Psychosomatic medicine and consultation-liaison psychiatry in Hungary

Abstract

Psychosomatic medicine (PM) has a strong tradition inHungary—several leading figures of psychoanalysis wereof Hungarian descent. Franz Alexander (1891–1964) whowas a Hungarian-American psychoanalyst is consideredone of the founders of psychosomatic medicine. SandorFerenczi (1973–1933) was a close associate of Freud andhas been one of the founders of the “Budapest School ofPsychoanalysis.” Hans Selye (1907–1982) was alsoHungarian, born in Vienna in the Austro-HungarianMonarchy, and is perhaps best known for the generaladaptation syndrome and stress theory. His work isconsidered a central element of the theoretical foundationsof PM. Michael Balint (1896–1970) developed a group-model for family physicians based on psychoanalytictraditions in the 1950s, which has spread worldwide.In Hungary, a strong stream of psychosomatic researchfocused on psychophysiology (E. Grastyan, P. Molnar, M.S. Kopp), which is considered by many as the basic scienceof PM. Over the last decades, there has also been a strongemphasis on epidemiological research, studies on theeffects of chronic stress as well as on behavioralinterventions dealing with stress. We have to mentionhere large-scale population-based epidemiologic studiesfocusing on mental health issues and health behavior (M.S.Kopp, E. Szadoczky).After the political changes in Hungary in 1989, the 4medical schools in the country (Budapest, Szeged, Pecs,Debrecen) adapted the American model, and departmentsof behavioral sciences were established. According to thismodel, subjects relevant to the bio-psycho-social model ofmedicine are taught over several years in the graduatecurriculum. These areas include medical communication,medical sociology, medical anthropology, medical psychol-ogy, psychosomatic/behavioral medicine, and bioethics.Included also in the graduate curriculum at most uni-versities is the participation of medical students in “juniorBalint-groups.”The institutes/departments of behavioral sciences teachboth graduate and postgraduate courses as well as host PhDprograms. The largest in the country is the Institute ofBehavioral Sciences at the Semmelweis University Buda-pest (www.behsci.sote.hu), founded by Maria S. Kopp in1993. This department plays an important role in the areaof PM and Behavioral Sciences in Central and EasternEurope. The institute has published several textbooks forthe subdisciplines of these areas and has maintained a widerange of active international research and teachingcollaborations [1–5]. The institute also hosts severalprofessional societies and foundations in the area ofpsychophysiology and behavioral sciences, including theSelye Society (www.selyesociety.hu).These strong psychosomatic traditions have an importantimpact on many current activities in Consultation-LiaisonPsychiatry (CLP) in Hungary. Although CLP is an importantcomponent of the clinical workload of many colleagues whowork in general hospital psychiatric wards, the Hungarianliterature on CLP has been very scarce until recently. Thefirst review in the field was published by Furedi andMoussong-Kovacs [6], and subsequently textbook chaptersand original papers addressed practical [7] and researchtopics [8,9]. The most extensive study in CLP has beencarried out by Vincze et al. [10] in several hospital wardsacrossthecountrypointingoutthehighprevalenceofmentalhealth issues in the medically ill.