On our need to move beyond folk medicine: A commentary on Karen Gubb's paper, "Psychosomatics today: a review of contemporary theory and practice".

In her thoughtful review and synthesis, Karen Gubb overstimates the breadth of resurgent interest among psychoanalysts in psychosomatic medicine. Such a modest revival as there has been reflects primarily the activity of a few authors and editors. Still, after several decades of inactivity following the intense excitement about this subject during the 1940s and 1950s, there has been some renewal of interest, primarily in Europe and among a small group in the United States. The golden age of psychoanalytic psychosomatics came to an end with the failure to find evidence in support of the promising but overly simplistic specificity theories, especially those of Franz Alexander. If we were going to better understand the complex relations between bodily states (including illnesses) and mental phenomena new theories and modes of investigation would be required. Many apparently new theories have been put forward over the past few decades. Of these, Gubb focuses her attention on two that relate somatic illness to failures in linguistic or symbolic elaboration, that is, to failures in the working over or binding of somatic excitations by the mental apparatus. These theories share the attractive feature that they seem consistent with the claim that psychosomatically ill patients are impaired in their language capacities, being unable to put feelings into words (alexithymia) and unable to move to abstract from concrete thinking (pensée opératoire). While apparently new, when closely examined these theories turn out to be but minor variations of one of Freud's own fundamental theories of mind/body, the one explicated in The Interpretation of Dreams and based upon the neurological model of the reflex arc as known in the 19th century. We know too much today about neuronal functioning, brain operations, and the importance of our subtle interactions with others to be satisfied with a superannuated scientific model. If we analysts are to lay claim to a science beyond a quaint folk medicine we need to create new models that are at consistent with our own more advanced findings and those of our neighboring disciplines.