CHAPTER 21
Psychosomatics
Splitting off the mind as a completely separate entity from the body is often
lamented in contemporary times, and its start is attributed to the dualism
of Descartes (seventeenth century). In fact, Plato (fourth centuryBC)said.
‘This is the great error of our day, that physicians separate the mind from
the body.’
Nowadays most paediatricians and child and adolescent psychiatrists
accept the need for a holistic approach, recognising that the physical
disorders described in paediatric texts have psychological dimensions, just
as the psychological disorders described in this book have physical dimen-
sions. Paediatrics should no more be mindless than child and adolescent
psychiatry should be disembodied!
A list of all the disorders that involve both body and mind would
potentially include the whole of medicine. In some instances the direction
of effect is primarily somatopsychic, with physical antecedents leading
on to psychological consequences. For example, chronic illnesses often
have considerable psychological consequences. In other instances, the
direction of effect is primarily from psychological antecedents to physical
consequences; this is what most people mean by psychosomatic. Such pre-
sentations may be called ‘medically unexplained symptoms’, ‘functional’,
or ‘psychogenic’. Distinguishing categorically between conditions that are
and are not psychosomatic is bound to be arbitrary and leads, predictably
enough, to boundary disputes. In the case of asthma, for example, al-
though it is clear that psychological stress can induce or intensify attacks
of wheezing in some predisposed individuals, many people would resist
calling asthma a psychosomatic disorder since stress is just one precipitant
among many. More people would agree that headaches or stomach-aches
are often psychosomatic conditions, and yet this may partly reflect our
current ignorance of physical predisposing and precipitating factors. It
is probably best to speak instead of a psychosomatic approach that is
potentially relevant to some extent to any condition.
In this chapter, a general introduction to the psychosomatic approach is
followed by sections on three illustrative disorders: recurrent abdominal
pain, chronic fatigue syndrome and conversion disorder. Somatopsychic
Child and Adolescent Psychiatry, Third Edition. Robert Goodman and Stephen Scott.
©c2012 Robert Goodman and Stephen Scott. Published 2012 by John Wiley & Sons, Ltd.
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