It’s time to phase out the word “psychosomatic”

Psychosomatic. I learned not to use that word forty years ago, after I’d told a patient her malady might be psychosomatic in origin. She turned red, jumped up, and on her way out said, “I hope you fall into an open manhole and die!”

Well, maybe I should’ve been more circumspect. I hadn’t realized until then that people can understand “psychosomatic” in a different way than I do. I’d meant what I still do, that the mind can affect the body. She thought psychosomatic was code for imaginary, as though I’d said it was all in her mind. And I suspect most of us believe that psychosomatic means crazy or hypochondriacal or flat-out faking.

I’m intrigued that that view persists, considering what we’ve learned about how the mind thoroughly informs the body. Ironically, most of us accept this to some degree even while we resent a P-word diagnosis. For example, was your last cold preceded by a period of intense stress? Beyond colds, do you believe stress can aid the development of heart disease and high blood pressure? Or let me ask you this: If you suffer low back pain, where do you predict it would hurt more — at your daughter’s wedding or at your IRS audit? And to ask this more generally, what illnesses are not created or influenced by choices we’ve made in our lifestyle?

It’s no longer touchy-feely to believe sickness can arise from emotions and attitudes, so it seems strange, even frankly scandalous that we doctors practice with only physical tools like chemicals, surgery, and radiation. We’re trained essentially as engineers to set physiology alright, but unequipped to address the inner worlds of our patients — to question their habits, elucidate their experiential history, or counsel them in the changes that would improve their health.

We docs are thus limited to apply technological fixes to our patients’ bodies and then return them to the same lifestyles — that is, the mind habits — in which their illness developed. Our training deficit isn’t part of a medical plot to deliberately half-treat patients. It only expresses the cultural assumption that body and mind are separate entities.

That assumption is decaying, leaving the word “psychosomatic” too misunderstood to be useful anymore. It’s time we phased it out. Instead of replacing it, though, why not adjust how we frame the whole issue? Once we see body and mind not as separate entities, but as head and tail of a single coin, we’ll practice medicine differently. Illness will no longer exist in a vacuum, but in the undeniable context of a unique life.

Jeff Kane is a physician and is the author of Healing Healthcare: How Doctors and Patients Can Heal Our Sick System.

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