Introduction and historical overview

The term ‘psychosomatic’ was first used in the early nineteenth century by Heinroth to mean ‘belonging to the body and the mind’ (Bynum, 1983). Psychosomatic conceptions were much older than this however. Plato observed that the ability of the ‘physicians of Hellas’ to cure disease was limited because they disregarded ‘the Whole, which ought to be studied also, for the part can never be well unless the whole is well’ (Plato (transl) See Padis, 1952). The term ‘psychosomatic’ is a modern designation for that holistic view of man and medicine which has its roots in ancient Greece. Throughout the nineteenth century it was widely accepted that psychological factors could play a part in the aetiology of physical illness.

The term has been used in a number of different ways in the last hundred years however. In the first half of the twentieth century three psychosomatic schools emerged and competed for prominence: the psychoanalytic, the psychophysiological and the psychobiological (holistic, biopsychosocial). The development of these three schools, which proved difficult to integrate, will be briefly described.

The psychoanalytical school, led by Alexander, focused on the postulated psychogenesis of a handful of somatic disorders of unknown cause such as bronchial asthma, rheumatoid arthritis, ulcerative colitis, essential hypertension, neuro-dermatitis, thyrotoxicosis and peptic ulceration. Alexander (1950) proposed that emotional changes in human beings were accompanied by physiological changes which led in turn to pathological physical changes: once physical pathology was established, psychological factors could help to maintain or aggravate it or to trigger relapse.