Georges Jean Franz Kohler
The medical views of the Greeks came to be recycled in complex ways in eighteenth-century Europe. They helped shape the views, for example, of the physiognomists, such as the eighteenth-century Swiss divine, Johann Caspar Lavater, who believed that character and the body were one. Philosophical approaches in the seventeenth century, such as those of René Descartes and Gottfried Wilhelm Leibniz, provided models for the relationship between the mind and the body. Monistic theories, such as those of Descartes, saw the mind and body as one unit, with all aspects of one present automatically in the other. Leibniz's views were not quite as schematic, yet he believed that each aspect of the human being was necessarily linked in a ‘predisposed harmony’ with other aspects. Such views attempted to bridge long-held dualistic views that mind and body were separate entities that bore little or no relationship one to the other. Such theories saw ‘madness’ as a sign of imbalance.
The modern medical view was set at the turn of the eighteenth century with the rise of the concept of psychosomatic illness — illness that arises in the mind but has bodily as well as psychological symptoms. Building on German Romantic thought, psychiatrists, such as Johann Heinroth and Karl Wilhelm Ideler, evolved complex ideas of the relationship between illnesses of the mind and the state of the body. Your body is what your mind deems it to be. Mental illness, illness of the psyche, could also be illness of the body. These followers of the ‘psychic’ theory assumed the primacy of the mind over the body. Such views ran parallel to the views of materialist physicians of the time, the so-called ‘somaticists’, such as Wilhelm Griesinger, who, seeing the mind (and mental illness) as a product of the brain, argued that ‘mind illness is brain illness’. All assumed that ‘mental illness’ (always differently defined) was the core phenomenon that would prove their views. The former gave rise to the theories of psychosomatic illness; the latter to theories of somatopsychic illness.
If one could show that the ill mind could create pathological effects in the body in the form of specific and definable symptoms, or the other way around, one could move to treat one aspect of the monistic body/mind by treating the other. Mental illness was the means by which the physician could show the relationship between the ill body and the ill mind: Mens non sana in corpore insano.
It was not by chance that this view began to dominate the understanding of the body with the German Romantics at the beginning of the nineteenth century. The fascination with the ‘nightside’ of life, with the ill and the corrupt as well as with the psychologically unstable, became one of the hallmarks of Romantic fantasy. The philosophical question came to be about where the interaction between mind and body took place. Carl Gustav Carus, in his book Psyche (1846), stated that the ‘unconscious was the key to the knowledge of the conscious life.’ This view dominated anti-materialist European medicine during the closing decades of the nineteenth century. Even materialists came to be influenced by this notion. Jean Martin Charcot, the leading neurologist of nineteenth-century Paris, thus moved from an interest in the somatic results of brain lesions to an understanding of the physical nature of hysterical symptoms as the result of some hidden physical trauma.
When Sigmund Freud came to study with Charcot during 1885–6, it was to learn more about juvenile neurological problems. In Paris he was confronted with Charcot's hysterical patients and their physical symptoms, and he returned to Vienna convinced that the hidden truth was somewhere between Carus and Charcot. During the 1880s and 90s Freud developed a complex theory of psychosomatic illness, locating in the unconscious the illness process that produced physical symptoms, such as the globus hystericus (inability to speak). His interest before 1895 focused on the conversion of psychological trauma into specifically related physical symptoms.
Freud's interest in psychosomatic illness lessened after 1895, and he abandoned his trauma theory, but he inspired a long line of psychoanalysts (from Georg Groddeck to Alexander Mitscherlich) to examine the questions of the origins of physical illness in the psyche. Of all the psychoanalysts to write on psychosomatic illness, none was more influential than the Berlin/Chicago psychoanalyst Franz Alexander. In Alexander's work one can see the refining of Freud's views in Alexander's own distinction between conversion neurosis, functional illness, and psychosomatic illness. His most important work in this regard is The Medical Value of Psychoanalysis of 1936.
Other approaches, such as the return of the Hippocratic ‘characters’ in the form of the ‘constitutional types’ of Ernst Kretschmer, in the 1920s, led to work on a clinical theory of constitutions. Here the work of Friedrich Curtius on the psychosomatic basis of colitis and asthma is typical of the application of a twentieth-century theory of ‘types’ as a means of understanding how physical predisposition relates to mental and physiological states.
Of the early twentieth-century philosophers whose work served as an underpinning for much of the work on psychosomatics, none was more important than Victor von Weizsäcker, specifically in his 1898 study of Pathophysiology. For von Weizsäcker, illnesses differ from individual to individual, since each patient provides a different structure for his/her illness. Each illness is influenced by the psychic structure of the patient. These variations on the model of psychosomatic illness provide a wide range of positions for its possible interpretation.
The wide acceptance of the psychosomatic model was such that a whole range of popular as well as medical adaptations of it appeared during the mid-twentieth century. Thus in 1979 Norman Cousins, the former editor of the American Saturday Review, published what became a best-selling account of his overcoming of a collagen disease through his positive attitude under the title Anatomy of an Illness as Perceived by the Patient: Reflections on Healing and Regeneration. Such texts of self-help to overcome somatic illness through the improvement of attitude have become a staple of the English-language reading public. They rely on the audience's acceptance of a psychosomatic model that would imply conscious control over somatic illness and its psychological results. Be happy and you will not be sick, is their motto.
Conversely, the ‘somatopsychic’ model is closely related with theories of physical therapy (such as that of Moshe Feldenkrais) for the relief of psychic discomfort. Here the view is that a healthy body makes for a healthy psyche.
The rejection of mind–body dualism in the twentieth century was virtually total. Yet the problems of understanding how the ‘mind’ and the ‘body’ function remain. Indeed, the very continuation of a bipolar (if interconnected) model for ‘mind’ and ‘body’ suggests a continuing understanding of these as two different sites for illness and healing.
Sander L. Gilman
Gilman, S. L. (1996). Seeing the insane: a cultural history of psychiatric illustration. University of Nebraska Press, Lincoln.
Shorter, E. (1993). From paralysis to fatigue: a history of psychosomatic illness in the modern era. Free Press, New York.
Shorter, E. (1994). From the mind into the body: the cultural origins of psychosomatic symptoms. Free Press, New York.
See also philosophy and the body; psychological disorder; psychosomatic illness.