Psychosomatic Medicine: A Psychoanalyst's Journey Through a Somatic World

Abstract

Clinical discussions within the broad field of psychosomatic medicine tend to be concerned with either psychological influences on somatic functioning or somatic influences on the mental functioning of individual patients and tend to be conceptualized through either a psychological or a somatic lens. Gottlieb (2003) described this dichotomization by following the different paths taken by Freud and Janet. Efforts to bring these lenses together to form a psychosomatic whole, by bringing together the traditions of psychoanalysis and psychiatry, have generally resulted in a clash of cultures. This article represents an attempt to bridge the cultures of psyche and soma, by providing a case example of the daily practice of a psychoanalyst consulting in a medical–surgical healthcare setting, by highlighting important contributions to the consultation literature, and by describing ways of shifting focus from the individual patient to the system within which the patient exists.

Notes

¹PM is designated a subspecialty of psychiatry by the American Board of Psychiatry and Neurology and the American Board of Medical Specialties (http://abpn.com/downloads//core_comp_outlines/core_psychosomatic_medicine_060308.pdf).

²My attempts to integrate psychoanalysis and PM have included: (1) offering a preconference minicourse at the 2006 annual meeting of the APM, which I titled “A Psychoanalytically Informed Approach to the Medically Ill” (Lichtman 2006); and (2) contributing a book review of the Psychodynamic Diagnostic Manual (PDM Task Force, 2006) to the APM journal, Psychosomatics (Lichtman, 2008).

³Thomas P. Hackett, M.D., was Chief of Psychiatry at the Massachusetts General Hospital (1974–1989) and was a leading figure in the history of the field of PM.