Infomedica Nr.1 (143)/2008 Psychosomatics today – after its semantic dissolution
| Psychosomatics today – after its semantic dissolution |
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Psychosomatics today – after its semantic dissolution Autori: Ioan Bradu Iamandescu*
Rezumat: „Abolirea”, de catre DSM III si IV, a Psihosomaticii ca stiinta/ disciplina de studiu pentru pregatirea medicala si psihologica, a avut ca rezultat disparitia termenului de „psihosomatica” (disolutia sa semantica) din vocabularul (inclusiv din indexul) catorva manuale de Psihologie a Sanatatii. Medicina Psihosomatica a fost substituita de Psihologia Sanatatii si Medicina Comportamentala, sau a fost limitata la psihiatria de legatura. Totusi, a persistat in multe tari avand o arie vasta de studiu, ceea ce este de fapt Psihosomatica clasica, dar purificata de tendintele fanteziste psihanalitice, si intarita de argumente ale Medicinii bazate pe dovezi, sustinute de studii psihologice si biomoleculare. O astfel de Psihosomatica nu refuza consultatia psihiatrica a bolnavilor somatici (ceea ce este respectat), dar largeste aria de studiu pana la nivelul cercetarii etiopatogeniei psihosociale a bolilor somatice, a unei abordari biopsihosociale sustinute a bolnavilor somatici de catre medici somaticieni si chirurgi si care implica de asemenea psihologi si psihiatri in echipa terapeutica. Pe de alta parte, propunand termenul de Psihosomatica Aplicata, noi avem in vedere selectia unor boli somatice cu o frecventa mare si responsabile de o rata crescuta a mortalitatii, cuprinse in aproape toate subspecialitatile medicale si chirurgicale si unificate printr-o larga participare etiopatogenica a factorilor psihosociali sau printr-un rasunet psihologic major al disconfortului si impactului existential provocate de aceste boli. Acest tip de selectie - cu riscul asumat de a include prea multe sau prea putine boli in categoria de psihosomatice - poate determina sau chiar incita concentrarea eforturilor profesionistilor medicali spre o ingustare a campului de patologie, acolo unde este foarte justificata nevoia de instrumente psihodiagnostice si psihoterapeutice, la fel ca si de specialisti (psihiatri, psihologi, sociologi, etc.). Abstract: The “abolition” of Psychosomatics as science/ study discipline for medical and psychological tuition, by DSM III and IV, resulting in the disappearance of the “psychosomatics” term (its semantic dissolution) from the lexicon (including indexes) of several textbooks of health psychology. Psychosomatic Medicine was substituted by Health Psychology and Behavioral Medicine or was limited to liason-psychiatry. However, it persisted in many countries having a vast area of study, as the classical Psychosomatics is, but purified of fantasist tendencies with psychoanalytical shade and strengthened with arguments of Evidence-Based Medicine sustained by psychological and biomollecular studies. Such a Psychosomatics does not refuse the psychiatry consultation of somatic patients (which is respected), but also widens its area of study to the level of research of psychosocial etiopathogeny of somatic diseases, of sustained biopsychosocial approach to somatic patients by somatic physicians and surgeons and also involves psychologists and psychiatrists into the therapeutic team. On the other hand, by proposing the Applied Psychosomatics term, we take into account the selection of somatic diseases with an increased frequency and responsible of high mortality, being comprised in about all medical and surgical subspecialities and unified through a large etiopatogenic participation of psychosocial factors or through a major psychological rebound of disconfort and existential impact of these diseases. This type of selection – with the assumed risk of including too many or too less diseases in the category of psychosomatic – could allow or even incite to concentrate the efforts of the medical professionals towards a narrower field of pathology, where it is very justified the need for psychodiagnostic and psychotherapy instruments, as well as for specialists (psychiatrists, psychologists, sociologists etc.).
Prof. dr. Ioan Bradu Iamandescu Medical Psychology and Psychosomatics Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania Adresa pentru corespondenta Prof. dr. Ioan Bradu Iamandescu Chairman of Medical Psychology and Psychosomatics Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest
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