2021, still the Middle Ages regarding psycho-somatics. Forty years ago, I would have thought it impossible.
Starting with the term itself
‘Psychosomatics’ is an obsolete term, being replaced/obfuscated by ‘functional syndromes’ and ‘medically unexplained syndromes.’
I more or less consistently use the term ‘psycho-somatics’ to denote issues for which a psyche-oriented and a soma-oriented viewpoint are both substantially important. Of course, in a mind-body unity view, this is frequently the case. Abstractly seen, this makes the whole of medicine psycho-somatic. One is never ill without the mind being involved. Even in a non-conscious state, the non-conscious mind may be functional.
‘Psycho-somatics’ can be used when one finds it important to invoke the psyche in causality and management of any health-related issue. To some degree, this is a subjective criterium.
Some somatic physicians still see a somatic explanation of events as the only way patients can be taken seriously ― as if the psyche is not to be taken seriously.
That is weird, to say the least.
The psyche should always be taken seriously, especially in such a severe domain as health and illness.
‘Between the ears’ as an insult
Not validating the psyche, what remains is moral weakness, gullibility, or make-belief. Noteworthy in this is that mental illness was regarded entirely as a moral weakness a few centuries ago. The mentally ill were regarded as moral failures who should be coerced or even punished into morally good behavior or ostracized one way or another ― no place for them in ‘sane society.’
Many shell-shocked soldiers were treated as such – with the most severe punishments – during the first world war.
No wonder that ‘between the ears’ still has a negative ring. Meanwhile, between these ears may be make-belief as well as the most serious stuff that demands the most serious attention.
Using the term ‘between the ears’ – or alluding to the same in a derogatory manner – should itself be seen as an insult to rationality.
Please, no fight between psyche and soma (mind and body)
Validating the one should never be seen or felt as invalidating the other. Mind-oriented management should never lead to a neglect of the body, nor vice versa.
There is no proper reason for seeing both domains as competitive to each other.
Unfortunately, many colleagues are uncomfortable with the mind.
Thus, they feel ‘this weirdly annoying distraction from real practice’ as competing with the latter.
Patients feel this and keep their mouths shut, also if not happy, as many are. No wonder they look elsewhere for something more personally meaningful and may find it in some irrational CAM.
In gastroenterology, for instance,
it is very well known that around half of patients should be managed psycho-somatically. Nevertheless, I personally witnessed a case just a few days ago, in which with all somatic examinations being normal, the psyche didn’t get one inch of attention. Instead, the gastroenterologist recommended… homeopathy.
More disturbingly, in the same domain as in others, the search for somatic causes is still frequently brought as a search to relieve patients from not being taken seriously. Just one random quote as an example from way too many:
“Very often these patients are not taken seriously by physicians, and the lack of an allergic response is used as an argument that this is all in the mind, and that they don’t have a problem with their gut physiology,” says Professor Guy Boeckxstaens, a gastroenterologist at KU Leuven and lead author of the new research. “With these new insights, we provide further evidence that we are dealing with a real disease.” [https://nieuws.kuleuven.be/en/content/2021/scientists-reveal-mechanism-that-causes-irritable-bowel-syndrome]
This quote is from 2021, regarding irritable bowel syndrome. The boldface is by me.