psychosomatic illness ‘Psychosomatic illness,’ writes Edward Shorter, author of a comprehensive history of the subject, ‘is any illness in which physical symptoms, produced by the action of the unconscious mind, are defined by the individual as evidence of organic disease and for which medical help is sought. But how, we may ask, do the actions of the unconscious mind produce these physical symptoms? ‘Is it real, or just in your head?’ is a most common turn of phrase, but does the juxtaposition bear scrutiny? Are symptoms any less ‘real’ if their origin lies in the mind, rather than in more tangible, organic sources? Should they be treated differently? What, in short, is the relationship between the mind and the body in the formation and expression of this type of
illness?
Western thinkers have grappled endlessly with these issues, positing shifting and historically-contingent theories of the mind–body relationship for centuries. The dichotomy between mind and body, which traces back to Plato's distinctions between transient materiality and transcendent truths, was reinforced by the Christian belief in the supremacy of spirit over flesh, and found its modern expression in Descartes' philosophical dualism, which confirmed and celebrated the autonomy of consciousness.
Indeed, Western medical thinkers have long been aware of the mind's influence over the body. Nevertheless, the idea that illnesses originate — and can be cured — in the mind first entered modern medicine around the late eighteenth century. Before this period, madness — or what we now call mental illness — had been considered a thing of the body, originating in disturbances of
humours (bodily fluids), physiological processes, or nerves. As the physician George Cheyne colourfully noted in his 1733 opus,
The English Malady:
I never saw a person labour under severe obstinate, and strong nervous complaints, but I always found at last, the stomach, guts, liver, spleen, mesentery, or some of the great and necessary organs or glands of the belly were obstructed, knotted, schirrous, spoiled or perhaps all these together.A decisive turn from the body to the mind occurred just decades later. In 1789, the year of the Revolution in France, a British surgeon attributed insanity to the psyche, ‘independent and exclusive of every corporal, sympathetic, direct, or indirect excitement, or irritation whatever.’ This dictated a new focus on, in the words of the French alienist Esquirol, ‘the ideas, thoughts, [and] projects of the lunatic. Accompanying this change was a shift in therapeutic tactics and the rise of the ‘moral treatment’, a non-coercive, semi-psychotherapeutic, and often highly theatrical doctor–patient encounter meant to reveal the delusion or moral (read ‘mental’) flaw at the core of the disorder. This approach was made most famous, perhaps, by the treatment of George III by the English physician Francis Willis.
But the path from the moral treatment to the therapist's couch was long and twisted. Mid-nineteenth-century doctors, seeking to elevate the status of the care of the insane, pinned their hopes on science and showed decreasing tolerance for these moral cures. By the end of the century, the new field of scientific psychiatry had established itself at the university, spawned numerous professional journals, and reverted, in a sense, from the mind to the brain. New research technologies and clinical facilities furthered attempts to localize behavioural anomalies in neuroanatomy, and new diagnostic systems subsumed mental illness to what the German neurologist Max Nonne called ‘the narrow straight-jacket of exact science’. As a result, therapeutic success suffered; there was, according to an asylum doctor in Posen, ‘an enormous blossoming of psychiatric literature alongside a low level of practical success. We know a lot and can do little.’
This late-nineteenth-century paradigm shift proved both incomplete and short-lived, collapsing under the weight of various medical and social forces. By the middle of World War I, a new, psychogenic view seemed to hold sway, as the tens of thousands of cases of ‘shell-shock’ — the tics, stuttering, shaking fits, and mutism so often observed among soldiers in the aftermath of explosions — were increasingly attributed to fear,
anxiety, and
memory, rather than any somatic mechanism. The wishes and fears produced in modern war, noted Nonne, ‘are of a previously unimaginable versatility.’
It was around this time that Freud and his followers first turned their attentions to mind–body disturbances. Freud had, of course, described the conversion of pathological ideas into hysterical symptoms already in the 1890s, but it was the ‘wild analyst’ Goerg Groddeck who first applied psychoanalysis to the treatment of specifically organic disorders. Groddeck's Baden-Baden sanatorium was soon supplemented by the clinic of the Berlin Psychoanalytic Institute under Max Eitingon and Ernst Simmel's Tegel sanatorium, all of which treated organic disturbances with psychoanalytic methods in the 1920s.
This brief sketch should suffice to show that today's belief in psychosomatic illness — a belief under siege by accumulating advances in genetics, biopsychiatry, and psychopharmacology — represents just one phase in a cyclical and fraught process. But even in its most ‘psychological’ phases, Western society seems to cling to distinctions between pain and suffering that is ‘real’ and maladies that lie ‘just in the mind’.
Paul Lerner
Bibliography
Shorter, E. (1992). From paralysis to fatigue: a history of psychosomatic illness in the modern era. New York.
Porter, R. (1995). Psychosomatic disorders: historical perspectives. In Treatment of functional somatic symptoms, (ed. R. Mayou, C. Bass, and M. Sharpe). Oxford.
See also
mind-body interaction;
nervousness.
