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Changing Explanations in Mind-Body Medicine

Class 6: The Modern Era

Introduction: Major changes overtook medicine in the nineteenth and twentieth centuries. Only in the nineteenth century were long-standing classical conceptions abandoned and broadly replaced by views based first on pathoanatomy and later on cellular pathology, biochemistry, and bacteriology. Specialization then fragmented medicine into separate and compartmentalized organs and systems, each with its own special biology and each with little room for psychological considerations. Advances in diagnostic technology in the form of X-rays, electrocardiograms, and the like cumulatively distanced doctors from patients, who were seen more and more as objects to be scientifically probed rather than as people with emotions that were relevant to their medical conditions. The culmination of these developments by the turn of the twentieth century was the effective separation of mind from body in much of modern medicine. In the majority of fields, detailed somatic specifics became the almost exclusive focus of medical attention, and psychological factors, if they were still noticed at all, were thought to be of little or no influence on the physical state of the body.

A few decades into the twentieth century, however, new fields called “psychoanalysis” and “psychosomatic medicine” arose and strongly reasserted mind-body interactions. In the 1920s and 1930s, Sigmund Freud and other pioneers of the new fields often restated classic medical mind-body relationships in psychoanalytic terms, and claimed that both psychiatric and physical diseases needed to be understood in terms of “psychodynamics.” But the surge of enthusiasm for psychological approaches in medicine did not last very long. Thus the wave of twentieth century, psychoanalytically-based psychosomatic medicine for physical diseases such as peptic ulcer and asthma and psychoanalytically-oriented psychiatry for mental diseases, peaked in the 1950s and began declining rapidly in the 1960s. By the 1970s, the psychological wave was receding quickly.

Problems for the psychological approach started in the field of psychosomatic medicine, first in the form of skepticism about key psychoanalytic concepts and methods. Research on “stress” as a causal agent was promoted by Hans Selye (1907–1982) and quickly became very popular, as did studies on biofeedback, stress management, and the biochemistry of the neuroendocrine system. Mainstream medicine also moved strongly in the biochemical and genetic direction, followed soon by the “molecular revolution.” Where psychology had been a central presence in the form of theories of disease causation and management just a few years before, psychological considerations were now pushed to the margins or eliminated entirely. Even diseases recently thought to be “classic” psychosomatic conditions—like ulcer and asthma—were now explained in genetic, biochemical, or microbiological terms.

The same strong trends were apparent in psychiatry. Attacks on the theory and techniques of psychoanalysis were followed by critiques of psychoanalytic diagnoses, which in the 1960s were said to have been overextended and often erroneously applied. In the seventies, the molecular revolution in medicine extended to psychiatry, which entered an era of “neuroscience” as new discoveries of powerful pharmaceutical agents—antipsychotic medications, tranquilizers and anti-anxiety medications, and antidepressants—went hand-in-hand with an exploration of the chemistry and micro-anatomy of the brain. By the 1990s, Time magazine declared Freud “finished,” his psychodynamic therapy replaced by psycho-pharmaceuticals like Prozac and BuSpar as the new wonder drugs

While some psychiatrists and general physicians today still urge a continuing consideration of psychological factors in the form of a “bio-psycho-social” approach or pursue clinical studies of emotionally-caused psychiatric conditions or organic illnesses, others search for molecular and microanatomical connections between the nervous, neuroendocrine, and immune systems. Ironically, the field of “psycho-neuro-immunology,” which explores connections between the various systems, seeks to provide legitimacy for psychological factors long-observed in clinical medicine by searching in the laboratory for underlying biological foundations.

Readings

  • Porter, Roy. The Greatest Benefit to Mankind: A Medical History of Humanity. New York: W.W. Norton & Company, 1997, 306–314, 493–503, 507–519, 545–549
  • Brown, Theodore M. “Mental Diseases.” In Companion Encyclopedia of the History of Medicine. Edited by W.F. Bynum and Roy Porter. London: Routledge, 1993. Vol. 1, 438–463.
  • Weissman, Gerald. They All Laughed at Christopher Columbus. New York: Times Books, 1987, 147–160.
  • Aronowitz, Robert. Making Sense of Illness. Cambridge: Cambridge University Press, 1998, 39–56.
  • Wallis, Claudia et al. “Pills for the Mind.” Time Magazine (July 6, 1992): 52–60.
  • Moyers, Bill. Healing and the Mind. New York: Doubleday, 1993, 213–248.

Discussion Questions

  1. There is much about the rise and fall of psychoanalysis that suggests it was more of a cultural and intellectual fad than a scientific movement. What lasting legacies are there in today's “common sense” that suggest there was more to psychoanalysis than faddish and foolish enthusiasm?
  2. When the medical journal Psychosomatic Medicine began publication in 1939, its editors included the following introductory statement: “The medical profession has awakened to the necessity of studying systematically … the therapeutic utilization of the psychic component in the disease process, and in the emotional relationship between physician and patient. This intensive interest and research in medical psychology is a symptom of a new orientation toward the problem of disease, in fact, the sign of the beginning of a new era in etiological and therapeutic thought.” Why did they believe that a turning point had been reached in medicine and why did they consider it so momentous?
  3. In his 1998 book, Making Sense of Illness, physician-historian Robert Aronowitz suggests that there were clearcut fads in the understanding of such diseases as asthma and ulcerative colitis. “Stress” research also exhibited faddish dimensions. What is it about medicine that allows such fads to appear and disappear?
  4. Was it the advance of biological science alone that pushed psychological factors to the margins of medicine or were other factors involved, such as the well-funded support of research in certain selected areas but not in others? What role did the powerful pharmaceutical industry likely play in pushing its highly profitable, biology-targeted products?
  5. Why do many of those who wish to defend the importance of psychological factors in medicine do so by turning with greatest enthusiasm to the development of the laboratory- and biology-based field of “psycho-neuro-immunology” rather than continuing to pursue direct bedside observations of mind-body clinical connections? What does this tell us about what is highly valued in modern medicine and what is not?
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