Psychoanalysis and Psychosomatics: A New Synthesis (Taylor, 1992)

When I wrote “Psychoanalysis and Psychosomatics: A New Synthesis” 30 years ago, my aim was to describe a dysregulation model of illness and disease that could replace earlier psychosomatic models and help bridge the gap between psychoanalysis and psychosomatic medicine, which had widened considerably during the 1970s and 1980s. The dysregulation model is based on general systems theory and a conception of human beings as self-regulating cybernetic systems, the psyche being one component within a hierarchical arrangement of reciprocally regulating subsystems. By including the idea that internal object representations as well as interpersonal relationships function as psychobiological regulators, and also encompassing deficits in affect development and affect regulation, the model suggests psychotherapeutic approaches that are likely to enhance the regulatory capacities of the patient's psyche and the feedback it has with other subsystems, thereby benefiting bodily health. Although few authors refer to the dysregulation model by name, the article anticipated changes that were to take place within the field of psychosomatic medicine over the past three decades. In a presidential address to the American Psychosomatic Society in 2017, Christoph Herrmann-Lingen stated, “Systems medicine, cybernetic feedback models of physiological regulation, and complex risk factors have widely replaced earlier and much criticized unidirectional ‘one cause-one disease’ concepts of biomedicine from early years of psychosomatic medicine.”

One complex risk factor that has gained increased attention among physicians is childhood trauma. This attention was prompted by evidence from several epidemiological studies that adverse experiences in childhood are associated with an elevated risk for not only psychiatric disorders in adulthood, but also for a wide range of physical disorders,