Psychosomatic medicine: past and present. Part II. Current state.

The first historical phase of psychosomatic medicine was largely dominated by the psychoanalytic approach to research and theory. The current phase has shown a radical shift away from that approach. It has focused on the study of the physiological mechanisms mediating between psychological states and body functions in health and disease, and on the role of personally meaningful life events and psychophysiological responses to them in the etiology, course, and outcome of a wide range of physical illnesses. The concepts of psychosocial stress, psychophysiological response specificity, coping, adaptation, and social supports predominate in psychosomatic theory. Research has grown in scope, diversity, and methodological sophistication. Concurrently, clinical application and the psychosomatic approach to patient care has expanded in the form of consultation-liaison psychiatry and behavioural medicine. The author reviews the current state of the field in its scientific and clinical aspects, and offers definitions delineating its scope.