the causes of
many diseases and might be used for therapeutic pur-
poses (7).
One may wonder why the early medical writers singled
out emotions from the whole array of psychological con-
cepts to serve as putative etiologic factors. Perhaps the
everyday observation that. intense emotions are accom-
panied by physiological changes and that rage or fear, for
example, can precipitate sudden chest pain or even death,
may have led observers to infer that their effects could be
pathogenic. They seemed to be the most somatic and
visible of all the psychological, or mental, phenomena,
and hence inspired the belief that they could exert harm-
ful effects on bodily functions. Moreover, emotions pro-
vided a set of plausible etiologic factors in the case of any
disease whose causation was unknown. Be that as it may,
statements about their pathogenicity.were based on natu-
ralistic observations which were then interpreted in the
form of causal hypotheses. It was only in 1833 that an
American physician, William Beaumont, published the
results of his studies of a man with exposed gastric
mucosa and reported that emotions such as anger and
fear influenced its appearance and function (8). That
report was an important landmark, in that it represented
a crucial shift from casual observations and anecdotes to
systematic empirical study of psychophysiological corre-
lations. Yet it was only in the first decades of this century
that Pavlov (9) and Cannon (10) pioneered experimental
research on the physiological correlates of emotions and,
thus, built the foundations of modern psychophysiology.
The notion of psychogenesis took on a new look with
the emergence of psychoanalysis. Freud himself was not
concerned with the influence of psychological factors on
somatic functions and disease, but provided a new
methodological strategy for the study of the mind as well
as a set of theoretical concepts and explanatory hypo-
theses which could be applied to speculations about dis-
ease etiology. Some of his followers, such as Groddeck,
Deutsch, Ferenczi and Jelliffe, tried to apply Freud's
concept of conversion to that end. Groddeck, for
instance, evolved sweeping psychogenic postulates and
asserted that every physical illness served the purpose of
symbolically representing an inner conflict and aimed at
resolving it, repressing it, or preventing that which was
already repressed from becoming conscious (11). His was
3
the most radical formulation of psychogenesis couched in
psychoanalytic terms and provoked a sharp rejoinder
from other psychoanalysts, notably Franz Alexander,
who advanced more moderate psychogenic hypotheses
also derived from psychoanalysis (12).
Alexander rejected the notion that the concept of con-
version could be applied to account for the occurrence of
any physical illness, and explicitly distinguished hysteri-
cal conversion symptoms from those physical illnesses
which he labelled "organ neuroses" to underscore their
hypothesized psychological causation as non-symbolic,
"vegetative" conseq uences of "chronic emotional states"
(12). He postulated that unresolved unconscious conflicts
between aggressive or dependent wishes on the one hand,
and the opposed forces of the ego and superego on the
other, engender chronic emotional tensions, whose spe-
cific physiological correlates might result in dysfunction
of and, ultimately, structural changes in specific target
organs. Alexander applied these psychogenic notions,
referred to generically as the "specificity theory", to sev-
eral chronic diseases of unknown etiology such as essen-
tial hypertension, rheumatoid arthritis, thyrotoxicosis,
peptic ulcer, ulcerative colitis, bronchial asthma, and
neurodermatitis. Those diseases were often referred to as
"psychosomatic disorders". He was careful to point out,
however, that psychogenesis implied no more than a
linear causal chain, one beginning with those cerebral
processes which could be most conveniently specified in
psychological terms, and ending in manifest organic dis-
ease. He postulated that a "dynamic constellation", one
consisting of a "nuclear" unconscious conflict, the
defenses against it and the emotions engendered by it,
constituted the first link in such a causal chain. Alex-
ander emphasized that the notion of psychogenesis could
not fully. account for the development of any disease,
since constitutional and other biological factors must be
assumed to co-determine its occurrence in accordance
with the doctrine of multicausality of all disease.
Alexander's theory of psychogenesis represented the
most elaborate formulation, in modern dress, of the
ancient belief that emotions could cause disease. That
theory dominated psychosomatic medicine for some
twenty-five years, that is, from the early 1930's until
about 1960. It achieved widespread currency that was
followed by equally widespread disenchantment. Speci-
ficity hypotheses proved difficult to validate and failed to
bring about the hoped for gains in the treatment of the
diseases to which they had been applied. Their eclipse
marked the end of the dominance of the psychoanalytic
approach to psychosomatic research .and theorizing.
Alexander's methodology had several major weaknesses
which gradually came to be recognized (13). His observa-
tions were confined to small and skewed clinical samples,
consisting of patients who not only sought medical help,
but also were accepted for and underwent psychoanaly-
sis. He made no attempt to study the psychophysiological
mechanisms and processes which were supposed to
mediate between his "dynamic constellation" of psycho-
 4 CANADIAN JOURNAL OF PSYCHIATRY
logical variables on the one hand, and the development of
a given disease on the other. Moreover, his specificity
theory of psychogenesis had an explicit resemblance to
the germ theory of disease, which asserted that for every
infectious disease there must exist a specific causative
microorganism, one that constitutes both a necessary and
a sufficient condition for the disease to occur. Such sim-
ple linear causality is no longer acceptable today. It is
generally assumed that even a specific microorganism
does not constitute a sufficient condition for the occur-
rence of a corresponding infectious disease. On the con-
trary, its development is postulated to be the outcome of
a complex interaction between the infectious agent, its
human host, and the host's environment. Furthermore,
Alexander'S specific "dynamic constellations" do not
seem to be in any sense "specific" at all (13). As one critic
summed it up, "psychosomatic formulations have
become stereotypes into which each patient's life history
and situation is molded by special focusing, selective
interpretation, and omission or neglect of the incongru-
ent" (13, p. 15).
The concept of psychogenesis generally, and of the
etiologic role of emotions in particular, has been the
subject of criticism for decades (1). As early as 1948,
Halliday lamented that the term "psychogenic" was a
"seducement to neglect all requirements of etiological
discipline. In the absence of a strict definition, its con-
tinued usage can only lead to further confusions and thus
render inteIligible communication impossible" (14).
Regarding the role of emotions, Wolff, one of the leading
psychosomatic researchers and theoreticians, pointed
out thirty years ago that emotion constituted part of a
person's psychophysiological reaction to some event or
situation and not the cause of that reaction (15). In other
words, emotions must not be viewed as "causes" of
anything.
In this author's opinion, the traditional concept of
psychogenesis is obsolete and should be relegated to the
annals of history. It is a simplistic, linear concept, one
incompatible with modern notions of multifactorial dis-
ease etiology. Consequently, the psychogenic connota-
tion of the term "psychosomatic" should be dropped as it
reflects historically interesting, but no longer tenable,
views on causation of disease. the term "psychosomatic"
must not be used to imply causality, in the sense of
something "psychic" causing something "somatic".
Observations on the etiologic role of psychological fac-
tors in physical illnesses accrued over the centuries
should not be discarded. Rather, they need to be re-
evaluated and re-interpreted in the light of modern
research and views on causal relationships. Emotions as
such should not be 'considered causative agents but
viewed as part of a person'a psychophysiological
response to information inputs. Psychosomatic medicine
is not concerned with demonstrating psychogenesis of
ever more physical illnesses. On the contrary, its major
task is to study the complex interaction of psychosocial
and biological factors in maintaining health and in the
Vol. 31, No.1
development, course and outcome of all human diseases.
The Concept of Holism
The other concept basic to psychosomatic medicine
and the second common connotation of the term "psy-
chosomatic" may be referred to as holism (1). This word
is derived from the Greek holos, or whole, and was first
introduced by Smuts in 1926 (16). Despite its recent
vintage, the term "holism" stands for certain notions
about the nature of man and about health, illness and
patient care, as old as the concept of psychogenesis. Its
lineage leads back to ancient Greece, to Hippocrates,
Plato, Aristotle, and other thinkers. It refers to the postu-
lates that mind and body constitute an indivisible unity,
or whole, and that the study and treatment of the sick
need to take into account the whole person rather than
isolated parts. Aristotle asserted that it was no more
meaningful to ask if the body and soul were one, than it
was to ask if a piece of wax and the imprint of a seal on it
were one (17). Speaking of medical practice, Plato
observed that, "As you ought not to attempt to cure the
eyes without the head, or the head without the body, so
neither ought you to attept to cure the body without the
soul ... for the part will never be well unless the whole is
well" (18). '
While the Greek philosophers made a distinction
between mind, or soul, and body, it was never sharp, and
a holistic view of man as a mind-body unity prevailed. It
was only in 1637that the French philosopher, Descartes,
formulated a radical and almost un bridgeable distinction
between mind and body, and split them asunder (19). He
separated the thinking mind (res cogitans) from the non-
thinking, machine-like body (res extensa), In his view,
passions were bodily phenomena which could cause dis-
ease. Thus, Cartesian dualism was compatible with the
notion of psychogenesis but dealt a blow to the holistic
view of man and to the related concepts in medicine. It
has exerted a far-reaching influence on Western medi-
cine, in that it encouraged it to focus predominantly on
the machine-like body to the relative neglect of the psy-
chosocial aspects of illness, and fostered biological reduc-
tionism in medical thought and research (20). It was
actually the influence of Cartesian dualism on modern
medicine which had led to the emergence of psychoso-
matic medicine as a reaction against it fifty years ago.
Despite Descartes' profound influence on Western
medicine, the holistic conceptions survived and were
expressed, in one form or another, by many medical
writers of the 17th, 18th, and 19th centuries (1). The
central issue became how mind and body, viewed as
separate entities rather than merely distinct aspects of
man, acted one upon the other. One,of the most striking
statements reaffirming the holistic position in medicine
came from Rush: "Man is said to be a compound of soul
and body. However proper' this language may be in reli-
gion, it is not so in medicine. He is, in the eye of a
physician, a single and indivisible being, for so intimately
united are his soul and body, that one cannot be moved,
February, 1986 PSYCHOSOMATIC MEDICINE: PART I
without the other" (7, p. 256). Rush was the first physi-
cian in America to emphasize in his teaching of medicine
the role of psychological factors in illness and its treat-
ment, and to include lectures on disorders of the mind.
Unfortunately, that exemplary attempt to integrate med-
icine and psychiatry ended with Rush's death in 1813,and
the two disciplines remained split throughout the rest of
the 19th century. Since about 1850 on, medicine was
becoming increasingly more technological and biologi-
cally oriented, while psychiatry, at least in America, was
largely, if not entirely, confined to the asylum. Several
major developments had a deep impact on medicine:
formulation by Virchow of the cellular theory of disease,
discovery of the microorganisms by Pasteur, and the
setting forth of the postulates of the germ theory of
disease by Koch. Those developments propelled medi-
cine powerfully in the direction of biological
reductionism.
Holistic conceptions were voiced by a few 19th century
writers, such as Hughes .(21), but had little impact. One
major theoretical development, however, proved to be
fruitful in the long run. In 1859,France's foremost physi-
ologist, Claude Bernard, enunciated the concept of
"milieu interieur" (internal environment), and proposed
that the stabililty of that milieu was an essential condition
for life (21). Disease represented a disturbance or disloca-
tion of the regulating mechanisms of that stability. Some
seventy years later, Cannon developed Bernard's views
further and formulated the concept of homeostasis, one
which provided a physiological basis for the holistic con-
ception, in the sense that anything including psychosocial
factors, that disturbed the dynamic steady state of the
internal milieu was liable to affect the functioning of the
human organism as a whole.
Reaction against the biomedical reductionism began
to take shape early in this century and followed two main
directions: First, a revival of interest in psychogenesis
which was inspired by the emergence of psychoanalysis.
And second, the formulation of a set of holistic concepts
by an American psychiatrist of Swiss origin, Adolf
Meyer, under the label of "psychobiology" (23). Meyer
conceived of psychobiology as a science of man as a
person, both in health and disease. Mind and body were
two distinct yet integral aspects of the human organism, a
psychobiological unit, as a whole. Hence to advance
knowledge about man, and about health and illness, one
had to study the psychological and the biological aspects
in their dynamic and complex interaction. To confine the
study to either the mental or the physical aspects would
not do.
Meyer's holistic views had a far-reaching impact on
American psychiatry in the first thirty years of this cen-
tury (24). They gave impetus to the development of gen-
eral hospital psychiatry, of psychobiologial research on
mental illness, and of eclecticism in psychiatric practice.
Moreover, psychobiology facilitated the emergence of
psychosomatic medicine in the early 1930's and the
acceptance by it of the holistic viewpoint as a basic pre-
5
mise. One of Meyer's followers, Helen Flanders Dunbar,
was among the founders of psychosomatic medicine and
authored a book in 1935 which helped launch it and
achieve instant popularity (25). The holistic concept was
explicitly endorsed by all the pioneers of the new field
regardless of their methodological approach to it. That
concept, one asserting mind-body unity, antidualistic
and antireductionistic, constitutes the second major con-
notation of the term "psychosomatic". In this writer's
opinion, it ought to be the only one employed today (I). It
must not be confused with the so-called holistic medicine,
a set of beliefs and practices with scientifically dubious
credentials.
Psychosomatic Medicine: The First Phase
The notions of psychogenesis and holism became
adopted by a reformist movement against biomedical
reductionism, namely, by psychosomatic medicine, in the
early 1930's. While the core assumptions were of ancient
lineage, that movement had a crucial new feature: it
initiated a systematic scientific: study ofthe interaction of
psychological and biological factors in health and dis-
ease. What used to be personal convictions, anecdotes,
and medteal folklore, was to become a subject of rigorous
empirical research. Moreover, the founders of psycho-
somatic medicine acted as outspoken advocates of a
holistic approach to medicine, one that called for due
attention to be given to the psychological factors in dis-
ease etiology and in the care of patients. The emergence
of psychosomatic medicine has fostered the development
of closer links between psychiatry and medicine (24).
The first phase of psychosomatic medicine in America
lasted about twenty-five years, i.e. from about 1935 to
1960. Three major conceptual and methodological
approaches to the field could be distinguished from the
start: the psychoanalytic, the psychobiological, and the
psychophysiological (26). The already discussed psy-
choanalytic approach was most prominently represented
by Franz Alexander and his collaborators and followers
(12).
The psychobiological point of view was mainy pro-
mulgated by Helen Flanders Dunbar, whose most
influential book appeared in 1935 (25). A follower of
Meyer, she advocated a holistic approach to patient care,
initiated clinical research on the correlations between
personality types and several physical illnesses, and
helped pioneer consultation-liaison.work (24). Her main
contributions included the popularization of psychoso-
matic medicine, and the founding of the American Psy-
chosomatic Society and of the first journal in the field of
Medicine in 1939.
Finally, the psychophysiologial approach, one
inspired by the earlier studies of Pavlov and Cannon, as
well as by Meyer's psychobiology, was most prominently
represented by Harold G. Wolff, whose sefninal book,
"Stress and Disease", came out in 1952 (I5). He made
several major contributions to the field. On the theoreti-
cal level, he elaborated the concepts of psychological
6 CANADIAN JOURNAL OF PSYCHIATRY
stress and stressful life changes as contributory causal
factors in human diseases. He asserted that man's capac-
ity to respond to symbolic threats, derived from social
interactions, made him vulnerable to maladaptive psy-
chophysiological responses and disease in response to a
whole range of psychosocial stimuli. Disruption of'famil-
ial and social structures, deprivation of basic human
needs, and 0 bstacles to fulfillment of personal goals and
potentialities were examples of stressful stimuli with
pathogenic potential (15). Moreover, a variety ofthreats
and symbols of danger as well as such stressful events or
situations as death of a loved person, marriage, retire-
ment, loss of a job, and outbreak of war, could also be
potentially noxious. In the area of research, Wolff and his
co-workers initiated studies of the impact of life changes
on health. Wolffs research was marked by careful des-
cription and measurement of both the psychological and
the physiological variables under study; by focus on con-
scious rather than unconscious emotions; and by caution
in generalizing from clinical and experimental data. The
importance of his approach lies in his adherence to the
scientific method, emphasis on the need for empirical
data as a basis for theoretical formulations, and focus on
clinical observation as a source of such data. The numer-
ous studies which he and his co-workers conducted over a
period ofthirty years have provided an exemplary model
and inspiration for psychosomatic medicine in its second,
current phase.
The early psychosomatic investigators paid relatively
little attention to the social environment as a factor con-
tributing to health and disease in individuals. The work
of James Halliday, a Scottish public health physician,
who wrote, in 1948, an influential book, Psychosocial
Medicine (14), represented a notable exception. He deve-
loped the concept of "psychosomatic affections" to refer
to those disorders in which "the application of a psycho-
logical approach provides information of high etiological
relevance" (14, p. 240). Halliday asserted that "sick
society", one characterized by social disintegration, con-
tributed to their development. While the notion of a "sick
society" is quite vague, Halliday's contribution drew
attention to the need to take into account the social
environment in the study of human morbidity.
In the late 1950's, psychosomatic medicine underwent
a crisis resulting from a gradual eclipse of the dominant
psychoanalytic approach. For those who tended to
equate the field with that approach its demise seemed to
be inevitable. Yet the crisis was soon overcome thanks to
the heuristic value of Wolffs psychophysiological and
epidemiological research and his theoretical formula-
tions, as well as to the contributions of such investigators
and theoreticians as Grinker, Engel, Lazarus, and many
others. Grinker (13) published, in 1953, a penetrating
critique of the then most prominent psychosomatic
research and theories, and pointed out the weaknesses of
both the holistic and the psychogenic concepts. He
asserted that while holism represented a necessary
advance in medical and psychiatric thought, it offered no
Vol. 31, No.1
clear focus for research, since the study of the patient as a
whole was impossible. There was need for methodologi-
cal reductionism. Engel (27) developed a unified concept
of health and disease, one that he subsequently called the
"biopsychosocial" model (28). He carried out influential
psychosomatic studies on fainting, hyperventilation,
ulcerative colitis, psychogenic pain, and many others,
and helped expand the scope of psychosomatic research
beyond its initial narrow focus on the so-called psycho-
somatic disorders. Finally, Lazarus (29), a psychologist,
elaborated the concepts of psychological stress, coping,
and cognitive appraisal of information.
The research and writings of the above investigators
and theoreticians, along with many others, have enabled
psychosomatic medicine to ride out the crisis occasioned
by the decline and fall of the psychoanalytic and psycho-
genic approaches, and to enter its second and current
historical phase (30). Highlights of that phase are the
focus of the remaining parts of this overview.
References
I. Lipowski ZJ. Psychosomatic medicine and liaison psychia-
try. Selected papers. New York: Plenum Publishing Corp.,
1985.
2. Ackerknecht EH. The history of psychosomatic medicine.
Psychol Med 1982; 12: 17-24.
3. Archer J. Every man his own doctor. London, 1673.
4. Corp. An essay on the changes produced in the body by
operations of the mind. London: Ridgway, 1791.
5. Falconer W. A Dissertation on the influence of the passions
upon disorders of the body. London: Dilly 1796.
6. Rather LJ. Mind and body in eighteenth century medicine.
Berkeley: University of California Press, 1965.
7. Rush B. Sixteen introductory lectures. Philadelphia: Brad-
ford and Innskeep, 1811.
8. Beaumont W. Experiments and observations on the gastric
juice and the physiology of digestion. Plattsburg, NY: F P
Allen, 1833.
9. Pavlov JP. The work of the digestive glands. Translated by
W H Thompson. Philadelphia: Lippincott, 1902.
10. Cannon WB. Bodily changes in pain, hunger, fear, and
rage. New York: Appleton, 1915.
I I. Groddeck G. The book of the it. New York: Vintage Books,
1961.
12. Alexander F. Psychosomatic medicine. New York: Norton,
1950.
13. Grinker RR. Psychosomatic concepts. Revised Ed. New
York: Jason Aronson, 1973.
14. Halliday JL. Psycho-social medicine: a study of the sick
society. New York: Norton, 1948.
15. Wolff HG. Stress and disease. Springfield, Ill: Charles C.
Thomas, 1953.
16. Smuts JC. Holism and evolution. New York: Macmillan,
1926.
17. Bames J, Aristotle. Oxford: Oxford University-Press, 1982.
18. Plato. Charrnides, in the best known works of Plato. Trans-
lated by B Jowett. Garden City, NY: Blue Ribbon Books,
1942.
19. Descartes R. Discourse on method. Translated by J.
Veitch. La Salle: Open Court, 1946.
February, '1986 PSYCHOSOMATIC MEDICINE: PART I
20. Lindeboom GA Descartes and medicine. Amsterdam:
Radopi, 1979.
21. Hughes CH. The nervous system in disease and the practice
of medicine from a neurologic standpoint. JAMA 1894;
22: 897-908.
22. Kollar EJ, Alcalay M. The physiological basis for psycho-
somatic medicine. A historical view. Ann Intern Med 1967;
67: 883-895.
23. Meyer A. Psychobiology: a science of man. Springfield, Ill:
Charles C. Thomas, 1957.
24. Lipowski ZJ. Holistic-medical foundations of American.
psychiatry: A bicentennial. Am J Psychiatry 1981; 138:
888-895.
25. Dunbar H. Emotions and bodily changes: a survey of
literature on psychosomatic relationships: 1910-1933. New
York: Columbia University Press, 1935.
26. Powell RC. Helen Flanders Dunbar (1902-1959) and a
holistic approach to psychosomatic problems. I. The rise
and fall of a medical philosophy. Psychiatr Q 1977; 49:
133-152.
27. Engel GL. Psychological development in health and dis-
ease. Philadelphia: W B Saunders Co., 1962.
28. Engel GL. The need fora new medical model: a challenge
for biomedicine. Science 1977; 196: 129-136.
29. Lazarus RS. Psychological stress and the coping process.
New York: McGraw-Hill, 1966.
30. Lipowski ZJ. Psychosomatic medicine in the seventies: an
overview. Am J Psychiatry 1977; 1324: 233-244.
7
Resume
En tant que champ de recherche scientifique et facon
d'envisager Iesoin des malades, la medecinepsychosoma-
tique existe depuis cinquante ans. Jusqu'ici, cette disci-
pline s'est penchee surtout sur l'interaction des facteurs
biologiques et psychosociaux de la santeet de la maladie,
D'origine relativement recente, elle s'inscrit quand meme
dans une longue tradition de la pensee et de la medecine
occidentale, qui s'est preoccupee de la relation de
reciprocite entre l'esprit et Ie corps, deux elements essen-
tiels de l'organisme humain. Cette tradition qui remonte
ala Grece ancienne existe en contrepoint des conceptions
dualiste et reductionniste. La medecine psychosomatique
a reagi aces tendances et a tente de soumettre a une
recherche systematique les dtfferents aspects de la rela-
tion esprit-corps dans la sante et la maladie. Trois
approches methodologiques principales ont ete pro-
posees : l'approche psychanalytique, Tapproche psycho-
physiologique et l'approche psychobiologique. Dans cet
article, I'auteur expose lafacon doni chacune a eontribue
a la premiere etape de revolution de la medecine psycho-
somatique entre les annees 1930 et 1960.