Alexander F. – Psychosomatic Medicine – Chapter 1. Introduction
Psychosomatic medicine
“Psychosomatic medicine. Principles and application”, F. Alexander; per. from English. A. M. Bokovikov, V. V. Starovoitov; under scientific ed. S. L. Shishkina. Moscow: Institute for General Humanitarian Research, 2006
Chapter 1 Introduction
The patient as a person with his anxieties, fears, hopes and despair, as a whole, and not just as a carrier of organs – a diseased liver or stomach – again becomes a legitimate object of medical interest. In the last two decades, the role of emotional factors in the occurrence of diseases has received increasing attention. Among doctors, a psychological orientation is being affirmed. Some respectable conservative clinicians see this as a threat to the hard-won foundations of medicine, and influential voices are heard warning physicians that the newfound "psychologism" is incompatible with medicine as a natural science. They would prefer that medical psychology remain limited to the realm of medical art, tact and intuition in dealing with the patient, distinct from the strictly scientific method of therapy based on physics, chemistry, anatomy and physiology.
However, in the light of a historical perspective, this psychological interest is nothing more than a revival of old prescientific ideas in a new, scientific form. Caring for a suffering person was not always shared between the priest and the doctor. Once healing functions, mental and physical, were combined in one hand. Whatever the explanation for the healing power of the medicine man, or the evangelist, or the holy water of Lourdes, there can hardly be any doubt that all of them often produced an amazing curative effect, in some respects even more impressive than many of our remedies, which we can analyze chemically and whose pharmacological effects we know for sure. This psychological aspect of medicine has survived only in a rudimentary form as a medical art and approach to the patient, carefully separated from the scientific aspect of therapy and perceived mainly as referring to the doctor's influence on the patient through comfort and suggestion.
Modern scientific medical psychology is only an attempt to put medical art, the psychological influence of a doctor on a patient, on a scientific basis and make it an integral part of therapy. There can hardly be any doubt that much of the therapeutic success in the profession of the healer—the medicine man and priest, and the modern medical practitioner—is due to the indeterminate emotional bond between the healer and his patient. However, this psychological function of the physician was largely ignored in the last century, when medicine became a truly natural science based on the application of the principles of physics and chemistry to the living organism.The main philosophical postulate of modern medicine says that the body and its functions can be understood from the position of physical chemistry, that living organisms are physical and chemical mechanisms, and the ideal of a doctor is to become an engineer of the body. The recognition of psychological forces, that is, a psychological approach to the problems of life and illness, seems to some people a return to the ignorance of the Middle Ages, when illness was considered the act of an evil spirit, and therapy consisted in a spell, the expulsion of an unclean spirit from a sick body. It is only natural that the new medicine, based on laboratory experiments, zealously defended its newly acquired scientific halo against such obsolete mystical concepts as those of psychology. Medicine, that newcomer to the natural sciences, has in many respects assumed the attitude of the upstart who wants to make his lowly origins forgotten and become more intolerant, haughty and conservative than the true aristocrat. Medicine became intolerant of anything reminiscent of its spiritual and mystical past, while its elder brother, the physicist, the aristocrat of the natural sciences, made a thorough revision of its fundamental concepts, questioning even the key principle of science, the universal validity of determinism.
These remarks are not intended to belittle the achievements of the laboratory period in medicine, the most prominent phase in its history. The physico-chemical orientation, characterized by the exact study of fine details, has led to significant advances in medicine, as exemplified by modern bacteriology, surgery, and pharmacology. One of the paradoxes of historical development is that the greater the scientific value of a method or principle, the more it will hinder subsequent development. The inertia of the human mind causes it to cling to ideas and methods that have proven their value in the past, even if they have already served their purpose. Many examples of this can be found in the history of the development of exact sciences such as physics. Einstein claimed that Aristotle's ideas about motion slowed down the development of mechanics for two thousand years. Progress in every area requires a reorientation with the introduction of new principles. While these new principles may not conflict with the old ones, they are often rejected or accepted only after a hard struggle for recognition.
"How easy it is to start a conversation with anyone"
Have you ever walked into an unfamiliar company and did not know how to start a conversation? You wanted to make acquaintance with the opposite sex, but you did not know what to talk about? Did the words get stuck in your throat, and did your palms sweat from excitement? Conversation is the key to everything you want to achieve in life.
The scientist is as limited in this respect as the man in the street. The same physico-chemical orientation, to which medicine owes its greatest achievements, has become, because of its one-sidedness, an obstacle to further development.The laboratory era of medicine was characterized by an analytical approach. Typical for this period was specialized interest in the details of the mechanisms, to the understanding of private processes. The discovery of more subtle methods of observation, especially observation using a microscope, revealed a new microcosm, providing an unprecedented opportunity to study the smallest parts of the body. When considering cases of diseases, the main goal was the localization of pathological processes. In ancient medicine, a humoral theory prevailed, claiming that body fluids are carriers of the disease. The gradual development of autopsy methods in the revival era made it possible to accurately study the parts of the human body, and thus led to the development of more realistic, but at the same time more localization etiological concepts. Morgania, in the middle of the eighteenth century, argued that many diseases are localized in certain organs, such as heart, kidneys, liver, etc. With the advent of the microscope, the localization of the disease was even more limited: the location of the disease became the cell. It was Vihov, who, such as many, pathology is obliged, proclaimed that there are no systemic diseases, but there are only diseases of organs and cells. His great achievements in pathology and his authority established a dogma in cell pathology, which affects medical thinking to the present. The influence of Virchov on etiological thinking is a classic example of a historical paradox that the greatest achievements of the past become the most great obstacles for further development. The observation of histological changes in patients who became possible due to the microscope and the sophisticated testicular color technique determined the scheme of etiological thinking. Finding the causes of the disease for a long time remained limited search for local morphological changes in tissues. The concepts that such local anatomical changes themselves may arise as a result of more general disorders that develop as a result of pathology of function, excessive stress or even emotional factors, there was a lot later. A less narrow humoral theory, which was discredited when Virhov successfully defeated her last representative, Rokitansky, had to expect his rebirth in the form of modern endocrinology.
Not many understood the meaning of this medical development phase is better than Nemydik Stefan Collegu. In his book, "Healing the Spirit" he writes:
Now the disease no longer means what is happening with the whole person, it means only what is happening with his authorities. Therefore, the initial and natural mission of the doctor, an approach to the disease as a whole, is replaced by smaller tasks of the localization of the disease, its identification and assigning it to the already established group of diseases.This inevitable objectification and technicalization of therapy was carried to the extreme in the nineteenth century, because a third entirely mechanical thing, the apparatus, began to be placed between doctor and patient. The insightful, creatively synthesizing understanding of the born physician became less and less necessary for diagnosis.
No less impressive is the statement of the humanist Alan Gregg, who considers the past and future of medicine in a broad perspective:
The whole, which is the human being, was divided into parts and systems for research. One should not blaspheme this method, but no one is obliged to be satisfied with its results alone. What keeps our various organs and multiple functions in harmony and union with each other? And what can medicine say about the hasty separation of "mind" and "body"? What makes the individual, as the word itself implies, indivisible, whole? The need for deeper knowledge is painfully obvious here. But stronger than just a need, a premonition of future changes. Psychiatry is on the move, neurophysiology is developing, neurosurgery is flourishing, and the star is still burning over the cradle of endocrinology. Participation in the solution of the problem of the dichotomy of soul and body, left to us by Descartes, must be sought from such fields of knowledge as psychology, cultural anthropology, sociology and philosophy, as well as chemistry, physics and therapy.
Thus, modern clinical medicine has been divided into two heterogeneous parts – one that is considered more advanced and scientific and includes all disorders that can be explained in terms of physiology and general pathology (for example, organic heart disease, diabetes, infectious disease, etc.). .d.), and another, considered less scientific, which includes a huge conglomerate of disorders of obscure, often mental origin. Characteristic of this ambivalence – a typical manifestation of the inertia of the human mind – is the tendency to squeeze more and more diseases into the etiological scheme of infection, where the connection between pathogenic cause and pathological effect seems relatively simple. When the infectious or other organic explanation fails, the modern clinician only consoles himself with the hope that sometime in the future, when organic processes are studied in more detail, the reluctantly acknowledged mental factor will eventually be eliminated. But at the same time, more and more clinicians are gradually coming to understand that even in disorders with a satisfactory physiological explanation, such as diabetes or essential hypertension, only the last connections in the causal chain are known, and the primary etiological factors still remain unclear.In these, as in other chronic conditions, accumulating observations seem to point to "central" factors, with "central" apparently being a mere euphemism for "psychogenic" factors. This state of affairs easily explains the peculiar discrepancy between the official-theoretical and real practical attitudes of the doctor in his work. In scientific publications, in speeches before medical groups, he will emphasize the need for knowledge of more and more details of basic physiological and pathological processes and will refuse to take psychogenic etiology seriously; however, in private practice, he will not hesitate to advise a patient suffering from hypertension to try to relax, take life less seriously, avoid overwork, and will try to convince the patient that his overly active and ambitious attitude towards life is the real source of high blood pressure. This "split personality" of the modern clinician most clearly reveals the weak point of modern medicine. Within the medical community, the practitioner can afford to portray a "scientific" attitude that is essentially dogmatic and anti-psychological. Since he does not know exactly how the psychic element operates, which is so contrary to everything he has learned during medical training, and since the recognition of the psychic factor seems to destroy the coherence of the physico-chemical theory of life, such a practitioner tries, as much as possible , do not take into account the mental factor. However, as a doctor, he cannot completely ignore it. When confronted with patients, his therapeutic conscience compels him to pay special attention to this detestable factor, the importance of which he instinctively feels. He has to deal with it, but in doing so, he justifies himself with the phrase that medical healing is not only a science, but also an art. He is unaware that what he calls the art of medicine is nothing more than a deeper, intuitive, that is, non-verbalised, knowledge that he has acquired through many years of clinical experience. The significance of psychiatry, and in particular the psychoanalytic method, for the development of medicine lies in the fact that it provides effective ways to study the psychological factors of diseases.
Franz Alexander is recognized as one of the founders of psychosomatic medicine (psychosomatics). It was his psychoanalytic work that played a decisive role in recognizing emotional stress as a significant factor in the emergence and development of somatic diseases. This work is central in the work of F. Alexander.It summarizes the experience of the rapid development of psychosomatics in the first half of the 20th century and outlines the methodology of a new, psychoanalytic approach to understanding and treating diseases.