Psychosomatic psychiatry: A Spanish proposal for a new dimension

Psychosomatic Medicine has undergone important evolutionary changes throughout its history, from its flowering in the 20th century up to the present. Two important reasons have determined this evolution. The first one has to do with the movement out of the focus in illnesses such as the “holy seven,” illnesses with histological lesions once believed to have a psychogenic origin [1]. The knowledge about biological, ethiopathogenic mechanisms involved and effective treatment in these illnesses has improved considerably; on the contrary, psychogenic theories have been criticized on the basis of insufficient evidence. The second reason is the increasing demand for psychiatry to care for mental disorders in medical patients.

Psychiatric disturbances are common in medical patients. On the other hand, the sharp increase in all aspects of medical practice, including prevention, diagnosis, and treatment, has generalized health care. Diagnostic and therapeutic techniques have dramatically improved life expectancy, and present-day prospects for recovery from illness would have been considered to be fantastic only a few years ago. However, extreme situations arise as a result of the new developments and the ethical problems they give rise to, which constantly threaten the psychological balance of the individual. The probability of needing psychiatric help when suffering somatic illnesses has increased significantly. A conservative estimate by the European Consultation-Liaison Workgroup for General Hospital Psychiatric and Psychosomatics [2] considers that approximately 10% of the patients admitted to a general hospital require consultation with a psychiatrist.

Liaison psychiatry is to a good extent the answer from psychiatry to meet doctors' demands. It is concerned with psychopathological problems in medical patients, organic mental disorders, and comorbidity; psychopathologies with serious somatic repercussions; adjustment disorders; triggered psychopathologies; and somatizations. Furthermore, among its objectives are the study of the doctor–patient relationship, its difficulties, and its repercussions on the illness and its evolution. Liaison psychiatry has become a demanding practice, which has forced the specialists to train extensively within the fields of general psychiatry, medicine, and psychotherapy.

In recognition of the interest of the discipline, the American Board of Medical Specialists has recently approved this newest psychiatric subspecialty, with the name Psychosomatic Medicine [3]. However, this denomination has stirred controversies [4], and many nonpsychiatrists state that they also practice “psychosomatic medicine” because “all medicine should be psychosomatic” [5]. The question of the name for the discipline is not unimportant. Throughout the years, various denominations have been used, including Behavioral Medicine, Psychological Medicine, General Hospital Psychiatry, Medical-Surgical Psychiatry, and Psychiatry of Primary Care, each one emphasizing different aspects of its orientation.

The present denomination in Spain is Liaison Psychiatry. Although this discipline has not yet a recognition as a subspecialty, it is official in some clinical programs in the National Health System, in the teaching program of the National Commission for the Specialty of Psychiatry, and in the National Research Network of the Instituto de Salud Carlos III. After much debate with our colleagues throughout the last few years, we have argued in favor of the denomination Psychosomatic Psychiatry for the discipline [6]. A reappraisal of the bases for this proposal may be summarized as follows:

Therefore, we maintain the proposal to name this subspecialty Psychosomatic Psychiatry. It has the advantage of accurately indicating the field we refer to, a psychiatric theory and practice covering mind and body, in the intersection with medicine.