Review of Consultation Psychiatry and Psychosomatic Medicine

The meaning and scope of psychosomatic medicine are defined in both their scientific and applied aspects. The semantic and conceptual ambiguities in which this field abounds are pointed out and an attempt at their attenuation is made. Some key theoretical concepts and current explanatory hypotheses in the field of psychosomatics are critically reviewed. The multifaceted concept of psycho-logical stress is seen as the main unifying construct in current psychosomatic theory. A trend away from preoccupation with specific psychogenesis of "psycho-somatic " disorders is noted. Recognition of the complexity of the psycho-socio-biological processes determining health and disease has displaced earlier reduc-tionist psychogenic hypotheses derived mainly from psychoanalytic theory. I N THE FIRST TWO PARTS of this Re-view75'78 an attempt was made to define the scope and functions of psychiatric consultative activity in the nonpsychi-atric divisions of general hospitals. Part I dealt primarily with the various aspects of psychiatric consultations in this type of setting. Part II included a critical sur-vey of the studies of psychiatric mor-bidity among medical and surgical pa-tients as well as an overview of psycho-logical problems encountered by the consultants. One of the main purposes of Parts I and II was to emphasize (1) the wealth and diversity of the clinical material accessible to psychiatric stud