Introduction
Major changes overtook medicine in the 19th and 20th centuries. Only in the 19th 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 20th 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 20th 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 20th 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.
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Discussion Questions
- 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?
- 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?
- In his 1998 book, Making Sense of Illness, physician-historian Robert Aronowitz suggests that there were clear-cut 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?
- 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?
- 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?
Project Topics
The following potential topics applied to extension activities, such as research papers, small group presentations, or classroom debates, help students expand their understanding and analysis beyond the readings and discussions in this class resource. See the list of online resources, and primary and secondary sources as a starting point for further research and reading for extension activities.
- Research ideas about a particular physical disease over a long period of time, perhaps a century or more—heart disease or asthma, for example—and examine the respective roles that biological and psychological factors were thought to have played in the disease you have studied. Try to identify periods in medical history when psychological factors were given particular prominence in the explanation of the disease you have investigated.
- Explore how mental illness was understood in various periods and by different individuals, and investigate what factors seem to have influenced whether a particular physician looked primarily to biological or psychological causes and treatments for the mental symptoms and behaviors studied.
- Research the ways in which different physicians at various times understood how their patients’ emotions influenced the onset, intensification, or amelioration of physical symptoms and syndromes. Be alert to ways in which these physicians may have differentiated symptoms and syndromes into several categories, some of which were highly responsive to emotional influences and others were not.
- Research groups of physicians in different periods to determine whether some individuals were more biologically-prone and others more psychologically prone in the same period of time. Explore what scientific, philosophical, professional, and personality factors may have influenced physicians to be more inclined one way or the other.
- Locate case records from various periods in medical history and use them to find evidence for both patients’ and physicians’ alertness to psychological dimensions in practice. Study these records to see whether or not there is evidence that patients talked to their physicians and physicians listened to their patients.
- Track down detailed biographies or autobiographies of physicians in the 20th century and study them closely for indications of sensitivity or insensitivity to psychological vs. biological circumstances in their patients’ illness experiences. Consider how these sensitivities may have been influenced by the contemporary popularity of psychoanalysis, stress research, molecular medicine, or psychopharmacology.
- National Library of Medicine. 2021. Emotions and Disease, nlm.nih.gov/emotions-and-disease.
- Descartes, Rene. Philosophical Works; Translated by E.S. Haldane and D.R.T. Ross, Vol. I. New York: Dover Publications, 1955. 331-356.
- Hoffmann, Friedrich. Fundamenta Medicinae. Translated and Introduced by Lester S. King. London: Macdonald, 1971. 39-47, 55-58, 103-108.
- Maimonides, Moses. “Two Treatises on the Regimen of Health.” In Transactions of the American Philosophical Society, 54 (1964): 16. 23-26.
- Shah, Mazhar H. The General Principles of Avicenna’s Canon of Medicine. Karachi: Naveed Clinic, 1966. 5-14, 154-156, 180-182, 228, 254, 364-366.
- Ackerknecht, Erwin. A Short History of Psychiatry. New York: Hafner Publishing Company, 1959.
- ———. “The History of Psychosomatic Medicine.” In Psychological Medicine, vol. 12 (1982): 17-14.
- Aronowitz, Robert. Making Sense of Illness. Cambridge: Cambridge University Press, 1998.
- Braslow, Joel. Mental Illness and Bodily Cures: Psychiatric Treatment in the First Half of the Twentieth Century. Berkeley: University of California Press, 1997.
- Brumberg, Joan Jacobs. Fasting Girls: The Emergence of Anorexia Nervosa as a Modern Disease. Cambridge, MA: Harvard University Press, 1988.
- Conrad, Lawrence I. et al. The Western Medical Tradition:800 BC to AD1800. Cambridge: Cambridge University Press, 1995.
- Duffin, Jacalyn. History of Medicine: A Scandalously Short Introduction. Toronto: University of Toronto Press, 1999.
- Ellenberger, Henri. The Discovery of the Unconscious. New York: Basic Books, 1970.
- Frankel, Richard M. et al. The Biopsychosocial Approach: Past, Present, Future. Rochester: University of Rochester Press, 2003.
- French, Roger. Medicine Before Science: The Rational and Learned Doctor from the Middle Ages to the Enlightenment. Cambridge: Cambridge University Press, 2003.
- Grob, Gerald. The Mad Among Us: A History of the Care of America’s Mentally Ill. New York: The Free Press, 1994.
- Hale, Nathan G. Freud and the Americans: The Beginnings of Psychoanalysis in the United States, 1876–1917. New York: Oxford University Press, 1977.
- ———. The Rise and Crisis of Psychoanalysis in the United States: Freud and the Americans, 1917–1985. New York: Oxford University Press, 1995.
- Harrington, Anne. The Cure Within: A History of Mind-Body Medicine. New York: W.W. Norton, 2008.
- Healy, David. The Creation of Psychopharmacology. Cambridge: Cambridge University Press, 2002.
- ———. Let Them Eat Prozac. New York: New York University Press, 2004.
- Herzberg, David. Happy Pills in America: From Miltown to Prozac. Baltimore: Johns Hopkins University Press, 2009.
- Howells, John G. The Concept of Schizophrenia: Historical Perspectives. Washington DC: American Psychiatric Press, 1991.
- Jackson, Mark. Allergy: The History of a Modern Malady. London: Reaktion Books, 2006.
- ———. Asthma: The Biography. Oxford: Oxford University Press, 2009.
- Jackson, Stanley W. Melancholia and Depression from Hippocratic Times to Modern Times. New Haven: Yale University Press, 1986.
- ———. Care of the Psyche: A History of Psychological Healing. New Haven: Yale University Press, 1999.
- Lain Entralgo, Pedro. The Therapy of the Word in Classical Antiquity. Edited and Translated by Leland J. Rather and John Sharp. New Haven: Yale University Press, 1970.
- Lawrence, Christopher, and George Weisz (eds.). Greater Than the Parts: Holism in Biomedicine, 1920–1950. New York: Oxford University Press, 1998.
- Leese, Peter. Shell Shock: Traumatic Neuroses and the British Soldier of the First World War. New York: Palgrave, 2002.
- Lerner, Paul. Hysterical Men: War, Psychiatry, and the Politics of Trauma in Germany, 1890–1930. Ithaca: Cornell University Press, 2003.
- Lunbeck, Elizabeth. The Psychiatric Persuasion: Knowledge, Gender, and Power in Modern America. Princeton: Princeton University Press, 1994.
- MacDonald, Michael. Mystical Bedlam: Madness, Anxiety, and Healing in Seventeenth-Century England. Cambridge: Cambridge University Press, 1981.
- Makari, George. Revolution in Mind: The Creation of Psychoanalysis. New York: HarperCollins, 2008.
- Martensen, Robert. The Brain Takes Shape: An Early History. New York: Oxford University Press, 2004.
- Metzl, Jonathan. Prozac on the Couch. Durham: Duke University Press, 2003.
- Micale, Mark S., and Roy Porter, (eds.). Discovering the History of Psychiatry. New York: Oxford University Press, 1994.
- Nutton, Vivian. Ancient Medicine. London: Routledge, 2004.
- Oppenheim, Janet. “Shattered Nerves”: Doctors, Patients, and Depression in Victorian England. Bridgewater NJ: Replica Books, 1991.
- Porter, Roy. Mind-Forg’d Manacles. Cambridge: Harvard University Press, 1987.
- Pressman, Jack David. Last Resort: Psychosurgery and the Limits of Medicine. Cambridge University Press, 1998.
- Rather, Leland J. Mind and Body in Eighteenth-Century Medicine. Berkeley: University of California Press, 1965.
- Reiser, Joel Stanley. Medicine and the Reign of Technology. Cambridge: Cambridge University Press, 1978.
- Scull, Andrew. Hysteria: The Biography. Oxford: Oxford University Press, 2009.
- Shorter, Edward. Bedside Manners: The Troubled History of Doctors and Patients. New York: Simon & Schuster, 1985.
- ———. From Paralysis to Fatigue: A History of Psychosomatic Illness in the Modern Era. New York: Free Press, 1991.
- ———. A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. New York; John Wiley & Sons, 1997.
- Shorter, Edward, and David Healy. Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness. Piscataway, NJ: Rutgers University Press, 2007.
- Showalter, Elaine. The Female Malady: Women, Madness, and English Culture, 1830–1980. New York: Penguin Books, 1985.
- Simon, Bennett. Mind and Madness in Ancient Greece. Ithaca: Cornell University Press, 1978.
- Stepansky, Paul. Psychoanalysis at the Margins. New York: Other Press, 2009.
- Sternberg, Esther. The Balance Within: The Science Connecting Health and Emotions. New York: Freeman, 2001.
- ———. Healing Spaces: The Science of Place and Well-Being. Cambridge MA: Belknap Press, 2009.
- Sulloway, Frank J. Freud. Biologist of the Mind. New York: Basic Books, 1979.
- Swazey, Judith P. Chlorpromazine in Psychiatry: A Study of Therapeutic Innovation. Cambridge, MA: MIT Press, 1974.
- Tomes, Nancy. A Generous Confidence: Thomas Story Kirkbride and the Art of Asylum-Keeping, 1840–1883. Cambridge: Cambridge University Press, 1984.
- Tone, Andrea. The Age of Anxiety: A History of America’s Turbulent Affair with Tranquilizers. New York: Basic Books, 2009.
- Tracy, Sarah W. Alcoholism in America. Baltimore: Johns Hopkins University Press, 2005.
- Valenstein, Elliot. Great and Desperate Cures: The Rise and Decline of Psychosurgery. New York: Free Press, 1991.
- Viner, Russell. “Putting Stress in Life: Hans Selye and the Making of Stress Theory.” In Social Studies of Science, vol. 29 (1999): 391-410.
- Whorton, James. Nature Cures: The History of Alternative Medicine in America. Oxford: Oxford University Press, 2002.
- Young, Allan. The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder. Princeton: Princeton University Press, 1995.