Psychosomatic sensibility

“As the seventies unfolded, however, the ground under [George] Engel began to shift. . . Most significantly, psychiatry and internal medicine underwent dizzying and dramatic shifts. In psychiatry, the seventies were marked by the rapid decline of psychoanalysis, the rise of the neurosciences, and the general advance of an aggressive new ‘biological psychiatry.’ . . . Departments of medicine felt themselves reeling in ‘future shock’ as they struggled with unsettling changes in size, subspecialty fragmentation, geographic dispersion, and administrative balkanization. Tied up with these changes were further transformations: the displacement of physician-investigators by Ph.D.-trained biomedical scientists, the refocusing of research from human subjects and disease processes to ‘basic’ and increasingly molecular events, the alteration of study designs from selected patient cases to biostatistically rigorous clinical trials” (T. Brown II, 28). . . . Engel was also denied the opportunity to retreat to the ‘safe haven’ of psychosomatic medicine, because that field, took was undergoing disconcerting changes. From Engel’s point of view, the problems of psychosomatic research – already evident in the sixties – deepened in the seventies as animal ‘models,’ ‘stress’ studies, and psychoendocrine bench research took over a larger and larger portion of the field and tended to displace earlier, psychoanalytically grounded clinical studies” (29). In 1979, Engel stepped down from leadership of Rochester Liaison program which “had been a bridge connecting dynamic psychiatry to patient-centered internal medicine via extensive teaching and respected research. Now both fields pulled apart in their own, rapidly changing directions, and Engel was left without the scientific research legitimacy that had been crucial to his mainstream success. What primarily remained was teaching and the attempt to assure succession” (31-32).