Throughout history, and across many different cultures, the human being has been considered to consist of a mind with body (and sometimes a soul). Despite this, across much of modern medicine there has been a tendency to conceive of these aspects as distinctly separate entities, whether in disease generation or in its management. The problem of such an approach is that it engenders a sort of Cartesian confusion. In this way, healthcare providers may become oblivious to the idea, which seems so obvious to those who have not been blinded by excessive reductionism, that both of these facets can interact to manifest clinical conditions. This should not be a surprise since the findings of modern-day neuroscience have revealed an intimate link between the mind and the brain, and therefore the nervous system and the rest of the body – the scientific basis of the mind-body connection.
Whilst our understanding of the physiological systems underlying these mind-body, or “psychosomatic” interactions (from the Greek for mind and body), has improved greatly over the past century, their clinical relevance was recognised as early as the Greco-Roman era. Even before the days of Hippocrates, Soranus, and Galen, mind-body approaches were applied clinically in ancient Mesopotamia, Egypt, India, and China (irrespective of significant differences in their underlying theoretical frameworks). However, as with much of the knowledge that was scattered or lost in the days following the collapse of the Roman Empire, learned medicine, and thus mind-body thinking, seemed to have mostly disappeared from Europe by the early Middle Ages. It resurfaced in the 11th century, when Latin scholars working at the first European medical school in Salerno conferred comprehensively with experts in Greek and Arabic medicine, including discussions on women’s health topics such as infertility and childbirth.
With the arrival of the Enlightenment, psychosomatic medicine became dichotomised in the West, so that physicians were dealing with the physical aspect of health, whilst religious leaders dealt with the soul. However, even in this era, the utility of the psychosomatic concept continued to be recognised by certain perspicacious practitioners. These included the two Williams – Osler, the renowned Canadian physician; and Smellie, the Scot considered one of the forefathers of modern obstetrics, who applied the mind-body concept to the management of conditions such as hysterical paralysis or postpartum mood swings, respectively. These practitioners understood the clinical importance of addressing both aspects in many of the patients who sought their advice.
Since then, mind-body concepts have continued developing to facilitate accurate diagnosis and guide treatment, based on the patient’s clinical features. Today’s doctors would have honed clinical observation to become skilled at effective patient management. In so doing they have followed the same guiding principle that was practised by adept Greco-Roman or ancient healers. Even though today’s doctors have additional technology to aid in evaluation and clinical diagnosis, selecting such investigations for a given patient can be difficult. This is particularly relevant to those less familiar with clinical features, such as those in early training, or those less aware of the role of psychosomatic interactions in generating certain diseases, so that only the physical aspect is addressed, often limiting the benefit of any therapeutic intervention.
Such a clinical conundrum has been noted in medical practice by doctors aware of mind-body interactions, who frequently encounter patients who have visited several healthcare facilities in search of a satisfactory answer for their recurring symptoms, despite having followed medical advice. In some women, physical, mental, and social factors alike could be inextricably bound up in the presentation of chronic conditions, such as pelvic pain. Managing such patients can be a challenge for health providers, as pain may persist even after aggressive surgery to alleviate the pain if the underlying cause remains unaddressed. This is where psychosomatic evaluation comes in – a more comprehensive approach enables such conditions to be managed effectively, particularly if consultations are provided early in the course of the disease.
As was documented even in ancient texts such as Soranus’ Gynaecology, it is widely recognised today that psychosocial pressures can affect ovulation, and, more generally, a couple’s fertility. Accordingly, women may be unable to conceive without maintaining environments that are conducive to conception. Psychosomatic repercussions can affect them when failures occur, particularly if adequate counselling is inaccessible. Furthermore, mood symptoms associated with physical illnesses can manifest both during and after pregnancy, even if the woman had wanted, and had successfully delivered, a healthy baby. This can be related to their experience of childbearing, as well as its effects on the normal functioning of pelvic organs. A lack of support from partners, family, or health-carers may aggravate this further, resulting in ill-effects on physical, mental, and social health. Pregnancy can also be associated with benign or pre-malignant conditions that affect outcomes. Management of these medical challenges can benefit considerably from full-field evaluations. It therefore seems pertinent to apply the concept of mind-body interaction to the clinical evaluation of presenting symptoms.
Moreover, in a resource-strapped health service, there can be a considerable wait for specialised investigations. Globally, it may be difficult to provide certain investigations such as specialised scans where there are economic constraints, inadequately trained staff to interpret relevant results, or technicians to maintain such devices. Hence, considerable reliance has to be placed on bedside evaluations. Additionally, the basic infrastructure to support assessment of presenting symptoms, particularly in relation to mind-body interactions, can be problematic in less economically developed regions of the world, especially in zones affected by warfare. Ironically, patients in such areas are at increased risk of acquiring post-traumatic stress disorder, and other health conditions which would particularly benefit from psychosomatic evaluation and biopsychosocial support. Society may have to deal with the neglect of women and families’ health needs when displaced by migration, whether for economic benefit or for safety when fleeing from warring factions. The negative impact on future societies can be long-lasting.
Many patients are affected by psychosomatic conditions which cannot be categorised as arising solely from either the physical or the mental sphere. This article merely skims the surface of these, although they affect a large proportion of patients visiting healthcare facilities worldwide.
Is the need for greater recognition of mind-body interactions staging a comeback in healthcare? It appears so.
Featured image credit: Nerves by geralt. CC0 public domain via Pixabay.