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Epistemologica Aspects of Psychosomatic Dermatology

Treumund Wellentreter) concluded that the mentally ill (he classified 36 different categories) were responsible for their actions and acquired a new soul (not heredity, perhaps not even predisposition was considered) when God punished them with the loss of personal will. It seems absurd that Heinroth should have been the one to create the neologism ‘psychosomatic’2. In fact, J. Taylor attributes the term to Coleridge, a poet, not a psychiatrist. When Plato wrote: ‘This is the great error of our times ... physicians see the body separate from the soul’, it was the baptism, if not the birth, of psychosomatics, and the statement was used by Weiss and English as the epigraph for their book Psychosomatic Medicine [2]. The authors, both at Temple University, Philadelphia, mentioned the founding of the Journal of Psychosomatic Medicine in 1939, which was applauded by the Journal of the American Medical Association in a very favorable article on Freud and his work (when Freud had already fled to London and many of his colleagues to the United States). Historically, scientific psychosomatics has been supported by psychoanalysts, beginning with Freud. Weiss and English commented that ‘no work could have been done in psychosomatic medicine without Freud’s work on biological psychiatry’. They point out that Freud’s discoveries were followed by the work of many others: Ferenczi, Abraham, Jones, Jelliffe, Deutsch, Wittkower, Menninger, Alexander, the group of the Chicago Psychoanalytic School, Flanders and Dunbar (‘Emotions and Somatic Variations’, published in 1935, reviews all the then existing literature on this subject), and the group of the Presbyterian Hospital in New York. The conclusion was that ‘all medicine must become (meaning: is) psychosomatic medicine’. Up to now, experiences and opinions originating from many very different cultures have accumulated. One of the fundamental problems is the hybrid status of psychosomatic epistemology. On the one hand, it is part of medicine with its empirical tradition; on the other hand, it refers to psychology with all related hermeneutic torments. The variEpistemology (or theory of knowledge, also called gnosiology) is defined in the Encyclopedia Britannica [1] as the study of the nature and validity of human knowledge. Epistemologists examine the degrees of certainty and probability in knowledge and the difference between knowing (with certainty) and believing (without being certain). This knowledge about knowledge can be used to provide a basis for wise action, security, and truth. Two competing epistemological orientations are Rationalism, which stresses the role of reason in providing certainty, and Empiricism, which stresses that of sensory perception. Here we propose an epistemology of psychosomatic dermatology for the 21st century, based on a review of the epistemology of psychosomatics, psychosomatic medicine, and, in particular, psychosomatic dermatology. The term ‘psychosomatic’ was coined in the second decade of the 19th century as a reflection on knowledge, certainties and truths, as well as opinions, hypotheses and interpretations with rationalistic and/or empirical bases: an examination which dermatology first restricted and then enlarged, from the res expansa, the skin, to the whole human body, and then to the body and mind together. The term ‘psychosomatic’ was coined in 1818 by J. Heinroth (1778–1843), a psychiatrist ‘ein Psychicher, nicht Somatiker’, in Leipzig, Germany1. In his History of Psychiatry, E.H. Ackernecht reminds us that metaphysics, mysticism, ‘morality’, and poetry provided the cultural bases for the Psychicher, distinguishing him from the Somatiker. The former considered all disease to be a result of sin. And thus Heinroth, psychiatrist and poet (under the pseudonym of