Consultation-Liaison Psychiatry and Psychosomatic Medicine: Where Do We Go from Here?

Abstract

When this volume was planned, the title was Comparative Global Psychosomatic Medicine. As the book progressed, it became clear that there was a line of cleavage between psychosomatic medicine and consultation-liaison psychiatry. Consultation-liaison psychiatry emphasizes the role of psychiatry in general medical settings and psychiatric co-morbidities in patients with medical diseases rather than psychogenesis of medical diseases. The scope of consultation-liaison psychiatry is far broader than “conversion” or “somatization” as it includes the diagnosis and treatment of all psychiatric disorders co-morbid with medical/surgical disorders as well as of illness behavior, coping with and adaptation to disease, death, rehabilitation, and recovery. Thus, consultation-liaison psychiatry is defined largely by the location (general hospital and medical clinics) rather than by diagnoses. Consultation-liaison Psychiatry is widely accepted and vibrant in the English-speaking countries including UK, Australia, South Africa, Canada and the United States. In indigenous populations, there is significant utilization of traditional CAM practices which may or may not be used in conjunction with modern medicine. Psychosomatic Medicine, rather than Consultation-liaison Psychiatry, seems dominant in continental Europe, especially in Germany and France. In Germany, the law requires the teaching of psychosomatic medicine and the PSM Departments seem to have a psychodynamic orientation while the parallel psychiatry departments are more biologically oriented. Balint Groups seem to be widely accepted in Europe, they are almost non-existent in the United States. This chapter also summarizes the incorporation of traditional healing ideas with Western medicine in Asia and Africa. Placebo may be seen as an ingestion of a symbol- an information (meme) infusion. The old distinction between psyche and soma has become meaningless- what remains is information. In this digital age, homo sapiens may be on the cusp of a revolutionary change in its relationship with information. With internet and smart phones which may evolve into smart implanted chips, we may be able to download any information automatically, and even upgrade our brain. There should therefore be a convergence of medicine, psychiatry, psychosomatic medicine, psychology, and all neurosciences, as well as all humanities including all social sciences and arts – a unified information base. Perhaps all -ologies and -iatries and -isms will converge into philosophy.