1st Edition

Pathologies of the Mind/Body Interface Exploring the Curious Domain of the Psychosomatic Disorders

By Richard L. Kradin Copyright 2013
    192 Pages 28 B/W Illustrations
    by Routledge

    186 Pages 28 B/W Illustrations
    by Routledge

    Patients suffering from psychosomatic disorders represent a formidable challenge. Psychosomatic disorders are common, and account for substantial personal discomfort, unnecessary medical expenditures, socioeconomic loss, and disability. They are challenging to diagnose, treat, and are rarely completely cured. Furthermore, they often provoke strong negative reactions from family, friends, and caregivers, who are unable to fathom their inconsistencies. Currently, little is known as to how they develop or why their symptoms tend to transform over time. In Pathologies of the Mind/Body Interface, Richard Kradin, a medical internist, pulmonologist, and psychoanalyst at a large Harvard hospital, examines the historical, philosophical, cultural, psychological, and neurobiological factors that contribute to the development of psychosomatic disorders. He focuses on the role that developmental stress and attachment disorders appear to play in increasing the risk of developing psychosomatic symptoms, and advises medical practitioners and psychologists on how to diagnose and treat them. Dr. Kradin suggests areas of importance for future medical and psychological research into the causes and treatments of these debilitating disorders.

    Chapter One, The Body in Transition: Introduces the mind/body problem and reviews its historical roots in both the West and East. Changing concepts of the body are traced from Near Eastern religions, through Greco-Roman times, noting the importance of Platonic/Aristotelian influences, Cartesian philosophy and culminating in post-enlightenment perspectives.

    Chapter Two, Causes of Disease: Explores how both mental and somatic diseases are conceived. It addresses the historical importance of religion and how such notions continue to contribute to the pathogenesis of psychosomatic disorders.

    Chapter Three, The Curious History of Mind/Body Disorders: Traces the specific history of psychosomatic disorders from biblical accounts through the hysteria and neurasthenia of the 19th century. The transformation of psychosomatic complaints and the changing nature of their prevalence is explained.

    Chapter Four, The Re-Emergence of Medical Psychiatry: The uneasy position that psychiatry occupies within the medical sciences is examined. Its roots in notions of neurological degeneracy are contrasted with advance of psychoanalytical dominance.

    Chapter Five, Current Concepts of the Somatoform Disorders: Explores the current classification of the somatoform disorders as outlined in DSM-IV. Clinical and demographic features are considered together with possible mechanisms of their development.

    Chapter Six, Novel Manifestations of Mind/Body Disorders: Examines new candidates for psychosomatic disorders and explores why these disorders have supplanted diseases like hysteria.

    Chapter Seven, Working with Immagination: The imaginal underpinnings of the psychometric disorders are considered from a cognitive-behavioral and psychoanalytical perspective. Dreams and other forms of imagery produced by patients with these disorders are considered as a mode of understanding their psychological bases.

    Chapter Eight, Working with the Body: Explores behavioral and physical interventions that can be of benefit in these disorders.

    Chapter Nine, Healing the Mind/Body Split: Explores how mind/body approaches can best be integrated in treatment. It challenges the idea of multiple team approaches and formulates the critical importance of treatment integration.

    Chapter Ten, Where Do We Go From Here?: Explores how best to reframe the idea of the psychosomatic dysfunction in an age of neuroscience. It considers the upcoming DSM-V classification, the role of primary care, medication, and how best to reconfigure the current thinking and approach to these disorders.


    Richard L. Kradin, MD, is a practicing Pulmonologist and Psychoanalyst at Massachusetts General Hospital (MGH), and Associate Professor of both Medicine and Pathology at Harvard Medical School. He is Director of the Dyspnea Clinic at MGH, and also past Research Director of the Mind/Body Medical Institute in Boston, MA. He is the author of The Placebo Response and the Power of Unconscious Healing (Routledge 2008), and of approximately 200 articles in medical literature. His research interests include psychological aspects of pulmonary disease, chronic fatigue syndrome, and the role of early attachment disturbances in the development of psychosomatic symptoms and placebo responses.

    “Kradin’s unique perspective, as both a researching physician and a psychoanalyst, reminds one of the compassionate and courageous Freud, trusting the symptoms, even the psychosomatic ones, to lead us to a necessary understanding of the patient.” - Joseph Coppin PhD, Chair, Department of Depth Psychology, Pacifica Graduate Institute, California

    “This is a highly readable and multi-dimensional review of an important cluster of human conditions encountered in medical practice that account for much human suffering and societal expense. In this exceptional new book Dr. Kradin, a medical scientist and psychoanalyst, provides us with pragmatic and insightful counsel.” - Gregory Fricchione, MD, Associate Chief of Psychiatry; Director, Benson Henry Institute for Mind Body Medicine at MGH; Director, Division of Psychiatry and Medicine, Massachusetts General Hospital; Professor of Psychiatry, Harvard Medical School

    “A wonderful, wise, clear overview of where we are in understanding psychosomatic conditions. Dr. Kradin is one of the best qualified people to explore this important subject. He integrates the latest findings in neuroscience, attachment literature, psychoanalysis, the placebo effect, and internal medicine to help explain psychosomatics. This is a marvelous place to begin one's quest to understand psychosomatic illness, and mind-body medicine.”Norman Doidge MD, FRCPC, author of The Brain That Changes Itself

    “Dr. Kradin provides a very thorough overview of the historical thinking behind psychosomatic disorders, the complex developmental and psychosocial backgrounds of these patients, and the importance of a nuanced understanding of such individuals.  Most importantly, he provides concrete and compassionate guidance for clinicians seeking to work more effectively with these challenging patients.”Greg J. Lamberty, PhD, LP, ABPP, Rehabilitation Psychology Supervisor, TBI Model Systems Site Project Director, Clinical Neuropsychology Postdoctoral Residency Director, Minneapolis VA Health Care System

    "This is a thorough yet concise overview of the history, classification, and treatment options for patients who present with psychosomatic disorders. I recommend this book to practitioners who are new to the subject and wish to explore it further, as well as those who already have an interest in the field." –Adrian Hemmings

    "This is a volume that would be of interest both to readers in the general public as well as general practitioners and psychiatry residents. In 10 succinct and well-written chapters, he provides an excellent overview of the history and theoretical underpinnings of somatization." -Steven A. Epstein, MD, Journal of Psychiatric Practice