Psychological factors in dental disorders: a comprehensive approach

Abstract

The modern dentist is doubtless familiar with the term psychosomatic in the dis­ cipline of medicine. Essentially it refers to the psychogenic basis of many physical disorders. The term as such is recent, and is in part a reaction to the somatopsychic approach to medicine which for two cen­ turies has underscored the psychological effects of bodily disorders. Thus, pain, discomfort and physical illness were seen to cause irritability, unhappiness, anxiety and other dysphoric feelings. There is abundant evidence, however, that the situation may be the reverse. Feelings, motives, and attitudes— of which the in­ dividual may or may not be aware— can and do cause drastic changes in body structure and body function. It is not unusual to hear pediatricians, gynecolo­ gists, internists and skin specialists talk like psychologists and psychiatrists. Since the terms psychosomatic and somatopsychic suggest an artificial duality between mind and body, in which the one has an apparently irreversible effect on the other, their use is unfortunate. In reality the emphasis should be on the behavior of the whole person. The em­ phasis should be on the interaction, the interrelation, the covariation of the two elements of these terms, so that the pri­ macy of one over the other ceases to exist except in terms of the professional predi­ lections of a particular scientific dis­ cipline. What each discipline chooses to study, to understand and control, or to treat is only a facet of a multi-faceted whole person. Naturally, because dentists are fre­ quently more human than scientist, they tend to behave as if that facet which falls within their professional purview is the most important, or even the only one. The inadequacy of such a professional attitude has already been recognized by some circles of the medical profession. The term medical psychology is becoming more fashionable these days than psycho­ somatic medicine, and it is intended to be broader and to include a wider variety of interactions. This term is not much improvement over the older one, however, because it retains the suggestion of duality, and neglects the contributions of such other disciplines as anthropology, sociology and guidance. A more recent term, comprehensive medicine, has been suggested.1 This term seems more in keeping with the current vogue in medical thinking, with the basic premise o f a multifaceted whole person, and with research evidence bearing on the interaction of mental, social and physiological processes in causing illness.