2025/06/20 by Darius Valevicius · 1 voice
Arts and Humanities · Psychology · Neuroscience · #Mental Health and Psychiatry #Psychotherapy Techniques and Applications #Neurology and Historical Studies
paper · pdf · doi:10.31234/osf.io/keu7a_v1
openalex publication_date 2025/06/20 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/28
The idea of "psychosomatic disorders" represents a link between the mind and the body, in which bodily ailments are thought to be exacerbated or caused by psychological conflicts or distressing social situations.This essay will explore some of the history, philosophy, and scientific approaches to this family of phenomena.The first section will explore in more detail some definitions and conceptions of the term "psychosomatic".The two following sections will describe the history of the psychiatric family of somatoform disorders and the non-psychiatric functional somatic disorders respectively.The last three sections will explore some frameworks used in the interpretation and explanation of psychosomatic phenomena, including the cultural approach of "idioms of distress", neo-Janetian theories of dissociation, and the role of trauma and attachment. What does "psychosomatic" mean?The term "psychosomatic" evokes many different frameworks and may have different connotations for people working in somatic medicine, psychiatry, psychotherapy, or the layperson.Furst suggests that no dictionary definition of the term is helpful, as any one definition tends to assume one version to the exclusion of others (Furst, 2002).To clarify some of the confusion from the outset, we will explore some of these different conceptions of the term.There are perhaps three broad categories to which the term "psychosomatic" may be applied.In the first case is the idea of a disorder or condition in which somatic symptoms, that is, distress experienced in relation to the body (e.g.pain) or symptoms of an apparently neurological nature (e.g.paralysis, epilepsy, blindness, fatigue), are rooted in psychological or social conflicts.That is, they are "psychogenic" or have a psychological etiology.This is the most narrow case, and most practitioners in medicine and psychology may not attribute it to more than a handful of HPSC 300: Distress and the body 3 D. Valeviciusillnesses.An example of this may be the idea of "conversion disorder", now somewhat antiquated, although the term is still present in the latest edition of the DSM-V.In the original psychoanalytic view, a psychological stress or conflict is converted by some mechanism into a physical or seemingly neurological complaint for which no underlying physical pathology can be identified (North, 2015).A second version of "psychosomatic" may refer to illnesses which are in large part, but not exclusively, moderated by psychosocial factors.This can include any condition in which the physical symptoms are known to intensify or abate in response to psychosocial stress in a considerable way.However, a partly or entirely physical etiology is still compatible with this definition.This could include the family of chronic pain conditions, where the precipitating cause is often thought to be a physical injury or trauma, but where the development and course of the condition is heavily intertwined with psychosocial factors (Linton & Shaw, 2011).The third sense of "psychosomatic" is the most broad and all-encompassing, and reflects the fundamental inseparability of the mind and body.This stance is often confluent with a rejection of mind-body dualism, and sees the distinction between the biological and the psychological as rooted in philosophical misconceptions.This version is essentially accepted in modern medicine, where it is known as the "biopsychosocial" framework.Regardless of whether the illness is due to a cancer, infection, or broken limb, the interaction between the central nervous system and the immune system mean that psychosocial factors are always relevant (Furst, 2002).However, this "soft" version of psychosomatic medicine may ignore considerations of "psychogenesis", or psychological root causes, versus "organogenesis"physical root causeswhich may be critical in determining whether a patient is best served by psychotherapy or surgery.For example, HPSC 300: Distress and the body 4 D. Valevicius iatrogenic surgeries are a common issue in people presenting with somatization disorder (North, 2015).Since the third sense of psychosomatic can be taken for granted, the topics pursued in this paper will focus on the first two.Namely, in the first case, are somatic complaints that are thought to be psychogenic.As a case study, we will explore the history of hysteria, which developed into the modern category of somatoform disorders.In the second case are illnesses which are thought to have a physical pathology, but which are heavily intertwined with psychosocial factors.For this, we will explore the history of fibromyalgia, which is a chronic pain condition.However, the assumption of a physical etiology in this example is not taken for grantedas part of the family of "functional somatic syndromes", the roots of fibromyalgia remain uncertain, and it remains to be seen whether it falls solidly into the first or second category.The next two sections will explore the histories of two families of disorder concepts, which may arguably be called psychosomatic disorders.The first will be a study of the somatoform disorders, which are part of the speciality of psychiatry, and have their roots in the concept of hysteria.The second group will be the functional somatic syndromes, which are associated with several non-psychiatric medical domains.It will focus mainly on fibromyalgia, a musculoskeletal pain disorder that has its roots in rheumatology. History of somatoform disorders: Hysteria to the DSM-VAccording to Carole North, the idea of a hysteria-type syndrome goes back at least 4000 years.Records from ancient Egypt describe a condition with multiple physical and behavioural dysfunctions.The Bible contains a story of a man possessed by spirits who claimed, "My name is HPSC 300: Distress and the body 5 D. ValeviciusLegion, for we are many," evoking the multiple identities sometimes observed in hysteria.Hippocrates (460 -370 BC) coined the term "hysteria" at a time when it was conceptualized as a displacement of the uterus throughout the body.The movement of the uterus into different organs was thought to produce the various symptoms.Throughout antiquity to the end of the 18 th century, the dominant interpretation of hysterical phenomena, including altered states of identity, convulsive fits, and other unexplained presentations, was through the supernatural lens of spirits, demonic possession, witchcraft, and sorcery.In the 19 th century, these beliefs were maintained through the popularity of spirit seances and other occult practices (North, 2015).The modern medical history of hysteria began when a Swiss alchemist and astrologer, Paracelsus (1493 -1541), provided the first clear description of a case of multiple personalities.Paracelsus gave a complex medicalised account of the condition involving a theory of magnetism and its effects on mental and bodily health.This theory was later adopted by the German doctor Anton Mesmer (1734 -1815), who advanced the theory of "animal magnetism", which proposed the influence of the planets and tidal forces on human health.His therapeutic practices, which seemed to operate though suggestion and social contagion, paved the way for the practice of hypnosis and its application to hysteria.Though this led to a professional medical interest in hysteria which displaced the older supernatural notions, Mesmer's work also contributed to a rise in popularity of occultism and charlatanism in the 19 th centuryas well as perhaps contributing to epidemics of hysteria (North, 2015).The practice of treating hysteria with hypnosis was taken up by Jean-Martin Charcot (1825 -1893) and his student Pierre Janet (1859 -1947) at the Salptrire state hospital in Paris in the 19 th century.They viewed hysteria as a neurodegenerative disorder, and eagerly attempted to separate it from its historical roots in superstition and supernatural ideas.However, Charcot, like Mesmer, HPSC 300: Distress and the body 6 D. Valeviciuswas also fond of dramatic and flamboyant public demonstrations of his therapies, and this may also have contributed to epidemic rates of hysteria at the time.He was criticized for many methodological flaws, such as influencing reactions in subjects via suggestion, and promoting symptoms in patients by housing hysterical patients together with non-hysteric epileptics (North, 2015).Janet, Charcot's student, coined the term dissociation, which he thought played an essential role in generating the various physical and psychological symptoms of hysteria.While Janet's theories strongly influenced subsequent writers, such as William James, Sigmund Freud, and