Psyche, soma, and society: the social construction of psychosomatic disorders

Culture, Medicine, and Psychiatry - Tập 9 - Trang 1-26 - 1985
Cecil G. Helman1
1Dept. of Anthropology University College, University of London, London, UK

Tóm tắt

This pilot-study examines the self-perceptions, and explanatory models, of 42 patients with either respiratory or gastrointestinal psychosomatic disorders. For several reasons, these disorders comprise an anomalous category within the biomedical model. It is suggested that clinicians explain their chronic, unpredictable course by ‘psychologization’ - — shifting responsibility for etiology, exacerbations or therapeutic failure to patients’ emotions, personality, or lifestyle. Evidence is presented that psychologization is socially constructed, in clinical encounters over time. Patients respond to this process by reifying pathogenic emotions, personality traits, or malfunctioning body parts, and thus separating them from an idealized concept of the social self. It is also suggested that patients with gastrointestinal or respiratory conditions differ in their self-perceptions and explanatory models: a proportion of patients in each group organize their experiences around a central natural symbol — respiration or digestion/excretion. These 2 images link physiological experiences to concepts of pathogenic emotions or personality, physical weakness, and types of social relationships.

Tài liệu tham khảo

Alexander, F., French, T. M., and G. H. Pollock (eds.) 1968 Psychosomatic Specificity. Vol. 1. Chicago: University of Chicago Press.

Barsky, A. J. and G. L. Klerman 1983 Overview: Hypochondriasis, Bodily Complaints, and Somatic Styles. American Journal of Psychiatry 40: 273–283.

Bauer, J. 1942 Constitution and Disease. New York: Grune and Stratton.

Cassell, E. J. 1976 The Healer's Art: A New Approach to the Doctor-Patient Relationship. New York: Lippincott.

Cassell, E. J. 1976 Disease as an “It”: Concepts of Disease Revealed by Patients presentation of Symptoms. Social Science and Medicine 10: 143–146.

Cheren, S. and P. H. Knapp 1980 Gastrointestinal Disorders. In M. I. Kaplan, A. M. Freedman and B. J. Sadock (eds.), Comprehensive Textbook of Psychiatry, Vol. 2. Third Edition; Baltimore: Williams and Wilkins, pp. 1862–1972.

Douglas, M. 1973 Natural Symbols. Harmondsworth: Penguin Books, pp. 93–112.

Drossman, D. A., Powell, D. W., and J. Y. Sessions 1977 The Irritable Bowel Syndrome. Gastroenterology 73(4): 811–822.

Dunbar, F. 1948 Introduction. In F. Dunbar(ed.), Synopsis of Psychosomatic Diagnosis and Treatment. St. Louis: C. V. Mosby and Company, pp. 13–27.

Eisenberg, L. 1977 Disease and Illness: Distinctions between Professional and Popular Ideas of Sickness. Culture, Medicine and Psychiatry 1: 9–23.

Engel, G. L. 1960 A Unified Concept of Health and Disease. Perspectives on Biology and Medicine 3: 459–485.

Engel, G. L. 1967 The Concept of Psychosomatic Disorder. Journal of Psychosomatic Research 11: 3–9.

Engel, G. L. 1975 Psychological Aspects of Gastrointestinal Dusorders. In M. F. Reiser (ed.) American Handbook of Psychiatry, Vol. 4, 2nd Edition; New York: Basic Books, pp. 653–692.

Engel, G. L. 1977 The Need for a New Medical Model: A Challenge for Biomedicine. Science 196: 129–136.

Fisher, S. 1968 Body Image. In Polhemus, T. (ed.), Social Aspects of the Human Body; Harmondsworth: Penguin, pp. 154–173.

Freud, S. and J. Breuer 1966 Studies on Hysteria. Trans. J. Strachey. New York: Avon.

Gildea, E. F. 1968 Special Features of Personality which are Common to Certain Psychosomatic Disorders. Psychosomatic Medicine 11: 273–281.

Good B. J. 1977 The Heart of What's the Matter: The Semantics of Illness in Iran. Culture, Medicine and Psychiatry 1: 25–58.

Good, B. J. and M-J. D. V. Good 1981 The Semantics of Medical Discourse. In Mendelsohn, E. and Y. Elkana (eds.), Sociology of the Sciences. Vol 5; Dordrecht: D. Reidel Publ., Co.

Grace, W. J. and D. T. Graham 1952 Relationship of Specific Attitudes and Emotions to Certain Bodily Diseases. Psychosomatic Medicine 14 (4): 243–251.

Graham, D. T. et al. 1962 Specific Attitudes in Initial Interviews with Patients Having Different ‘Psychosomatic’ Diseases. Psychosomatic Medicine 24: 257–266.

Groen, J. 1948 Psychogenesis and Psychotherapy of Ulcerative Colitis. In Dunbar, F. (ed.), Synopsis of Psychosomatic Diagnosis and Treatment; St. Louis: C. V. Mosby and Company, pp. 108–114.

Hendrick, I. 1948 Homeostasis. In Dunbar, F. (ed.), Synopsis of Psychosomatic Diagnosis and Treatment; St. Louis: C. V. Mosby and Company, pp. 55–56.

Houck, C. 1983 Anxiety Attacks That Trigger Terror. Woman's Day. 13 September; 30–35.

Karush, A. et al. 1977 Psychotherapy in Ulcerative Colitis. Philadelphia: W. B. Saunders.

Katon, W., Kleinman, A., and G. Rosen 1982 Depression and Somatization: A review. American Journal of Medicine 72: 241–247.

Kleinman, A., Eisenberg, L., and B. Good 1978 Culture, Illness and Care: Clinical Lessons from Anthropologic and Cross-Cultural Research. Annals of Internal Medicine 88: 251–258.

Kleinman, A. 1980 Patients and Healers in the Context of Culture. Berkeley: University of California Press.

Knapp, P. H. 1975 Psychosomatic Aspects of Bronchial Asthma. In M. F. Reiser (ed.), American Handbook of Psychiatry, Vol. 4, 2nd Edition; New York: Basic Books, pp. 693–707.

Knapp, P. H. 1980 Current Theoretical Concepts in Psychosomatic Medicine. In H. I. Kaplan, A. M. Freedman, and B. J. Sadock (eds.), Comprehensive Textbook of Psychiatry, Vol. 2, 3rd Edition; Baltimore: Williams and Wilkins, pp. 1853–1862.

Leff, J. 1981 Psychiatry Around the Globle: A Transcultural View. New York: Marcel Dekker, pp. 42–53.

Lipowski, Z. J. 1968 Review of Consultation Psychiatry and Psychosomatic Medicine. Psychosomatic Medicine 11: 273–281.

Littlewood, R. 1984 The Individual Articulation of Shared Symbols. Journal of Operational Psychiatry (in press).

Mechanic, D. 1972 Social Psychologic Factors Affecting the Presentation of Bodily Complaints. New England Journal of Medicine 286: 1132–1139.

Minuchin, S., Rosman, B. L., and L. Baker 1978 Psychosomatic Families. Cambridge: Harvard University Press.

Myers, F. R. 1979 Emotions and the Self: A Theory of Personhood and Political Order among Pintupi Aborigines. Ethos 7: 342–370.

Riesman, P. 1983 On the Irrelevance of Child Rearing Practices for the Formation of Personality. Culture, Medicine and Psychiatry 7: 103–129.

Sontag, L. W. 1948 Determinants of Predisposition to Psychosomatic Dysfunction and Disease: Problem of Proneness to Psychosomatic Disorder. In F. Dunbar (ed.), Synopsis of Psychosomatic Diagnosis and Treatment; St. Louis: C. V. Mosby and Company, pp. 38–66.

Svedlund, J. et al. 1983 Controlled Study of Psychotherapy in Irritable Bowel Syndrome. Lancet 2 (8350): 589–592.

Taussig, M. T. 1980 Reification and the Consciousness of the Patient. Social Science and Medicine 14B: 3–13.

Vaillant, G. E. 1978 Natural History of Male Psychological Health: What Kinds of Men Do Not Get Psychosomatic Illness. Psychosomatic Medicine 40: 420–431.

Weiss, E. and O. S. English 1942 Psychosomatic Medicine. Philadelphia: W. B. Saunders; pp. 10–11.

Wright, J. H. and A. T. Beck 1983 Cognitive Therapy of Depression: Theory and Practice. Hospital and Community Psychiatry 34 (12): 1119–1127.

Thông tin
Thông tin xuất bản

Culture, Medicine, and Psychiatry

Tập 9

1-26

Thông tin tác giả