late University of
uffalo, 4230 Ridge Lea Road, Buffalo,
espite its impressive rate of growth in the past few decades, an increasing amount if dissatisfaction with the area of psychosomatic medicine is reflected in recent literature. The discipline’s failures relate to concepts of pathogenesis and therapeutic application of research findings. These failures are explained as a necessary consequence of the philosophical tenet of mind-body dualism which underlies medical theory. It is urged that advocates of psychosomatic medicine give the concept of ““holism” meaning at the most fundamental level by establishing a rational basis for theory, or else forsake this line of research for others which yield causal relationships conducive to effective therapy.
insure full understanding of the disease process and effective ception of the organism as a unity is of necestherapy. approach. Their insistence upon holism has sity for even led a number of authors to disparage use of the term “psychosomatic”, as it implies duality of psyche and soma (5’ 6). The exact meaning of csholism”, however, at the most basic level, is a question which has been ignored almost entirely. The typical definition states simply that “mind” and ““body” form a unified whole. The terms “mind” and “body”, however, define mutually exclusive entities which are not only separate, but incapable of any form of interaction. If one accepts “holism” at face value, one accepts a logical, and therefore a bioiogical impossibility. It is thus understandable that advocates of psychosomatic medicine have evaded the question of the ultimate meaning of holism. o broach the question is to confront a firmly established p hical structure strictly pro) warned medicine of the imhibitive of holism itself. s work has been fairly widely plications of dualism, an read. This warning, however, did not lead advocates of psychosomatics to a confrontation with the problem as it exists at the philosophical hard core of medical theory. ince the late seventeenth century when dualism became established as a philosophical underpinning of scientific medicine, until the very recent past, physicians refrained from employing psychosomatic concepts (8). tance to such concepts existed throughout that period. Confinement to mechanistic physiopathology kept early physicians exempt from the problem of dualism, and events unexplainable by mechanistic physiopathology were .either ignored or denied. hen contemporary physicians began to employ psychosomatic concepts, they overcame the historical resistance by constraining theory and research in ways designed to evade the issue. They sometimes claimed that emotions were physiological rather than psychological variables. They a.dopted physicalistic analogies like “stress” and “tension” which lent an aura of scientific repute to these otherwise enigmatic concepts. For research purposes they
sitianstherefore knowingby wha sion the was caused, may well inferre humor abo~ndeth,what remedy to be applyed;and qfier, how
n the past few decades the area of sychosomatic grown from a state of virtual nonexistence ence on an international scale. Today the field is represented by more than a dozen professional societies in not less than eight countries with membership of nearly ten thousand persons. impressive rate of growth’ an increasing amount of dissatisfaction with the progress tic medicine is reflected in recent literature. his Psychosomatic Conceptswith the prefatory statement: ‘“There has been little progress in the field of psychosomatic medicine in the last few decades” (1, p. ix). Lader says “‘the area of psychosomatic medicine has lost its pristine promise” (2’ p. 297). Lipowski comments upon “a spreading sense of disantment with the whole concept of psychosomatic tine” (3’ p. 396). The dissatisfaction derives in part from the fact that the field has failed to exert “the sweeping’ revolutionary imp on medicine of which it appears capable” (4, p. 176). more significant factor, however, is a problem inherent in the psychosomatic approach itself-a problem which proponents of the approach have neglected to confront. The present paper attempts to demonstrate the necessity of either confronting this issue directly’ or of abandoning psychosomatic concepts as unproductive in light of the needs of contemporary medicine.
The term ““holism” has been used by advocates of psychosomatic medicine to signify their fundamental interpretation of the organism as a unity. It has been urged that holism be adopted in all areas of clinical medicine to 112
employed correlations between cognitive and bodily processes almost exclusively, claiming that psychological or behavioral variables correspond temporally with or “accompany” somatic processes or symptoms. These evasive measures have proven successful as they have accorded with an assumption of parallelism or simultaneous, independent functioning of mind and body. They have freed proponents of holism from the prohibitive implications of dualism, but at the cost of holism itself.
sizable body of literature on psychological and behavioral variables which accompany various diseases. There is’ however, serious question about the value of such research. Correlations may provide accurate descriptive accounts of two aspects of the disease process’ but because they can give no information concerning causation of disease’ they do not lead to an understanding of pathogenesis and thus .fall short of yielding information of direct relevance to therapy. Some zealous proponents of psychosomatic medicine have fallen into the logical error of claiming causation or “psychogenesis” based upon data derived from correlation studies. This error may have hindered the progress of the field. Eader described the non-scienttjicapproach and excessive claims made by some enthusiastic advocates of the psychosomatic approach. This approach still seeks chimaeric connections between psyche and soma and believes that emotions ‘cause’ bodily changes (a, p. 309). hen causation of a pathological state by a psychoal variable has been assumed, critics have occasionally responded with the equally viable, and yet equally logically impossible claim that the physiological variable may have caused the psychological state. Even when priority of the psychological variable has been established, however’ the case for psychogenesis has failed. Independent functioning has proven to be a more reasonable and thus preferable assumption.
N In addition to the fundamental irrationality of the notion of psychogenesis, other problems surround the question of causation. One of these is demonstrable by an incident from medical history. The “‘psychosomatic disorder” has a directly analogous counterpart in nineteenth century medicine. In the early eighteen-hundreds psychosomatic concepts were forbidden. If the physical cause of a somatic event was unidentifiable, either the occurrence of that event was denied or the search for a physical cause continued. There gradually emerged, however, an ambiguously defined diagnostic category into which physicians placed disorders today referred to as “psychosomatic”. This category was called “nervous”. When no evidence of morphological change was detectable, the condition was often imputed to “nervousness”. The nerves themselves were not considered diseased’ and 113
thus as far as causation was concerned’ diseases “of neurotic origin” were actually dissociated from physiological states. Constipation’ anorexia’ emesia and certain cardiac respiratory disorders fit into this category, Nervous disorders were not considered curable, and if a physician had evidence that a patient was “only nervous99,it was %.tfficient to stop further inquiry. is then without the pale of rational medicine” (9, p. 126 not to diagnose nervousne inquiry might disclose a phy be treated. eral factors aided physicians in distinguishing nervous ers from other conditions. Coffee, tea, lack of sleep, “emotions of the mind”’ alcoholic beverages and other variables were said either to aggravate or to mimic such conditions. Nervous affections were presumed less dangerous or deadly than conditions with physical causes. The former were said to be marked by a “‘periodic return”, and frequently by an accompanying “deranged circulation”. The cause was enigmatic insofar as nonphysical states appeared etiologicahy involved: How certain emotions of the mind should circulate through the arteries . . . or shouldfor a time obstruct the ordinary return of blood b_ythe veins, is a subject into which we shall notpresume to enter (10, p. 168). Time has proven use of the term “nervous” to be a mask of ignorance and an illegitimate means of ading the logical impossibility of holistic functioning. the mideighteen hundreds this was coming to be recognized: When a physician pronounces a complaint to be nervous, it is a sure proof that he knows nothing about it (11, p. 42). ospital The Gyoscope (Guy’s agazine) satirized medical use of the concept: A group of symptomsunexplainedyou label a neurosis And this is rather clever for you’ve made a diagnosis (12, p. 88). It is not difficult to find instances of the use of ““psychosomatic” in contemporary terminology analogous to historical use of “n ous” as explanatory of diseases with obscure etiology. onald (13) related such an instance and warned physicians to be hesitant in interpreting the events as causally related to psychological variables: An example of how wrong one can be is thatfor many years shrewd clinicians described two groups among people with acute or chronic respiratory failure, usually chronic bronchitis who were actually ill with pneumonia. They spoke from their experience of j?ghters’ who were manfestly breathing with great dt@icultv but battling to remain alive and ‘nonfighters’ who floated gently away and died without apparent dyspnoea or distress. In the last fifteen years it has been shown that the ‘j?ghters’had, infact, fairly normal $02 levels, their ventilator-y response remained normal and they continued to ventilateeven though they were suJ,Xering from severe &spnoea. The ‘non-fighters have now been shown to be people who had been give ox_vgenat high pCO2 levels. They were, infact, narcotized by carbon dioxide, they were underventilating and died quiet&, often on high oxygen.
at was an obviousdivisionof a random population into ffishters’and ‘non-jighters’ infact was describing twodyerent physiological situations.All one can cotieludefrom this is that we must beware offilling in the gaps in our knowledge with this type of false interpretation (13, pp. 318-319). The telling phrase here is ““fXing in the gaps in our danger facing the “psychosomatic disorder” knowledge”. as a category of pathology is that it may become the twentieth century analogue of the ““nervous disorder” of the former century. s soon as a ‘“physical” cause is identified, the psych anation, like the nervous explanation, will be physical causation is in harmony with the underpinning of contemporary theory. Insofar as this is the case, pleading ignor is more justifiable than proposing psychogenic origin. can continue indefinitely to claim that the physical cause has not yet been identiiied, and remain within the confines ional explanation. more insidious problem surrounding causation of sowas recognized as early rted the case of a patient choanalysis. The patient died a short time afterward and autopsy revealed a tumor in the third ventricle. sychogenic” vomiting may be curable by suggestion, but s also can vomiting produced by a brain tumor. Even successful outcome of psychotherapy cannot. lead one to assume “psychogenesis”. Too extensive use of such therapy could conceivably prove more harmful than beneficial. Etiology of the seemingly psychosomatic disorders remains in as primitive a state as it occupied before the area had gained official recognition as a discipline.
ism have not con-
fuge or a truly unrealistic concept. solutions to the There seem to be only two pos problem of psychosomatic medicine. e is to forsake this line of research and continue in harmony with dualistic edicine has needs for practical application pport a research program from which only correlations are forthcoming. ecause medicine requires causal variables, time might be better spent in searching for these. An alternative solution is to make psychosomatic medicine a theoretical science by establishing a sound, non-dualistic basis for theory. To date, holism has been given ample lip service but nothing more. It could, however, be given meaning if psychophysiology or psychosomatic medicine established an alternative philosophical underpinning for theory. This latter solution seems preferable because of the large accumulation of data indicating the reality of what have been termed “psychosomatic” phenomena. The placebo effect, for instance, is an anomaly in scientific medicine today, and apparently cannot be explained with-
out recourse to psychosomatic concepts. The number of diseases placed in the category of psychosomatic is steadily one of these phenomena is comprehensible in the theory, and theory will never arise from a metaphysical basis which forbids these events. It may appear an exorbitant task to set for physicians when philosophers have endured the mind-bodyproblem for three centuries. Its problematic nature in medicine, however, more urgently requires solution. The problem may not be as forbidding as it at first appears. Although axiomatic today, dualism was nonexistent in the premodern history of medicine. Instead, holism resided at the metaphysical hard core of medicine, and led to theory which accounted for phenomena in an invariably psychosomatic any events for which we have no explanation easily accounted for the in premodern era. The so-called ‘placebo effect’, for example, was predicted and explained (14), along with many respiratory and cardiovascular conditions associated with “outward” or experiential system followed from causes (15). An elaborate therap moral pathology and holistically-based theory ( 16- 17 temperament theory spring from holism and were ideally suited to account for psychosomatic events. No one, of course, would favor a return to the vital spirit or biological soul which formed the substrate of psychophysiological phenomena in the premodern era. The lesson to be learned from our early predecessors is that some such substrate is necessary as an explanatory construct. Neither mind nor matter can accommodate the phenomena in question. It has taken nearly three centuries for medicine to overcome the problem of dualism to the extent of acknowledging the reality of psychosomatic events. It is, however, nothing by way of advancement or progress to attest to the reality of events forbidden by rationality and unamenable to scientific explanation. If no such explanation is provided we can anticipate that “psychosomatic disorders” will eventually assume the same historical status as “nervous disorders” of the former century.
1. Grinker R. Psvchosomatic Concepts. New York: Jason Aronson, 1973. Lader M. Psychophysiological research and psychosomatic medicine. In Ciba Foundation Symposium 8. Physiology, Emotion and Psychosomatic Illness. Amsterdam: North Holland, 1912. Pp. 291-1211 _-_ 3. Lipowski ZJ. Review of consultation psychiatry and psychosomatic medicine III. Theoretical issues. Psvchosom Med 3 1968 4. Mason J. Presidential address to the American Psychosomatic Society (1970). In Langley L, Brand J. The mind-body issue in early twentieth century American medicine. Bull Hist Med. 179, 1972 5. Dunbar HF. Emotions and Bodilv Changes. New York: Columbia University Press, 1935 6. Henry JP. In Ciba Foundation Symposium 8. Physiology, Emotion ;;t Psychosomabc Illness. Amsterdam: North Holland, 1972, p. 2.
I.
Ryle G. The Concept of Mind. London: Hutchinson’s University Library, 1949 8. McMahon CE. The wind of the cannon ball: an informative anecdote from medical history. Psycother Psychosom. 26, 125, 1975. 9. Lefever G. ,411Apo1og.r jbr the Nerves: or, Their Influence and Importance in Health and Disease. London: Longman, 1844 10. Carson J. An Inquiyv Into the Causes cj+the Motion of the Blood. Liverpool: F B Wright, 18 15
114
15.
McMahon CE. The psychosomatic approach to heart disease: a study in premodern medicine. Chest. 69,531, 1976. 16. McMahon CE, Voluntary control of ‘involuntary’ functions: the approach of the Stoics. Psychophysiol. 11, 710-714, 1974 17. McMahon CE. Psychosomatic concepts in the works of Shakespere. J. Hist Beh Sci. 1976 (in press)
11. Macnish R. Book of Aphorisms. London: McPhum, 1859 12. Cowan L, Cowan M (Eds). The Wit of Medicine. London: Leslie Frewin, 1972 13. Donald KW. In Ciba Foundation Symposium 8. Physiology, Emotion and Psschosomatic Illness. Amsterdam: North Holland, 1972, pp. 318-319 14. McMahon CE. The role of imagination in the disease process: pre-Cartesian history. Psycholog Med. 1976 (in press)
115
uffalo, 4230 Ridge Lea Road, Buffalo,
espite its impressive rate of growth in the past few decades, an increasing amount if dissatisfaction with the area of psychosomatic medicine is reflected in recent literature. The discipline’s failures relate to concepts of pathogenesis and therapeutic application of research findings. These failures are explained as a necessary consequence of the philosophical tenet of mind-body dualism which underlies medical theory. It is urged that advocates of psychosomatic medicine give the concept of ““holism” meaning at the most fundamental level by establishing a rational basis for theory, or else forsake this line of research for others which yield causal relationships conducive to effective therapy.
insure full understanding of the disease process and effective ception of the organism as a unity is of necestherapy. approach. Their insistence upon holism has sity for even led a number of authors to disparage use of the term “psychosomatic”, as it implies duality of psyche and soma (5’ 6). The exact meaning of csholism”, however, at the most basic level, is a question which has been ignored almost entirely. The typical definition states simply that “mind” and ““body” form a unified whole. The terms “mind” and “body”, however, define mutually exclusive entities which are not only separate, but incapable of any form of interaction. If one accepts “holism” at face value, one accepts a logical, and therefore a bioiogical impossibility. It is thus understandable that advocates of psychosomatic medicine have evaded the question of the ultimate meaning of holism. o broach the question is to confront a firmly established p hical structure strictly pro) warned medicine of the imhibitive of holism itself. s work has been fairly widely plications of dualism, an read. This warning, however, did not lead advocates of psychosomatics to a confrontation with the problem as it exists at the philosophical hard core of medical theory. ince the late seventeenth century when dualism became established as a philosophical underpinning of scientific medicine, until the very recent past, physicians refrained from employing psychosomatic concepts (8). tance to such concepts existed throughout that period. Confinement to mechanistic physiopathology kept early physicians exempt from the problem of dualism, and events unexplainable by mechanistic physiopathology were .either ignored or denied. hen contemporary physicians began to employ psychosomatic concepts, they overcame the historical resistance by constraining theory and research in ways designed to evade the issue. They sometimes claimed that emotions were physiological rather than psychological variables. They a.dopted physicalistic analogies like “stress” and “tension” which lent an aura of scientific repute to these otherwise enigmatic concepts. For research purposes they
sitianstherefore knowingby wha sion the was caused, may well inferre humor abo~ndeth,what remedy to be applyed;and qfier, how
n the past few decades the area of sychosomatic grown from a state of virtual nonexistence ence on an international scale. Today the field is represented by more than a dozen professional societies in not less than eight countries with membership of nearly ten thousand persons. impressive rate of growth’ an increasing amount of dissatisfaction with the progress tic medicine is reflected in recent literature. his Psychosomatic Conceptswith the prefatory statement: ‘“There has been little progress in the field of psychosomatic medicine in the last few decades” (1, p. ix). Lader says “‘the area of psychosomatic medicine has lost its pristine promise” (2’ p. 297). Lipowski comments upon “a spreading sense of disantment with the whole concept of psychosomatic tine” (3’ p. 396). The dissatisfaction derives in part from the fact that the field has failed to exert “the sweeping’ revolutionary imp on medicine of which it appears capable” (4, p. 176). more significant factor, however, is a problem inherent in the psychosomatic approach itself-a problem which proponents of the approach have neglected to confront. The present paper attempts to demonstrate the necessity of either confronting this issue directly’ or of abandoning psychosomatic concepts as unproductive in light of the needs of contemporary medicine.
The term ““holism” has been used by advocates of psychosomatic medicine to signify their fundamental interpretation of the organism as a unity. It has been urged that holism be adopted in all areas of clinical medicine to 112
employed correlations between cognitive and bodily processes almost exclusively, claiming that psychological or behavioral variables correspond temporally with or “accompany” somatic processes or symptoms. These evasive measures have proven successful as they have accorded with an assumption of parallelism or simultaneous, independent functioning of mind and body. They have freed proponents of holism from the prohibitive implications of dualism, but at the cost of holism itself.
sizable body of literature on psychological and behavioral variables which accompany various diseases. There is’ however, serious question about the value of such research. Correlations may provide accurate descriptive accounts of two aspects of the disease process’ but because they can give no information concerning causation of disease’ they do not lead to an understanding of pathogenesis and thus .fall short of yielding information of direct relevance to therapy. Some zealous proponents of psychosomatic medicine have fallen into the logical error of claiming causation or “psychogenesis” based upon data derived from correlation studies. This error may have hindered the progress of the field. Eader described the non-scienttjicapproach and excessive claims made by some enthusiastic advocates of the psychosomatic approach. This approach still seeks chimaeric connections between psyche and soma and believes that emotions ‘cause’ bodily changes (a, p. 309). hen causation of a pathological state by a psychoal variable has been assumed, critics have occasionally responded with the equally viable, and yet equally logically impossible claim that the physiological variable may have caused the psychological state. Even when priority of the psychological variable has been established, however’ the case for psychogenesis has failed. Independent functioning has proven to be a more reasonable and thus preferable assumption.
N In addition to the fundamental irrationality of the notion of psychogenesis, other problems surround the question of causation. One of these is demonstrable by an incident from medical history. The “‘psychosomatic disorder” has a directly analogous counterpart in nineteenth century medicine. In the early eighteen-hundreds psychosomatic concepts were forbidden. If the physical cause of a somatic event was unidentifiable, either the occurrence of that event was denied or the search for a physical cause continued. There gradually emerged, however, an ambiguously defined diagnostic category into which physicians placed disorders today referred to as “psychosomatic”. This category was called “nervous”. When no evidence of morphological change was detectable, the condition was often imputed to “nervousness”. The nerves themselves were not considered diseased’ and 113
thus as far as causation was concerned’ diseases “of neurotic origin” were actually dissociated from physiological states. Constipation’ anorexia’ emesia and certain cardiac respiratory disorders fit into this category, Nervous disorders were not considered curable, and if a physician had evidence that a patient was “only nervous99,it was %.tfficient to stop further inquiry. is then without the pale of rational medicine” (9, p. 126 not to diagnose nervousne inquiry might disclose a phy be treated. eral factors aided physicians in distinguishing nervous ers from other conditions. Coffee, tea, lack of sleep, “emotions of the mind”’ alcoholic beverages and other variables were said either to aggravate or to mimic such conditions. Nervous affections were presumed less dangerous or deadly than conditions with physical causes. The former were said to be marked by a “‘periodic return”, and frequently by an accompanying “deranged circulation”. The cause was enigmatic insofar as nonphysical states appeared etiologicahy involved: How certain emotions of the mind should circulate through the arteries . . . or shouldfor a time obstruct the ordinary return of blood b_ythe veins, is a subject into which we shall notpresume to enter (10, p. 168). Time has proven use of the term “nervous” to be a mask of ignorance and an illegitimate means of ading the logical impossibility of holistic functioning. the mideighteen hundreds this was coming to be recognized: When a physician pronounces a complaint to be nervous, it is a sure proof that he knows nothing about it (11, p. 42). ospital The Gyoscope (Guy’s agazine) satirized medical use of the concept: A group of symptomsunexplainedyou label a neurosis And this is rather clever for you’ve made a diagnosis (12, p. 88). It is not difficult to find instances of the use of ““psychosomatic” in contemporary terminology analogous to historical use of “n ous” as explanatory of diseases with obscure etiology. onald (13) related such an instance and warned physicians to be hesitant in interpreting the events as causally related to psychological variables: An example of how wrong one can be is thatfor many years shrewd clinicians described two groups among people with acute or chronic respiratory failure, usually chronic bronchitis who were actually ill with pneumonia. They spoke from their experience of j?ghters’ who were manfestly breathing with great dt@icultv but battling to remain alive and ‘nonfighters’ who floated gently away and died without apparent dyspnoea or distress. In the last fifteen years it has been shown that the ‘j?ghters’had, infact, fairly normal $02 levels, their ventilator-y response remained normal and they continued to ventilateeven though they were suJ,Xering from severe &spnoea. The ‘non-fighters have now been shown to be people who had been give ox_vgenat high pCO2 levels. They were, infact, narcotized by carbon dioxide, they were underventilating and died quiet&, often on high oxygen.
at was an obviousdivisionof a random population into ffishters’and ‘non-jighters’ infact was describing twodyerent physiological situations.All one can cotieludefrom this is that we must beware offilling in the gaps in our knowledge with this type of false interpretation (13, pp. 318-319). The telling phrase here is ““fXing in the gaps in our danger facing the “psychosomatic disorder” knowledge”. as a category of pathology is that it may become the twentieth century analogue of the ““nervous disorder” of the former century. s soon as a ‘“physical” cause is identified, the psych anation, like the nervous explanation, will be physical causation is in harmony with the underpinning of contemporary theory. Insofar as this is the case, pleading ignor is more justifiable than proposing psychogenic origin. can continue indefinitely to claim that the physical cause has not yet been identiiied, and remain within the confines ional explanation. more insidious problem surrounding causation of sowas recognized as early rted the case of a patient choanalysis. The patient died a short time afterward and autopsy revealed a tumor in the third ventricle. sychogenic” vomiting may be curable by suggestion, but s also can vomiting produced by a brain tumor. Even successful outcome of psychotherapy cannot. lead one to assume “psychogenesis”. Too extensive use of such therapy could conceivably prove more harmful than beneficial. Etiology of the seemingly psychosomatic disorders remains in as primitive a state as it occupied before the area had gained official recognition as a discipline.
ism have not con-
fuge or a truly unrealistic concept. solutions to the There seem to be only two pos problem of psychosomatic medicine. e is to forsake this line of research and continue in harmony with dualistic edicine has needs for practical application pport a research program from which only correlations are forthcoming. ecause medicine requires causal variables, time might be better spent in searching for these. An alternative solution is to make psychosomatic medicine a theoretical science by establishing a sound, non-dualistic basis for theory. To date, holism has been given ample lip service but nothing more. It could, however, be given meaning if psychophysiology or psychosomatic medicine established an alternative philosophical underpinning for theory. This latter solution seems preferable because of the large accumulation of data indicating the reality of what have been termed “psychosomatic” phenomena. The placebo effect, for instance, is an anomaly in scientific medicine today, and apparently cannot be explained with-
out recourse to psychosomatic concepts. The number of diseases placed in the category of psychosomatic is steadily one of these phenomena is comprehensible in the theory, and theory will never arise from a metaphysical basis which forbids these events. It may appear an exorbitant task to set for physicians when philosophers have endured the mind-bodyproblem for three centuries. Its problematic nature in medicine, however, more urgently requires solution. The problem may not be as forbidding as it at first appears. Although axiomatic today, dualism was nonexistent in the premodern history of medicine. Instead, holism resided at the metaphysical hard core of medicine, and led to theory which accounted for phenomena in an invariably psychosomatic any events for which we have no explanation easily accounted for the in premodern era. The so-called ‘placebo effect’, for example, was predicted and explained (14), along with many respiratory and cardiovascular conditions associated with “outward” or experiential system followed from causes (15). An elaborate therap moral pathology and holistically-based theory ( 16- 17 temperament theory spring from holism and were ideally suited to account for psychosomatic events. No one, of course, would favor a return to the vital spirit or biological soul which formed the substrate of psychophysiological phenomena in the premodern era. The lesson to be learned from our early predecessors is that some such substrate is necessary as an explanatory construct. Neither mind nor matter can accommodate the phenomena in question. It has taken nearly three centuries for medicine to overcome the problem of dualism to the extent of acknowledging the reality of psychosomatic events. It is, however, nothing by way of advancement or progress to attest to the reality of events forbidden by rationality and unamenable to scientific explanation. If no such explanation is provided we can anticipate that “psychosomatic disorders” will eventually assume the same historical status as “nervous disorders” of the former century.
1. Grinker R. Psvchosomatic Concepts. New York: Jason Aronson, 1973. Lader M. Psychophysiological research and psychosomatic medicine. In Ciba Foundation Symposium 8. Physiology, Emotion and Psychosomatic Illness. Amsterdam: North Holland, 1912. Pp. 291-1211 _-_ 3. Lipowski ZJ. Review of consultation psychiatry and psychosomatic medicine III. Theoretical issues. Psvchosom Med 3 1968 4. Mason J. Presidential address to the American Psychosomatic Society (1970). In Langley L, Brand J. The mind-body issue in early twentieth century American medicine. Bull Hist Med. 179, 1972 5. Dunbar HF. Emotions and Bodilv Changes. New York: Columbia University Press, 1935 6. Henry JP. In Ciba Foundation Symposium 8. Physiology, Emotion ;;t Psychosomabc Illness. Amsterdam: North Holland, 1972, p. 2.
I.
Ryle G. The Concept of Mind. London: Hutchinson’s University Library, 1949 8. McMahon CE. The wind of the cannon ball: an informative anecdote from medical history. Psycother Psychosom. 26, 125, 1975. 9. Lefever G. ,411Apo1og.r jbr the Nerves: or, Their Influence and Importance in Health and Disease. London: Longman, 1844 10. Carson J. An Inquiyv Into the Causes cj+the Motion of the Blood. Liverpool: F B Wright, 18 15
114
15.
McMahon CE. The psychosomatic approach to heart disease: a study in premodern medicine. Chest. 69,531, 1976. 16. McMahon CE, Voluntary control of ‘involuntary’ functions: the approach of the Stoics. Psychophysiol. 11, 710-714, 1974 17. McMahon CE. Psychosomatic concepts in the works of Shakespere. J. Hist Beh Sci. 1976 (in press)
11. Macnish R. Book of Aphorisms. London: McPhum, 1859 12. Cowan L, Cowan M (Eds). The Wit of Medicine. London: Leslie Frewin, 1972 13. Donald KW. In Ciba Foundation Symposium 8. Physiology, Emotion and Psschosomatic Illness. Amsterdam: North Holland, 1972, pp. 318-319 14. McMahon CE. The role of imagination in the disease process: pre-Cartesian history. Psycholog Med. 1976 (in press)
115
