Major trends in psychosomatic medicine. The psychiatrist's evolving role in medicine.

Three developmental lines are identifiable in psychosomatic medicine: (1) psychodynamic investigations, (2) psychophysiologic and psychosocial research, and (3) consultation-liaison psychiatry. Although psychodynamic understanding of medical patients remains important, "psychogenesis" is no longer the principal concern of psychosomatic medicine, which has shifted emphasis to a holistic understanding that includes the biologic, psychologic, and social systems of medical and psychiatric patients. Recent investigations along the second line indicate that all medical and psychiatric illnesses can be regarded as "psychosomatic," in that comprehensive understanding and care cannot be achieved without considering the three interrelated systems. Consultation-liaison psychiatry is the practice of this holistic approach in the general hospital. The essential role of the consultation-liaison psychiatrist as a bridge between the biologic and behavioral disciplines may become a major part of the role of the general psychiatrist in the future.