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CHAPTER TWO Swings of the Historical Pendulum Patient: “The heart is on the left and the liver on the right.” Doctor: “Yes, that was so in the old days. But we have changed all that.” —Molière, Le medecin malgré lui “Until the mid-nineteenth century, . . . , all medicine was necessarily and ubiquitously ‘psychosomatic,’” the eminent medical historian Charles Rosenberg asserts in his incisive article “Mind and Body in Nineteenth -Century Medicine” (77). “Every clinician,” he goes on, “had to be something of a psychiatrist and family therapist” (78). So the necessity for a comprehensive view that Barbour learns with his perplexing patients and that Engel posits in his biopsychosocial model was intrinsic to medicine up to the mid-nineteenth century. The holistic mode was so much a matter of course that “there was no need for a special term to describe the unquestioned common sense of perceived experience.”1 Nor was there much need for the word “psychosomatic” because the style of medicine it denotes was the norm. Rosenberg’s statements raise two major questions that will be addressed in this chapter: Why was medicine “necessarily” psychosomatic until the mid-nineteenth century? And what happened at that period to eclipse the system of beliefs and practices that had up to that point supported this approach? A brief look at the history of medicine reveals the swings of the pendulum from holistic to somatic, and then at least some way back again. The movements of this pendulum were not regular; for centuries it was almost stationary, then it moved conspicuously from one pole to the other and then gradually returned part of the way, at least among some practitioners. 19 ❖ ❖ ❖ Medicine was “necessarily” psychosomatic from classical antiquity into the nineteenth century because its cornerstone from the time of Galen, a Greek physician born in A.D. 130, was the theory of the four “humors.” The universe was recognized as consisting of four elements: earth, air, water, and fire. These were thought to correspond in the human body to cold, dry, moist, and hot humors. Good health was believed to result from the proper balance of the humors; when one or another got the upper hand, the appropriate corrective was to resort to its opposite, applying heat to cold areas and vice versa, and treating dryness and moisture as parallel counteragents. Very important, this doctrine extended too to the individual ’s psychological profile, for each person was held to be endowed with a preponderance of one humor or another, resulting in a sanguine, phlegmatic , choleric, or melancholic temperament respectively. The first step toward remediating a humoral imbalance was to establish the patient’s distinctive humor. Then the chosen therapy was tailored to fit the particular patient in light of his or her dominant humor, age, and situation, that is, the time of year, the climate, the location, and so on. Two patients with identical symptoms might be given quite divergent treatments because of the perceived differences in their circumstances. Thus the outcome of humoral medicine was patient-specific treatment whose primary aim was to restore the individual’s natural homeostasis. This form of therapeutics rested on a close and extensive familiarity with the whole person on the physician’s part in order to achieve an encompassing cure. Attention had to be paid to the emotions as an essential facet of the patient’s temperament likely to determine the outcome. In other words, psyche and soma were not regarded as distinct entities. Clinical observation confirmed the supposition of the reciprocal interaction between mind and body: “The fact that bodily diseases and symptoms are profoundly influenced by mental processes, often partially caused by them, was well known to all great clinicians from Galen to Charcot.”2 Accordingly, medicine was holistic and empirical, drawing on experience to buttress humoral theory. The danger to the entire organism of uncontrolled feelings was a basic tenet of humoral medicine: “[E]motions out of balance meant physiological function out of balance.”3 So “psychogenesis, or ‘passion -produced disease,’ as Galen called it, was discussed abundantly until the nineteenth century.”4 This view marks the full swing of the pendulum toward the total integration of mind and body. By and large it maintained its ascendancy until the nineteenth century, making medicine “ubiquitously ‘psychosomatic,’” as Rosenberg puts it, and “necessarily” so, partly for lack of detailed knowledge of the workings of mind or body that would challenge the speculative 20 Swings of the Historical Pendulum [3.149.251.155] Project MUSE...

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