Meetings of the Psychoanalytic Association of New York

October 20, 1980. THE NEW PSYCHOSOMATIC MEDICINE. Lawrence Deutsch, M.D.

Dr. Deutsch addressed the important challenges for our profession raised by "the new psychosomatic medicine." He observed that the use of the term "psychosomatic," once restricted to the so-called "holy seven" illnesses described by Alexander, has now been broadened to include virtually all illness. Accordingly, psychoanalysts, once the guiding lights of the psychosomatic movement, are being replaced by the social epidemiologists and the neuroendocrinologists. Dr. Deutsch decried this trend, noting that while there is much to learn from the other disciplines which comprise holistic medicine, analysts are in a unique position to provide the understanding necessary if there is to be synthesis of the psychological, sociological, and physiological aspects of disease. Analysts must resume their role in the treatment of the classical psychosomatic disorders. Dr. Deutsch proposed that the term "psychosomatic" be retained for the classical diseases so described and that a new term, such as "biopsychosocial," be used when talking about the new holistic medicine.

Dr. Deutsch discussed social epidemiology in some detail. The literature is filled with large population studies in which morbidity and mortality from a variety of diseases are positively correlated with antecedent stress, such as retirement, natural catastrophe, and bereavement. Work on the correlation between the "type A personality" and coronary heart disease has been extensive. But the work of the social epidemiologists is, by definition, on "populations at risk." The understanding of how these diverse stresses lead to physical illness can best be achieved by examination of the affective, symbolic, and unconscious impact of the "stressful event" on a given individual, a kind of understanding that psychoanalysts are in a position to provide. Analytic interviews and psychological testing might provide data concerning the relationship