Cross-cultural, transnational or interdisciplinary? Eric Wittkower's psychosomatic medicine and transcultural psychiatry in historical context.

This article traces the career, scientific achievements, and emigration of the Berlin-born physician, psychoanalyst, and psychosomatic researcher Eric Wittkower. Trained in Berlin and practicing internal medicine, he became persecuted by the Nazi regime and, after fleeing Germany via Switzerland, continued his professional career in the United Kingdom, where he turned to psychosomatic medicine and worked in the service of the British Army during World War II. After two decades of service in the UK, Wittkower joined McGill University in Canada. His increasingly interdisciplinary work contributed to the establishment of the new research field of transcultural psychiatry. Finally the paper provides a detailed history of the beginning of the section of transcultural psychiatry at the Allan Memorial Institute.

Da medicina psicossomática à psicologia médica: a trajetória teórica e institucional de Julio de Mello Filho / From psychosomatic medicine to medical psychology: the theoretical and institutional trajectory of Julio de Mello Filho

Resumo Os estudos sobre as causalidades das patologias e da relação médico/paciente a partir de formulações psicanalíticas receberam duas denominações no Brasil: medicina psicossomática e psicologia médica. O médico e psicanalista Julio de Mello Filho assumiu o protagonismo dessa proposta a partir da doença incapacitante do psiquiatra e psicanalista Danillo Perestrello. A estruturação da concepção teórica do movimento psicossomático e as estratégias institucionais utilizadas para a consolidação desse campo disciplinar no cenário brasileiro são o objeto deste estudo. Por meio de um referencial epistemológico e histórico, conclui-se que a proposta inicial de transformação do modelo médico hegemônico perde força e observa-se um deslocamento da psicologia médica como um campo da psicologia da saúde.

Abstract Studies on the causality of pathologies and the doctor/patient relationship based on psychoanalytic formulations received two denominations in Brazil: psychosomatic medicine and medical psychology. The physician and psychoanalyst Julio de Mello Filho took a leading role in this movement after the psychiatrist and psychoanalyst Danillo Perestrello was incapacitated by illness. This study investigates how the theoretical concepts of the psychosomatic movement were structured and the institutional strategies used to establish this discipline in Brazil. From an epistemological and historical point of view, the initial notion of transforming the hegemonic medical model was seen to lose force, followed by a shift in medical psychology as a field of health psychology.

[Danilo Perestrello and the psychosomatic medicine movement in Brazil: from theory to institutional acceptance]. / O movimento da medicina psicossomática no Brasil: a trajetória teórica e institucional de Danilo Perestrello.

In the 1950s, the psychosomatic medicine movement emerged in Brazil, led by psychiatrist and psychoanalyst Danilo Perestrello. This article analyzes the strategies developed to configure this proposal and establish this field of study. From the beginning, this movement was characterized by a plan to reformulate medicine based on psychoanalytic theory and obtain favorable reception in institutions. During his career, Perestrello published articles and books with the intention of establishing a new way of thinking among physicians and worked at strategic institutions. His withdrawal from professional work due to a serious illness in 1976 was a factor contributing to the fragmentation of the psychosomatic movement in Brazil.

Na década de 1950, surgia o movimento da medicina psicossomática no Brasil, tendo como protagonista o psiquiatra e psicanalista Danilo Perestrello. A configuração dessa proposta e a análise das estratégias construídas para a formação desse campo disciplinar são o objeto deste estudo. Desde o início, esse movimento foi marcado por um projeto teórico-institucional de refundação da medicina sobre bases psicanalíticas e de institucionalização. Em sua trajetória, Perestrello publicou artigos e livros que tinham como intuito formar um novo estilo de pensamento entre os médicos, bem como a ocupação de instituições estratégicas. Seu afastamento profissional, devido a uma grave doença em 1976, representou um fator desagregador do movimento psicossomático no contexto brasileiro.

O movimento da medicina psicossomática no Brasil: a trajetória teórica e institucional de Danilo Perestrello / Danilo Perestrello and the psychosomatic medicine movement in Brazil: from theory to institutional acceptance

Resumo Na década de 1950, surgia o movimento da medicina psicossomática no Brasil, tendo como protagonista o psiquiatra e psicanalista Danilo Perestrello. A configuração dessa proposta e a análise das estratégias construídas para a formação desse campo disciplinar são o objeto deste estudo. Desde o início, esse movimento foi marcado por um projeto teórico-institucional de refundação da medicina sobre bases psicanalíticas e de institucionalização. Em sua trajetória, Perestrello publicou artigos e livros que tinham como intuito formar um novo estilo de pensamento entre os médicos, bem como a ocupação de instituições estratégicas. Seu afastamento profissional, devido a uma grave doença em 1976, representou um fator desagregador do movimento psicossomático no contexto brasileiro.

Abstract In the 1950s, the psychosomatic medicine movement emerged in Brazil, led by psychiatrist and psychoanalyst Danilo Perestrello. This article analyzes the strategies developed to configure this proposal and establish this field of study. From the beginning, this movement was characterized by a plan to reformulate medicine based on psychoanalytic theory and obtain favorable reception in institutions. During his career, Perestrello published articles and books with the intention of establishing a new way of thinking among physicians and worked at strategic institutions. His withdrawal from professional work due to a serious illness in 1976 was a factor contributing to the fragmentation of the psychosomatic movement in Brazil.

O movimento da medicina psicossomática no Brasil: a trajetória teórica e institucional de Danilo Perestrello / Danilo Perestrello and the psychosomatic medicine movement in Brazil: from theory to institutional acceptance

Na década de 1950, surgia o movimento da medicina psicossomática no Brasil, tendo como protagonista o psiquiatra e psicanalista Danilo Perestrello. A configuração dessa proposta e a análise das estratégias construídas para a formação desse campo disciplinar são o objeto deste estudo. Desde o início, esse movimento foi marcado por um projeto teórico-institucional de refundação da medicina sobre bases psicanalíticas e de institucionalização. Em sua trajetória, Perestrello publicou artigos e livros que tinham como intuito formar um novo estilo de pensamento entre os médicos, bem como a ocupação de instituições estratégicas. Seu afastamento profissional, devido a uma grave doença em 1976, representou um fator desagregador do movimento psicossomático no contexto brasileiro

Grief: A Brief History of Research on How Body, Mind, and Brain Adapt.

OBJECTIVE: Using an integrative view of psychology, neuroscience, immunology, and psychophysiology, the present review of literature curates the findings that have had an impact on the field of bereavement research and shaped its development. METHODS: Beginning with pivotal systematic descriptions of medical and psychological responses to the death of a loved one by Lindemann in the mid-1940s, this selective review integrates findings in bereavement research from studies that investigate medical outcomes after loss, their psychological predictors, and biopsychosocial mechanisms. RESULTS: Morbidity and mortality after the death of a loved one have long been a topic of research. Early researchers characterized somatic and psychological symptoms and studied immune cell changes in bereaved samples. More recent research has repeatedly demonstrated increased rates of morbidity and mortality in bereaved samples, as compared with married controls, in large epidemiological studies. Recent developments also include the development of criteria for prolonged grief disorder (also termed complicated grief). Newer methods, including neuroimaging, have observed that the greatest impact of the death of a loved one is in those who have the most severe psychological grief reactions. Research addressing the mechanisms tying bereavement to medical outcomes is relatively scarce, but differences in rumination, in inflammation, and in cortisol dysregulation between those who adapt well and those who do not have been offered with some evidence. CONCLUSIONS: Recommendations to propel the field forward include longitudinal studies to understand differences between acute reactions and later adaptation, comparing samples with grief disorders from those with more typical responses, and integrating responses in brain, mind, and body.

Emotions, Bodily Changes, and the Social Environment: How Did Early Psychosomatic Medicine Consider the Social Dimension in Health and Disease?

OBJECTIVE: Social relationships play an important role in human health and disease processes, and the field of psychosomatic medicine currently integrates social factors in its theoretical models and clinical interventions. This article provides a historical perspective on the field of psychosomatic medicine in the United States and examines the extent to which early American psychosomatic medicine incorporated the impact of social relationships on health and disease outcomes. METHODS: We searched PubMed across all issues of Psychosomatic Medicine for key words related to emotions versus social processes. Article counts are compared for these key words. We then performed a narrative review to analyze how concepts of associations among emotional, interpersonal, and physiological variables evolved in early publications. RESULTS: Of 5023 articles found in Psychosomatic Medicine, 1453 contained an emotional, 936 a social search term, and 447 contained both. In the qualitative review, influences of the social environment on emotional states and physiology were recognized already in the 1930s but they only played a subordinate role in early Psychosomatic Medicine. Publications often lacked a clear working model how interpersonal events exert their impact on physiology. With increasing understanding of developmental and neural mechanisms, a more differentiated view evolved. CONCLUSIONS: Early publications in psychosomatic medicine mainly focused on associations between emotions and physiology. However, some highlighted the importance of interpersonal and social factors. Later, the understanding of emotions, social relationships, and physiology with their developmental and neurobiological correlates have led to a fuller "biopsychosociocultural" understanding of health and disease, although more research on and within these networks is urgently needed.

Retorno al siglo XX: setenta años de psiquiatría, psicoanálisis y medicina psicosomática en Santiago de Chile / Return to the 20th century: seventy years of psychiatry, psychoanalysis and psychosomatic medicine in Santiago de Chile

Este trabajo resume los cambios en la psiquiatría clínica y el psicoanálisis y la medicina psicosomática en el siglo pasado, destacando a dos médicos chilenos, un internista y un psiquiatra que influenciaron profundamente al autor. Los Drs. Hernán Alessandri Rodríguez e Ignacio Matte Blanco fueron formadores de médicos no solo en la Facultad de Medicina de la Universidad de Chile, sino a nivel nacional e internacional, dejando su sello hasta hoy. El artículo recorre la historia de esa Facultad, así como de la Clínica Psiquiátrica Universitaria, cuyo primer director fue el Prof. Matte. Este fue también el promotor de la Asociación Psicoanalítica Chilena, admitida en agosto de 1949 como sociedad componente de la Asociación Psicoanalítica Internacional. Se revisan los antecedentes históricos del psicoanálisis freudiano y de la medicina psicosomática hasta la mitad del siglo XX, para luego analizar los desarrollos posteriores tanto de la psiquiatría clínica, del psicoanálisis post-freudiano y de la salud mental chilenas. Se concluye subrayando cómo las personalidades, sus vinculaciones familiares y el contexto socio-cultural marcan los avances y las dificultades de los progresos en salud.

[Psychosomatic research in 2018: Lost illusions, renewed hopes]. / La recherche psychosomatique en 2018 : illusions perdues, espoirs renouvelés.

A critical analysis of the basic hypotheses of psychosomatic research and the sometimes hasty assertions drawn from the previous works makes it possible to better discern the data confirmed by the most recent works or the most rigorous meta-analyses and to highlight the emerging tracks. If the hypothesis of behavioral patterns specifically related to the risk of certain pathologies seems abandoned, the predictive value of depression in the cardiovascular field, more than in that of oncology, becomes clearer. Negative affect and impaired emotional awareness emerge as two complementary factors of somatic vulnerability. Several vulnerability factors seem all the more effective as they affect individuals of lower socio-economic status. Social exclusion feeling and its links with the inflammatory response appear to be a possible common denominator, both for depression and for many somatic conditions. A series of studies on the cerebral regulation of emotions and stress, as well as on bidirectional brain-bowel relations and on the mediating role of the gut microbiota, complements the available epidemiological data. The same is true for certain advances in behavioral neuro-economics, which inform the decision-making processes of patients facing preventive health choices. Lastly, it appears that a significant part of the excess mortality associated with the existence of severe mental disorders is not due to factors inherent to the patients themselves, but to disparities in the quality of the care provided to them.

Consultation-Liaison Psychiatry vs Psychosomatic Medicine: What's in a name?

BACKGROUND: In November of 2017, The Academy of the Psychosomatic Medicine voted to change its name to the Academy of Consultation-Liaison Psychiatry. It followed a similar change in which the American Board of Medical Specialties voted to change the name of the field to Consultation-Liaison Psychiatry. OBJECTIVE: The authors, all instrumental in bringing about this change, discuss the history and rationale for this name change.

Past, Present, and Future of Psychosomatic Movements in an Ever-Changing World: Presidential Address.

OBJECTIVE: The American Psychosomatic Society was founded in 1942 and is celebrating its 75th anniversary in 2017. In recognizing the society's anniversary, this article provides a historical perspective on its history, the field of psychosomatic medicine in general, and anticipated future directions. METHODS: Essay and narrative review of the literature on the historic development of psychosomatic concepts and their impact on medicine over time. RESULTS: Mind-body associations have been described in the medical literature for more than 3500 years. Early concepts of mind-body dualism and attempts to overcome them are found in classical Greek medicine. Psychosomatic thinking can be observed ever since, but only in the 20th century, a "psychosomatic movement" emerged in Europe and North America, aiming at humanizing medicine by introducing a holistic understanding of man into what was considered a widely reductionistic practice of medicine. This movement led to the inauguration of the American Psychosomatic Society during World War II and of national and international societies of psychosomatic medicine and its subspecializations thereafter. CONCLUSIONS: Psychosomatic medicine has its roots in the beginnings of medicine. During the past 75 years, it has made substantial contributions to the science and practice of medicine. The field has also changed in response to developments in medicine, technology, and society and is facing new challenges and opportunities that may require further adaptation of its concepts and practice.

Sobre los efectos de la nocién de «lo arcaico» en la escucha del analista / On the effect of the notion of the «the archaic» upon the analyst´s listening

La aurora resume cuatro maneras en que las diferentes corrientes del psicoanálisis contemporáneo intentan comprender «lo arcaico»: en términos de lo traumático y lo no representado, como lo informe corporal, como fantasias inconscientes primitivas de carácter sensorial y presimbólico y desde la óptica del encuentro profundo con el otro. Se plantea entonces la siguiente pregunta: ¿en qué condiciones pueden las diversas concepciones de «lo arcaico» ampliar la escucha del analista o, por el contrario, saturarla y cerrar el acceso a aquello que precisamente se intenta alcanzar? Tras recordar la invitación de Bion a respetar tanto la individualidad del paciente como la del analista, la aurora discute la tension entre un psicoanálisis centrado en los contenidos y un psicoanálisis atento a los procesos. Esta problemática viene ilustrada por una viñeta en la que se discute la presentación de un análisis en un seminario clínico y el fracaso del intento de elaboración grupal (AU)

The author summarizes four ways in which the different currents of contemporary psychoanalysis comprehend «the archaic»: in terms of the traumatic and unrepresented; with regard to the formless corporeal; in connection with primitive unconscious phantasies of a sensorial and presymbolic nature and from the viewpoint of the profound encounter with the other. She then formulates the following question: under which conditions may the diverse conceptions of «the archaic» broaden the analyst’s listening or, conversely, saturate it and close off access to precisely that which we are attempting to reach? Calling to mind Bion’s invitation to respect both the analyst’s as well as the patient’s individuality, the author discusses the tension between a psychoanalysis focused upon the contents and a psychoanalysis attentive to the processes. This predicament is illustrated by a vignette which discusses the presentation of an analysis in a clinical seminar and the failed attempt at group working-through (AU)