Who’s a “Psychosomaticist?”
October 7, 2009 2 Comments
Blog Post by James J. Amos, Staff Psychiatrist, Dean Medical Center, Madison, Wisconsin, USA
As co-editor of a forthcoming introductory handbook on Psychosomatic Medicine, I was trying to track down our contributors in order to send an e-mail update on progress in the production phase. I also wanted to invite them to submit an article to this blog site. I noticed that one of the contributors who’d been enrolled in a Psychosomatic Medicine fellowship is now identified as a “Psychosomaticist”. I’ve always been a little ambivalent about the name “Psychosomatic Medicine” anyway, but I have to admit I cringed when I saw one of our newer practitioners labeled a Psychosomaticist. I get the same feeling whenever I hear “somaticizer”. I’ll never forget what a presenter said about the term a few years ago at the annual meeting of the Academy of Psychosomatic Medicine (APM): “And by the way, it’s not ‘somaticizer’, it’s “somatizer”!” Is it?
Thomas Wise wrote about how the subspecialty got its name years ago. There was the obvious problem with calling it Consultation Liaison Psychiatry (C-L )—many internal medicine subspecialists could lay claim to the name “consultant”. Other labels just didn’t seem to fit either. The name Psychosomatic Medicine was not chosen by members of the subspecialty, but by the American Board of Medical Specialties. After I passed the first certification examination offered in 2005 and received my handsomely framed certificate, the beauty of the document somehow didn’t dispel my uneasiness about the name. I still think some patients would prefer not to be linked to physicians with the title because of the “it’s all in your head” connotations. How much greater is the objection to Psychosomaticist? I’m afraid the matter remains unstudied. How much closer does that bring us to hybrids like “psychosomaticism, psychosomaticize, psychosomaticizer” and the like?
Our identity crisis dogs us through the years and produces new names that tend to stick in our throats or twist our tongues. See Roger Kathol’s “Psychiatrists for the Physically Ill” (PPIs? I thought that meant Proton Pump Inhibitors?), recently replaced by “Psychiatrists for Medically Complex Patients” (PMCs). Our ambivalence about what we call ourselves may stem from our ambivalence about the mind-body dichotomy and the either/or thinking it fosters. And the English language itself is probably partly to blame.
I wonder if those who are fascinated by and choose to practice PM it may be prone to playing with and collecting ambivalences and ironies like marbles. We tend to be the ones called when colleagues call a patient who has a near death experience “manic”. Maybe that’s what trying to cram as much life into the time one may have left can resemble. We are also called to explain phenomena for which there is no good explanation, like factitious behavior, something which seems simultaneously about lying to doctors and lying to oneself—leading to conundrums such as the case report of the patient who lied about having Munchausen’s Syndrome (itself a lie perpetrated by psychiatrists). I suppose it’s too late to just call ourselves “doctors”.
James J. Amos is co-editor of Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry.