Stress Illness and Psychiatry (1)

The single most common cause of symptoms that bring people to a primary care medical clinician is psychosocial stress.  As readers of this blog know, few of these patients are correctly diagnosed and treated.  This might lead you to wonder about what the psychiatric community is doing to solve this problem.  Unfortunately, the answer is “not nearly enough.”

There are two large organizations in America with the word “psychosomatic” in their names.  The mission of the Academy of Psychosomatic Medicine focuses on “persons with comorbid psychiatric and general medical conditions.”  What this means is that members work on traditional mental health conditions (as defined in DSM-IV) that happen to occur in people with medical illnesses.  This is important work but largely neglects people with medically unexplained symptoms whose psychosocial issues are largely hidden from clinicians and unrecognized by the patients.

The American Psychosomatic Society is interested in the “scientific understanding of the interaction of mind, brain, body and social context in promoting health and contributing to the pathogenesis, course and treatment of disease.”  While attending their recent convention, it became clear to me that APS members are primarily interested in brain-body physiology.  This is essential for unraveling the mechanisms whereby stress causes symptoms.  Unfortunately, the APS has far less interest in practical solutions for the millions of stress illness patients who will be evaluated in medical offices this year.

This means that the two premier organizations in the U.S. that are concerned with psychosomatic issues are not focused on the largest clinical problem in their purview.  Why is this and what can be done?  More in the next post.

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