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The Human Brain

Stephen Gislason MD


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Psychosomatic and Obsolete Idea

The whole enterprise of psychosomatic thinking is misleading and distracts from the practical and important pursuit of healthy environments and constructive action to alter disease-causing conditions. Physicians and patients are often in conflict because they occupy opposite sides of the same irrational psychosomatic belief system. The physicians believe that the mind can invent disease without outside help and their patients believe the mind can cure disease without outside help. Physicians tend to divide illness into two broad categories, the organic and the non-organic. The distinction is used by physicians when they talk to one another but there is no biology to support the irrational belief in "non-organic illness." In dismissing a patient's symptoms, a physician will remark to a colleague, for example, that the origin of the abdominal pain is "supratentorial." This is a neuroanatomical remark without much understanding. The tentorium is a membrane that forms a floor for the cerebral hemispheres inside the skull. A supratentorial event would involve any part of the brain above the midbrain and for many physicians, brain function at this level is indeed a mystery.

Medical lists of the causes of disease continue to include the term "psychogenic" and it is common to hear or read a physician claiming that symptoms are "psychological." Although in most respects medicine has become scientific, the area of psychogenic medicine remains primitive. The term psychogenic is associated with fuzzy thinking and superstitions still prevail. Psychiatry has several labels that suggest that patients make themselves ill but there is little or no biological justification for the belief in psychogenic causation. These are issues in patient-physician relationships mostly that go unexamined and ignorance of these issues often shows up as belief in psychogenic causes.

Physicians continue to rely on patients stories and medical students are still taught to take a history as an essential part of their examination of the patient. However, all story telling is imperfect, patients lie, both deliberately and inadvertently. Physicians tend to be impatient and biased listeners who want to hear a simplified story that fits their preconceptions of diagnostic categories.

The physician's tendency to dismiss descriptions that he or she does not understand leaves many patients frustrated and angry. They feel patronized, misunderstood and abandoned. Often, this perennial miscommunication allows irrational and superstitious beliefs to persist on both sides.

Psychosomatic thinking often assumes that each person has control over his or her behavior and mental states. This leads to the moralistic and punitive aspects of psychosomatic thinking. I have observed that physicians tend toward the punitive version of psychosomatics, blaming patients for dysfunction and disease. Patients tend toward the wish-fulfilling aspect, hoping that good intentions and mental trickery will assist them to recover from serious illness, especially when the physician is powerless to help. Many have suggested that psychosomatic notions are obsolete.

Psychiatrist, Lipovski, stated: "...the concept of psychogenesis of organic disease is as reductionistic as the germ theory of it, against which pioneers in psychosomatic medicine inveighed...To distinguish a class of diseases as `psychosomatic disorders' and to propound generalizations about `psychosomatic patients' is misleading and redundant. Concepts of single causes and of unilinear causal sequences - for example, from psyche to soma and visa versa - are simplistic and obsolete."

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