Holistic approach to diagnosis in psychosomatic dermatology

Abstract

Three decades ago, two psychosomatic skin clinics were established by this author—one at the Hadassah University Hospital (1955) in Jerusalem, Israel, and one at the Cincinnati General Hospital (1957) in the United States, with the close cooperation and assistance of their Department of Dermatology (headed by Dr. Leon Goldman) and the Department of Psychiatry (headed by Dr. Maurice Levine and Dr. W. Donald Ross.) Postgraduate dermatologists, residents, medical students, and nurses were trained in the close relationship and possible interaction of organic and emotional factors in certain dermatoses. The teaching was conducted by the author, a dermatologist trained in psychiatry and psychosomatic dermatology. A psychiatrist was only occasionally consulted in specifically psychiatric cases. The aim was to enable the dermatologist to gain sufficient knowledge and experience in psychosomatic dermatology that he could directly handle his own patients by a holistic approach. Thus, this method was on a one-to-one (dermatologist-patient) basis, as opposed to the conventional two-to-one (dermatologist-psychiatrist-patient) relationship. This led to interesting seminar sessions with the residents, as well as special conferences with the hospital patients, and case presentations. Long experience in teaching convinced us that the greatest difficulty of postgraduate and resident dermatologists was in making the correct diagnosis of psychosomatic dermatosis. The aim of this paper is to guide the dermatologist in achieving this goal. To be able to make a proper diagnosis of psychosomatic skin disorder, the dermatologist must free himself of some misconceptions relating to the term “psychosomatic.”