Psychosomatic Medicine

1939

Franz Alexander (1891–1964), Helen Flanders Dunbar (1902–1959)

Travel on the new train lines that began crisscrossing Europe in the middle of the nineteenth century led to reports of a puzzling new malady labeled “railway spine.” Travelers reported a variety of major and minor complaints for which physicians often could not find a physical cause. One explanation was that these were functional disorders, so called because they served a psychological purpose rather than reflecting physical pathology.

In the early twentieth century, the theories of Sigmund Freud concerning unconscious mental influences were used to account for these functional disorders, which he called conversion disorders. According to Freud, the conversion of psychological distress to bodily complaints occurs when psychic content—an image, an impulse, a desire—is incompatible with the ego, which represents societal conventions. As a result, the emotions associated with the psychic content are repressed so that they are not available to conscious thought. The energy associated with the affect is then converted into a physical disturbance that symbolizes the unacceptable content, thus partially solving the original psychological conflict. Freud called this the “jump from the psychic to the somatic.”

Between the world wars, theories about psychosomatic illness spread to the United States. Helen Flanders Dunbar, in her massive literature review, Emotions and Bodily Changes (1935), articulated it as the “interrelationships between emotional life and bodily processes both normal and pathological.” Hungarian émigré psychoanalyst Franz Alexander soon became the most visible figure in the new psychosomatic movement. Alexander argued in numerous books and articles that it was necessary to consider both psychological and physiological factors in diseases, including peptic ulcers, hyperthyroidism, gastrointestinal diseases, and coronary heart disease. In 1939, the journal Psychosomatic Medicine began publication and served as a legitimizing force for the new field.

Psychosomatic medicine was considered part of the mainstream for many years, but gradually fell out of favor. However, the research that it generated was important in helping to create the field of health psychology later in the twentieth century.

SEE ALSO Psychoneuroimmunology (1975), Biopsychosocial Model of Health (1977), Mind-Body Medicine (1993)

When doctors can’t pinpoint a physical cause for maladies such as chronic back pain, they might suggest that the patient is suffering from a psychosomatic ailment, in which psychological distress is converted into bodily pain.