Progress and Promise: Research and Education in Psychosomatic Medicine

Practitioners understand the wholeness and unity of their patients. Instead of being considered isolated organ systems or enzyme cycles, patients are understood as coherent entities composed of coordinated and interrelated processes and systems. This fundamental understanding guides investigative and clinical care approaches in psychosomatic medicine. As an integrative science, psychosomatic research investigates multilevel interactions that contribute to health and illness1--which include genetic susceptibility, biologic insults, early childhood experiences, socioeconomic status, personality, acute and chronic stressors, and social networks--and their combined effects on physiologic functioning. Committees of the National Research Council and the Institute of Medicine have recently published comprehensive reviews of this science.2,3 With its clinical approach, psychosomatic medicine includes social, psychological, behavioral, physiologic, and medical parameters in its evaluation and treatment of patients. Comorbid psychiatric conditions are accounted for--not excluded. For example, the anxiety disorder that complicates the care of the asthmatic patient is addressed and integrated into the overall care plan. In its inclusiveness, this approach provides the most comprehensive model for understanding and intervening in patients' care. Psychosomatic medicine is the core perspective not only for psychiatrists who also provide primary care or work in general medical settings but for all psychiatrists who are dedicated to the care of the whole patient. With the American Board of Medical Specialties' recent specialty designation of Psychosomatic Medicine for psychiatrists who care for the medically ill, many of these practitioners will take the lead in applying this approach to clinical care and medical education.