The earliest attempts in the United States to integrate psychiatry and medicine may be traced to the efforts of Benjamin Rush (1745-1813) at the Pennsylvania Hospital ( Lipowski, 1996). Amid all the "mind-body" controversies still brewing today, it is enlightening to recall Rush's words, in 1811 (cited in Lipowski, 1996):
Man is said to be a compound of soul and body. However proper this language may be in religion, it is not so in medicine. [Man] is, in the eye of a physician, a single and indivisible being.
The term psychosomatic was first used by the German physician Johann Christian Heinroth in 1818, when discussing causes of insomnia, and the term psychosomatic medicine is thought to have been introduced by Felix Deutsch, M.D., around 1922 ( Gitlin et al., 2004). As Lipsitt (2000) has pointed out, the roots of psychosomatic medicine in the United States "were distinctly psychoanalytic and psychodynamic" as a number of Sigmund Freud's students began to apply their theories to a variety of physical disorders. (Freud himself always maintained the hope that biological and psychological concepts would someday be integrated.)
The 1920s also saw the emergence of general hospital psychiatric units in the United States, such as the one at Henry Ford Hospital in Detroit. Indeed, the origins of C-L psychiatry can be seen in precisely this convergence of psychosomatic medicine and the general hospital psychiatric unit (Lipowski, 1996). The field was moved forward in the 1930s, with the founding of the journal Psychosomatic Medicine by Helen Flanders Dunbar, M.D., Ph.D. By the 1950s, C-L units were found in many U.S. hospitals. The 1960s saw the emergence of some outpatient psychiatric clinics that included social workers and psychologists on the treatment team; for example, the Integration Clinic founded by Don Lipsitt, M.D., at Beth Israel Hospital in Boston (Lipsitt D, personal communication, March 2005).
One of the leaders in the field, Donald S. Kornfeld, M.D., has summarized the numerous contributions of C-L psychiatry to the practice of medicine over the past 50 years (Kornfeld, 2002). Among many others, Kornfeld pointed to the areas of C-L research in the Table. Kornfeld also noted the immense contributions of the biopsychosocial model of George Engel, M.D., to the overall humanization of patient management.
As Gitlin et al. (2004) noted, the growth of C-L and psychosomatic medicine organizations and programs has been dramatic in the past 50 years. As of 2001, there were 32 C-L fellowship programs registered with the APM and 48 combined residencies (e.g., psychiatry combined with internal medicine, family practice, pediatrics or neurology). This trend in residency training points to the increasing integration of psychiatry with primary care medicine.
Within the past few years, the name of the field was changed from C-L psychiatry to psychosomatic medicine for a variety of reasons and after extensive discussion within the APM, APA and ABPN.
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