Psychosomatic medicine: integrating dynamic, behavioral and biological perspectives

Integration of psychodynamic, behavioral and biological perspectives is necessary to fully practice contemporary psychosomatic medicine. This discipline is best exemplified by the activities within consultation-liaison psychiatry. Common clinical tasks within consultation-liaison work are discussed from this integrated view.     

Psychosomatic medicine: emerging trends and perspectives

Developments have occurred in all aspects of psychosomatic medicine. Among factors affecting individual vulnerability to all types of disease, the following have been highlighted by recent research: recent and early life events, chronic stress and allostatic load, personality, psychological well-being, health attitudes and behavior. As to the interaction between psychological and biological factors in the course and outcome of disease, the presence of psychiatric (DSM-IV) as well as subclinical (Diagnostic Criteria for Psychosomatic Research) symptoms, illness behavior and the impact on quality of life all need to be assessed. The prevention, treatment and rehabilitation of physical illness include the consideration for psychosomatic prevention, the treatment of psychiatric morbidity and abnormal illness behavior and the use of psychotropic drugs in the medically ill. In the past 60 years, psychosomatic medicine has addressed some fundamental questions, contributing to the growth of other related disciplines, such as psychoneuroendocrinology, psychoimmunology, consultation-liaison psychiatry, behavioral medicine, health psychology and quality of life research. Psychosomatic medicine may also provide a comprehensive frame of reference for several current issues of clinical medicine (the phenomenon of somatization, the increasing occurrence of mysterious symptoms, the demand for well-being and quality of life), including its new dialogue with mind-body and alternative medicine.     

The logic of location: malaria research in colonial India, Darjeeling and Duars,1900-30

This article explores the scientific and entrepreneurial incentives for malaria research in the tea plantations of north Bengal in colonial India. In the process it highlights how the logic of 'location' emerged as the central trope through which medical experts, as well as colonial administrators and planters, defined malaria research in the region. The paper argues that the 'local' emerged as both a prerequisite of colonial governance as well as a significant component of malaria research in the field. Despite the ambiguities that such a project entailed, tropical medicine was enriched from a diverse understanding of local ecology, habitation, and structural modes of production. Nevertheless, the locality itself did not benefit from anti-malarial policy undertaken either by medical experts or the colonial state. This article suggests that there was a disjuncture between 'tropical medicine' and its 'field' that could not be accommodated within the colonial plantation system.     

Medicine and the critique of war: military psychiatry,social classification and the malingering patient in colonial India

The treatment of injured Indian soldiers in Britain during WWI deployed particular ways of recording injuries and using them to make judgments about loyalty to the Imperial Army by assessing the soldier’s ability to malinger. This was possible by using personal correspondences between soldiers and their families for ethnographic ends ie. to determine susceptibility to develop mental illness through a soldier’s ethnic background and whether he was from the so-called ‘martial races’ or not. This classificatory knowledge as well as the suspicion towards exaggerated symptoms was also inherited by Indian psychiatry after partition. However, while these psychiatrists reproduced some colonial biases about susceptibility of illness, they were much more receptive to considering the social experience of patients including their kinship relations at home and in the military. By the end of WWII, symptoms came to be regarded as signs of recovery and readjustment to social relations to make a case for the lasting impacts of war on the soldier’s mental and physical health.     

Citizens' perspectives on personalized medicine: a qualitative public deliberation study

Our objective was to explore citizens'' informed and reasoned values and expectations of personalized medicine, a timely yet novel genomics policy issue. A qualitative, public deliberation study was undertaken using a citizens'' reference panel on health technologies, established to provide input to the health technology assessment process in Ontario, Canada. The citizens'' panel consisted of five women and nine men, aged 18–71 years, with one member selected from each health authority region. There were shared expectations among the citizens'' panel members for the potential of personalized medicine technologies to improve care, provided they are deemed clinically valid and effective. These expectations were tempered by concerns about value for money and the possibility that access to treatment may be limited by personalized medicine tests used to stratify patients. Although they questioned the presumed technological imperative presented by personalized medicine technologies, they called for increased efforts to prepare the health-care system to effectively integrate these technologies. This study represents an early but important effort to explore public values toward personalized medicine. This study also provides evidence of the public''s ability to form coherent judgments about a new policy issue. Concerned that personalized tests might be used to ration care, they suggested that treatment should be made available if patients wanted it, irrespective of tests that indicate little benefit. This issue raises clinical and policy challenges that may undermine the value of personalized medicine. Further efforts to deliberate with the public are warranted to inform effective, efficient and equitable translation of personalized medicine.