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Although psychoanalysis played an important role in the history of psychosomatic medicine during the first half of the present century, over the past 30 years it has had little impact on the field. Nowadays, it is unusual to find courses on psychosomatic medicine in the training programs of psychoanalytic institutes, and articles reporting psychoanalytic treatments of physically ill patients are rarely published in the scientific literature. The drifting apart of psychoanalysis and psychosomatics is generally attributed to limitations in the early psychoanalytic theories of bodily disease and to advances in the biological sciences that strengthened physicians' allegiance to the traditional biomedical model of disease.
In this article, I will attempt to restore the importance of psychoanalysis to psychosomatic medicine by showing how some of the developments that have occurred within psychoanalysis over the past two decades can be integrated with new knowledge in developmental biology and the neurosciences and biomedical sciences. In particular, I will focus on the increasing emphasis on affect development and affect regulation (Emde, 1988a; Krystal, 1988), as well as on the growing trend away from Freud's one-person exclusively intrapsychic, drive-conflict model toward the two-person, relational models that relate psychopathology to deficits in psychic structure and functions (Mitchell, 1988). I will try to show how a synthesis of these modern psychoanalytic concepts with contemporary psychosomatic theories can provide psychoanalysts with a new theoretical model for working with physically ill patients.
Let us begin by reviewing briefly the development and limitations of some of the early psychosomatic models of disease that were derived from classical psychoanalysis during the 1940s and 1950s.