We Need a Theory of Psychosomatic Medicine.

Michael Schwartz, M.D.
Case Western Reserve University

Do we need a theory of psychosomatics? Modern psychosomatic medicine was reborn as an elaboration of psychoanalytic theory. Nowadays, theoretical assumptions have been replaced by an empirical, “evidence based,” atheoretical stance. Science requires theory. One cannot reason about a subject without taking a point of view. We assert that psyche and soma never constitute a whole apart from their surrounding world. The overarching unity of life is a unity of mind and body AND world. Living things are always involved in a relationship with that which is not themselves. This world-relatedness of living creatures always takes on a characteristic form: 1. An “inside” and an “outside.” 2. A semi-permeable barrier separating inside and outside. 3. Active processes bring parts of the surrounding world into the living creature (anabolism). 4. Active processes extrude parts of the living creature into the world (catabolism). We conclude that metabolism – anabolism/catabolism -- is an essential feature of life. All life finds itself in a relationship with that which is not itself, a relationship characterized by polarities: dependence/independence; world-relatedness/self-enclosure; being/non-being; and transcendence/deterioration. The author will go on to situate mind/body within the overall framework of this phenomenology of life, a framework which can also guide practice.