Formalization as a Field of Inquiry and Practice 453In other developments, the change in 1889 of William
James’s title from professor of philosophy to professor of
psychology at Harvard marked the beginning of a new era
for the discipline of psychology; thought and feeling had be-
come a major focus for intensive scientific study. In addi-
tion, two independent researchers were conducting work in
psychophysiology that was to become seminal in the field.
Walter Bradford Cannon investigated visceral aspects of
emotional experiences (specifically adrenaline and the ex-
citement of the sympathetic nervous system), inventing the
term “homeostasis” to describe the balanced state that
human physiology sought to maintain (Cannon, 1915). In
Russia, Ivan Pavlov received a Nobel Prize in 1904 for his
work on the conditioned reflex and the physiology of the
digestive gland, work that had profound implications for un-
derstanding learning processes and the development of psy-
chophysiological disorders. His work led to the development
in Russia of what was named “cortical-visceral-medicine,”
which has some overlap with psychosomatic medicine
but leaves out subjective dimensions of experience and
the unconscious processes (Lipsitt, 1999). Thus, by 1900,
forces within medicine, physiology, and psychology had re-
vived an integrated perspective of health and illness, mind
and body.
Meanwhile, psychoanalysis spread in popularity in both
Europe and the United States. Adolph Meyer, a Swiss psy-
chiatrist, moved to Johns Hopkins in 1910 and continued to
build on the concept of holism (derived from the Greek holos,
or “whole”), introduced by Jan Christian Smuts in 1926
(Lipowski, 1986). Meyer proposed a new field of study, psy-
chobiology, as the study of the person as a whole and not just
the disease. Mind and body were seen as separate but inte-
grated parts constituting a psychobiological unit (Meyer,
1957). This work helped bridge the gap between psychiatry
and the other medical specialties, laying the foundation
for the development of psychosomatic medicine and liaison
psychiatry (Lipsitt, 1999).
FORMALIZATION AS A FIELD OF INQUIRY
AND PRACTICE
The more formalized field of psychosomatic medicine
emerged between 1920 and 1950, dominated by two major
frameworks: psychodynamic and psychophysiologic. Major
contributions of psychosomatic medicine were the recogni-
tion of the role of psychological and social factors in the
etiology, course, maintenance, and treatment of disease
(especially those that defied biomedical explanations), and
the promotion of behavioral health research.
Helen Flanders Dunbar, a follower of Meyer, promoted
the idea that psychosomatic symptoms were associated with
certain personality types and not just with a single conflict, as
Freud had postulated. She believed that all illnesses were
psychosomatic and worked diligently to facilitate acceptance
of that view among physicians and the general public. Her
views were popularized through her 1935 book, Emotions
and Bodily Changes,and she became the founding editor of a
new journal, Psychosomatic Medicine,at a time when men
dominated American medicine. The preface to the first issue
(1939) declared its devotion to the study of the interrelation-
ships between psychological and physiological aspects of all
normal and abnormal bodily functions and the integration of
somatic therapy and psychotherapy. It is interesting to note
that Dunbar intended to advance psychosomatic medicine not
as a new specialty within medicine but rather as a way of
educating medical professionals and scientists to view illness
as multidimensional, a perspective that can be considered a
precursor to the later systems models (Lipsitt, 1999).
In 1942, a group of researchers, including psychiatrists,
physiologists, internists, psychologists, and psychoanalysts,
founded the American Psychosomatic Society (APS). A neu-
rologist, Tracy Putnam, was its first president. Levenson
(1994) describes these early members as adventurers and ex-
perimenters who were interested in exploring the mind–body
riddle. She notes that psychiatry was not yet well accepted in
the male-dominated medical schools or teaching hospitals,
and at a time when American education and medicine was
anti-Semitic, the APS welcomed refugees fleeing Nazi
Germany. Yet the psychosomatic medicine movement did not
promote any political or feminist agenda, nor was it bound to
any one theory, as members held widely different points of
view (e.g., Pavlovians, Freudians). Some members were
interested in specific diseases, others in the connections be-
tween emotions and bodily processes. A few researchers were
interested in topics such as overutilization of health care ser-
vices, but much work consisted of pathology-oriented treat-
ment reports of the “classic” psychosomatic disorders.
Psychodynamic theory as a framework continues to
dominate psychosomatic medicine in Europe, especially in
southern European countries. Historically, both psychiatrists
and psychologists have contributed to its expansion. Some
of these were European psychoanalysts who immigrated to
the United States to flee Nazi persecution, such as Franz
Alexander. In Chicago, Alexander built upon Freud’s formu-
lation of conversion hysteria to derive the specificity theory
of psychosomatic disease. From his clinical observation of
patients undergoing psychoanalysis, he concluded that spe-
cific emotional conflicts, called nuclear conflicts, were asso-
ciated with specific physical diseases such as peptic ulcer,