Emotions, Bodily Changes, and the Social Environment: How Did Early Psychosomatic Medicine Consider the Social Dimension in Health and Disease?

OBJECTIVE: Social relationships play an important role in human health and disease processes, and the field of psychosomatic medicine currently integrates social factors in its theoretical models and clinical interventions. This article provides a historical perspective on the field of psychosomatic medicine in the United States and examines the extent to which early American psychosomatic medicine incorporated the impact of social relationships on health and disease outcomes. METHODS: We searched PubMed across all issues of Psychosomatic Medicine for key words related to emotions versus social processes. Article counts are compared for these key words. We then performed a narrative review to analyze how concepts of associations among emotional, interpersonal, and physiological variables evolved in early publications. RESULTS: Of 5023 articles found in Psychosomatic Medicine, 1453 contained an emotional, 936 a social search term, and 447 contained both. In the qualitative review, influences of the social environment on emotional states and physiology were recognized already in the 1930s but they only played a subordinate role in early Psychosomatic Medicine. Publications often lacked a clear working model how interpersonal events exert their impact on physiology. With increasing understanding of developmental and neural mechanisms, a more differentiated view evolved. CONCLUSIONS: Early publications in psychosomatic medicine mainly focused on associations between emotions and physiology. However, some highlighted the importance of interpersonal and social factors. Later, the understanding of emotions, social relationships, and physiology with their developmental and neurobiological correlates have led to a fuller "biopsychosociocultural" understanding of health and disease, although more research on and within these networks is urgently needed.

[Psychosomatic disorders in ancient Greek medicine].

The concept of psychosomatic disorders, as defined by modern medicine, was difficult to be perceived by the ancient Greek physicians. Two main reasons contributed to this. One was that physicians in Greek antiquity had formed the idea that the mental illnesses that were recognized at that time, namely mania, melancholy, frenzy, caros, lethargy, apoplexy, but even epilepsy, was the result of a disturbance of the essential elements of the body, the balance of them contributed to the preservation of health. Thus, depending on the school of medical thought of each physician in antiquity, mental and corporal illnesses were the result of various disorders such as the dyscrasia of humors for the physicians of the Dogmatic school that followed the Hippocratic principles or the disorder of the qualitative characteristics of the humor and the pneuma (air), as the physicians of the Pneumatic School considered, but also of the stenosis or the expansion of the pores as the physicians of the Methodic school thought. Although there was the perception that the diseases were the result of various combinations of the previous theories, as concluded by the physicians who constituted the Eclectic school. The second reason was that ancient physicians could not perceive the autonomy of man's psychic world as an element of human nature in which emotional distress and irrational mental processing of stimuli from the social, cultural and natural environment of the individual would be aggravating to the challenge of mental imbalance. Nevertheless, many physicians such as physicians who wrote various work of Corpus Hippocraticum, Soranus of Ephesus (1st - 2nd c. AD) Galen (1st - 2nd c. AD), Aretaeus of Cappadocia (1st - 2nd or 4th c. AD) and Caelius Aurelianus (5th c. AD) did not forget to describe in their works psychosomatic disorders as they are defined by modern medicine. In their works there are the observations about intense sweating, tremor, eating disorders, hysteria and even death as a result of an intense and long psychological unrest. These corporal symptoms, although were onset due to a psychological unequilibrium they could not been listed by the ancient Greek physicians in any of the mental diseases as they were defined in antiquity. The psychological disturbance which could provoke the above corporal disorders arose by various phobias, shame, sorrow, anger, envy, excessive drinks and food, excessive sexual desire, passion for gambling and anxiety of everyday life.

Psycho-oncology: Overview, obstacles and opportunities.

Worldwide, psychological and social issues in cancer were not the subject of scientific inquiry until the past two decades. Since then, a new subspecialty of oncology has evolved, psycho-oncology. It addresses two dimensions of cancer: the emotional responses of patients at all stages of disease, as well as their families and caretakers (psychosocial); and the pyschological, social and behavioral factors that may influence cancer morbidity and mortality (psychobiological). Obstacles to development have been the facts of small numbers of clinicians and investigators worldwide and the few valid assessment instruments and research methods available to the biomedical community. These obstacles are increasingly giving way to the louder demand of the public for maximal quality of life in cancer care. Psycho-oncology is attaining subspeciality status by presently bringing a set of clinical skills in counseling, behavioral and social interventions to oncology, by providing training curricula which teach basic knowledge and skills in the area, and through creating a body of research and scholarly information about clinically relevant issues in the care of patients with cancer. Since it is increasingly recognized that psychological, social and behavioral variables influence treatment outcome, attention will likely to continue to increase. The field must meet the challenges of the 1990's in psychosocial care and availability of services, support for training clinicians and investigators in psycho-oncology, and implementation of an exciting research agenda. The focus of new research will encourage collaborative investigations combining biological and psychosocial variables, quality of life research in clinical trials, controlled studies of psychotherapeutic, behavioral and psychopharmacologic research, and crosscultural studies that will examine differences in prevention and detection, health care systems, alternative therapies and meta analyses.

Stendhal syndrome: a clinical and historical overview.

It could be argued that one of the few unifying qualities all human beings share is the ability to appreciate beauty. While the object of beauty may change from one person to another, the awe and the thrill experienced by an enthralled beholder remains the same. Sometimes, this experience can be so overwhelming it can bring someone to the edge of existence. A very rare condition, known as aesthetic syndrome and, more commonly, Stendhal syndrome, entails a clinical phenomenon in which the presence of a beautiful piece of work or architecture causes dysautonomic symptoms such as tachycardia, diaphoresis, chest pains and loss of consciousness. We present an historical and clinical review of this condition.

Stendhal syndrome: a clinical and historical overview / Síndrome de Stendhal: una revisión histórica y clínica

ABSTRACT It could be argued that one of the few unifying qualities all human beings share is the ability to appreciate beauty. While the object of beauty may change from one person to another, the awe and the thrill experienced by an enthralled beholder remains the same. Sometimes, this experience can be so overwhelming it can bring someone to the edge of existence. A very rare condition, known as aesthetic syndrome and, more commonly, Stendhal syndrome, entails a clinical phenomenon in which the presence of a beautiful piece of work or architecture causes dysautonomic symptoms such as tachycardia, diaphoresis, chest pains and loss of consciousness. We present an historical and clinical review of this condition.

RESUMO Podría decirse que una de las pocas cualidades comunes a todos los seres humanos es la capacidad de apreciar la belleza. Si bien, es cierto que el objeto considerado como bello cambia de una persona a otra, la admiración y profunda emoción que experimenta un espectador en trance, es la misma. En ocasiones, esta experiencia puede llevar una persona hasta el borde mismo de la existencia. Una condición muy rara, conocida como síndrome estético, y en algunos casos, síndrome de Stendhal, comprende un cuadro clínico en el que la presencia de una magnífica y bella pieza de arte o arquitectura, produce síntomas disautonómicos como taquicardia, diaforesis, dolor torácico y pérdida de la consciencia. Presentamos aquí una revisión clínica e histórica de esta condición.

Disruptive technology disorder: A past, present, and future neurologic syndrome.

Based upon an analysis of 6 major historical technological advances over the last 150 years, a new syndrome, disruptive technology disorder (DTD), is introduced. DTD describes the human health ailments that accompany the implementation of disruptive technologies. Elevator sickness, railway spine, and bicycle face are representative examples. Though the underlying causative disruptive technologies may differ, many neurologic symptoms (headache, dizziness, weakness) are common to multiple DTDs. Born of technology-driven societal change, DTDs manifest as a complex interplay between biological and psychological symptoms.

Consumed workers - Disable bodies. Historical knowledge formation after the cultural turn / Trabajadores consumidos - Cuerpos discapacitados: la formación del conocimiento histórico tras el giro cultural

Some recent OECD-studies tackle new psychosomatic symptoms in the context of work. So we find the paradoxical situation, that although the state of health and well-being in societies grows, statistics show growing rates of burn-out syndroms together with uneasiness, addiction and non-functioning. One in five workers suffer from a mental illness, such as depression or anxiety, and many more are struggling to cope. In a closer reading we can see, that the social-medical model still dominates this actual policy research, although the cultural model has gained growing recognition in the last fifteen years. But we find a double blank spot with relevance for historical knowledge formation: On the one side, studies on work that use the tool set of cultural studies can rarely be found. On the other side, disability studies that work with the cultural model are rarely tackling the working subject. Starting from this analytical point, this contribution wants to stimulate historical knowledge formation on the working subject. The epistemic perspective of this study is coined by the cultural model of disability; the methodology is based on the visual, the spatial and the linguistic turn. In studying historical artefacts like film scenes or juridical definitions, we can come to a closer understanding of how we conceptualise human beings. The thesis is, that during the 20th-century the changing 'microphysics of power' (Foucault) produced new forms of subjectivation: Either, workers tried to assimilate to the 'machine rhythms' or they uttered their needs in 'embodied dissent'. There are multilayered facets in between. I want to develop the argumentation that the body/mind-centering seems to be at the heart of the postfordist transformation. The article concludes by underlining the possibility to read bodies as a source, an approach Bryan S. Turner has theorized in his article 'Disability and the Sociology of the Body' (AU)

Algunos estudios recientes de la Organización para la Cooperación Económica y el Desarrollo (OECD) hablan de la aparición de nuevos síntomas psicosomáticos en el ámbito del trabajo. Nos encontramos con la paradoja de que a pesar de que el estado de salud y de bienestar crece en la sociedad, las tasas del síndrome de burnout, junto con la ansiedad, adicción y disfunción cada vez son más altas. Uno de cada cinco trabajadores padece algún tipo de enfermedad mental, como depresión o ansiedad, y muchos otros luchan para enfrentarse a ella. Una lectura atenta nos permite ver que el modelo socio-médico domina la investigación, a pesar de que en los últimos 15 años el modelo cultural ha ido cobrando cada vez más importancia. Sin embargo, existen dos puntos relevantes para el conocimiento histórico que necesitan mayor desarrollo: por un lado, existen pocos estudios sobre el trabajo que usen las herramientas de los estudios culturales y, por otro, los estudios sobre discapacidad basados en el modelo cultural raramente abordan el ámbito del sujeto trabajador. Partiendo de este punto de análisis, este artículo pretende estimular la reflexión sobre la formación del conocimiento histórico en el ambito del trabajo. La perspectiva epistemológica (AU)

[Pediatric psychosomatic medicine and the medicalization of childhood in Buenos Aires, 1940-1970]. / Pediatría psicosomática y medicalización de la infancia en Buenos Aires, 1940-1970.

This article analyzes how the dominance of pediatric psychosomatic medicine in the Argentine medical field caused a transformation in treatments. It shows how, beginning in the 1950s, psy-experts and interdisciplinary approaches found a space at the Hospital de Niños (Children's Hospital) in Buenos Aires; and how the growth of attachment theory made it possible for mothers to stay with their children in hospital. It explains the construction of certain conditions as "family diseases" in a context of declining birthrates. It focuses on the speeches of a key figure, Florencio Escardó, not only because he was hegemonic in the scientific field but because he also played an important role dispensing advice in the media.

Pediatría psicosomática y medicalización de la infancia en Buenos Aires, 1940-1970 / Pediatric psychosomatic medicine and the medicalization of childhood in Buenos Aires, 1940-1970

Resumen Analiza cómo el predominio de la pediatría psicosomática en el campo médico argentino supuso una transformación en los tratamientos. Estudia cómo, a partir de la década de 1950, los expertos psi y los abordajes interdisciplinarios encontraron espacios en el Hospital de Niños de Buenos Aires; y cómo la difusión de la teoría del apego facilitó la internación conjunta de las madres. Explica la configuración de ciertas dolencias como “enfermedades de familia” en un escenario en el que bajaron las tasas de natalidad. Se focaliza en los discursos de su principal referente, Florencio Escardó, no sólo porque fue hegemónico en el campo científico sino porque también ocupó un rol predominante como consejero en los medios de comunicación.

Abstract This article analyzes how the dominance of pediatric psychosomatic medicine in the Argentine medical field caused a transformation in treatments. It shows how, beginning in the 1950s, psy-experts and interdisciplinary approaches found a space at the Hospital de Niños (Children’s Hospital) in Buenos Aires; and how the growth of attachment theory made it possible for mothers to stay with their children in hospital. It explains the construction of certain conditions as “family diseases” in a context of declining birthrates. It focuses on the speeches of a key figure, Florencio Escardó, not only because he was hegemonic in the scientific field but because he also played an important role dispensing advice in the media.

The Misunderstood Asthma of Theodore Roosevelt.

In this special article, we examine the asthma of President Theodore "TR" Roosevelt (1858-1919). Through a comprehensive review of thousands of source documents, and a modern understanding of asthma, we examine several misunderstandings, including the longstanding assertion that TR's illness was "psychosomatic." TR's respiratory problems began in early childhood, and the historical record provides strong evidence for poorly controlled, persistent asthma. Like many patients, his asthma entered a relatively quiescent stage during adolescence, coincident with initiation of a vigorous exercise program when TR was 12 years old. Nevertheless, TR continued to suffer serious asthma exacerbations, both in adolescence and adulthood. Although psychosocial issues affect most chronic diseases, there is little (if any) support for assertions that TR's asthma was psychosomatic. We believe that TR's childhood struggles with asthma, and the misconception that he vanquished his illness through exercise, were experiences that profoundly affected his worldview. TR is known for his appreciation of life's struggles and for a bedrock belief that people can create major change with sufficient motivation and hard work. In different ways, misunderstandings about asthma contributed to the early development of these personal characteristics. Together with later experiences, they contributed to a lifetime of action that changed modern history.

Writing siblings: Alice James and her brothers.

This essay addresses the relationship of writing to embodiment, through representations of bodily sensation and fantasy in the journal of Alice James. It considers Alice James's writing in relation to her two writer brothers, William and Henry, and in light of their father's experiences of impairment and breakdown.

Proust, neurology and Stendhal's syndrome.

Marcel Proust is one of the most important French writers of the 20th century. His relationship with medicine and with neurology is possibly linked to the fact that his asthma was considered to be a psychosomatic disease classified as neurasthenia. Stendhal's syndrome is a rare psychiatric syndrome characterized by anxiety and affective and thought disturbances when a person is exposed to a work of art. Here, the authors describe neurological aspects of Proust's work, particularly the occurrence of Stendhal's syndrome and syncope when he as well as one of the characters of In Search of Lost Time see Vermeer's View of Delft during a visit to a museum.