The institutional management of mind-body dualism: The battle over psychosomatic medicine.

This study examines the emergence and persistence of the American psychosomatic movement as represented by the journal Psychosomatic Medicine founded in 1939, and the American Society for Psychosomatic Research which was established three years later. It traces the history of the movement from 1938 through 1979. Inspired by psychoanalysis, the founders of psychosomatic medicine called into question the profound metaphysical distinction between the mind and the body which has shaped Western philosophy and epistemology from ancient to modern times. How psychosomatic medicine became marginalized and absorbed into the bio-medical dominant discourse is the subject of this study. Unlike most approaches to sociology of science, which emphasize the role of social factors in shaping epistemology and knowledge, this study focuses on the role of epistemology in forming institutional choices and organizational structures and practices. The arguments are based on quantitative and qualitative analysis of extensive primary sources, such as the minutes of the Editorial Board and the Council from 1938 through 1979, comments of referees on rejected and accepted papers, and correspondence between central figures of the movement and external medical authorities. The study explores the convoluted interplay between the movement's inability to transcend dualistic language and epistemology, and the institutional and organizational processes that led to its eventual marginalization and absorption within the jurisdiction of the medical profession. It shows how its failure to mark a distinct discursive territory and to form its own scientific identity beyond the division between psychiatry and somatic medicine--in itself an institutional manifestation of the mind-body split--led to the movement's fundamental institutional uncertainty. Espousing legitimate organizational forms and practices was necessary to keep the psychosomatic enterprise alive and within the jurisdiction of the medical profession. This institutional mimesis was necessary for gaining legitimacy, attaining organizational and economic stability, and providing a cultural ethos and rationale for the movement. At the same time it played a role in maintaining and perpetuating the dualistic epistemology that the founders sought to supersede. Paradoxically, Psychosomatic Medicine's failure to transcend the Cartesian split was the key to its success in surviving as a legitimate medical organization seeking to keep up with the environmental changes in the growing field of behavioral medicine, and to secure its position at the margin--in the psyche province of the medical profession.Ph.D.Health and Environmental SciencesMedicinePhysiological psychologyPsychologyScience historySocial SciencesSocial structureUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/131056/2/9825308.pd