The following viewpoints were inspired by a recent request for references on psychoanalysis and psychosomatic medicine.

Over the past few decades, psychosomatic medicine, like social psychiatry was sidelined by the hegemony of more reductionistic molecular biological approaches to psychiatry.  Since the 1970s there had been a decreasing interest in this potentially fruitful integration of biology and psychosocial/interpersonal factors (despite the availability of such excellent journals as Psychological Medicine, Stress Medicine, Psycho-oncology, International Journal of Psychiatry in Medicine, etc.).  Recently, there has been a swing back towards recognizing the clinical value of psychosomatic medicine.  It has been formally approved by the American Board of Medical Specialties.  There have been many names for this re-emerging field: consultation-liaison psychiatry, psychological medicine, etc.  Since 2001, the American Board of Psychiatry and Neurology, the American Psychiatric Association, etc. have given formal approval to Psychosomatic Medicine as a subspecialty of psychiatry.  A good example of the popular trend away from an integrative approach is exemplified in our viewpoint of the etiology of peptic ulcers.  Usually it is ascribed to infection with H. pylori and the use of NSAIDs.  However, studies have demonstrated (Creed & Olden, 2005) convincing evidence that the onset, perpetuation, and recurrence of peptic ulcers are associated with stressful life events.  In addition to H. pylori and NSAID use, smoking and psychological stress appear to be independent risk factors for the development of peptic ulcers.

For a comprehensive and scholarly overview of the field of psychosomatic medicine see the Textbook of Psychosomatic Medicine edited by James L. Levenson (2005) and published by American Psychiatric Publishing, Inc.  I find this volume especially helpful with my patients who have such medical illnesses as asthma, IBD (irritable bowel disorder), endocrine and metabolic disorders, HIV/AIDS, rheumatological and other autoimmune disorders, etc.  One of my patients with polymyositis has a significant decrease in his CPK levels (which is a good thing for his disease) whenever he and his wife are more securely attached.  Normally they are living on the edge of divorce.  I realize this is anecdotal evidence, but it certainly has aroused interest in me in disorders usually not seen as having psychosomatic components.  Perhaps, the schizophrenias could usefully be seen from one perspective as psychosomatic with the brain as the target organ.  Another excellent volume demonstrating the salience of psychological factors in a range of disorders, including coronary heart disease, cancer, viral infections including HIV infection, autoimmune diseases, wound healing, etc., is Human Psychoneuroimmunology edited in 2005 by Kavita Vedhara and Michael Irwin for Oxford University Press,

Psychoanalysts have made many relevant observations concerning the interaction between mind and body.  Joyce McDougall's work seems to me to be still clinically relevant (McDougall, J. (1989). Theaters of the Body: A Psychoanalytic Approach to Psychosomatic Illness. NY: W.W. Norton & Company).  Can anyone on our listserv recommend other contemporary psychoanalytic approaches to psychosomatic illnesses?

Brian Koehler