The development of psychosomatic medicine during the past 25 years.

The past 25 yrs has seen the evolution from concepts based on specificity of stimulus, mediating pathway and target organ response to concepts embodying the multifactorical nature of psychosomatic disorders in which various combinations of causal factors operate within a particular disorder which is therefore heterogeneous rather than homogeneous. The recognition of the importance of social and psychological factors in all varieties of illness attests not only the psychosomatic unity of the organism, but a dynamic continuum of organism--environmental interaction. Many illnesses involve not only psychosomatic sequence of events in their productions but also somato-psychic sequences as well, sometimes resulting in a vicious circle. The wider recognition of the role of social and psychological factors in all illness has led to the remarkable expansion of consultation and liaison psychiatry in all branches of medicine and surgery. Further notable developments are the more precise and appropriate application of various forms of individual and group psychotherapy and therapies based on learning theories such as behaviour therapy, biofeedback and various relaxation techniques. We may conclude by hoping that further advances may be expected with the application of rigorous scientific methodology especially in longitudinal studies of random and representative samples of the disorder and the general population in which genetic and constitutional factors, neurophysiological, biochemical, endocrinological and other intrinsic changes interact with a variety of social and environmental factors in the multifactorial aetiology of disease.