Psychosomatic links in cardiovascular disorders

It is appropriate that the first Weiss-English Symposium in psychosomatic medicine deal with coronary heart disease, for with coronary heart disease more than with any other type of illness, the goal of those psychiatrists and other physicians interested in clinical psychosomatic medicine is beginning to be met: that we look at the whole person and consider emotional and environmental factors along with strictly "medical" factors in our approach to prevention, diagnosis, and treatment of disease.

In other areas of medicine, the role ofthe psyche and the environment in producing disease is still questioned by many, and in many cases the studies needed to clearly prove or disprove the role ofthese "nonmedical" factors to the satisfaction ofthe doubters have not been done or are still in their early stages. With coronary heart disease, however, we can safely say that the role ofstress factors and personality, after years ofstudy, has been accepted not only by the medical community, but even by the general public.

When Edward Weiss and O. Spurgeon English were doing their early work in psychosomatic medicine, there was little interest in or acceptance ofthis field, particularly among non-psychiatric physicians. Edward Weiss was an internist who rooted himselfin the basic sciences of anatomy, pathology, and medicine, and wrote extensively on the kidney, the heart, the lung, the blood, and a variety ofother subjects before he entered the field of psychosomatics. Spurgeon English was a psychiatrist who oame to Temple University in 1933 to work with Edward Weiss. Together, they combined a teaching exercise for medical students under the auspices of the department of medicine. Dr. Weiss would present the case with its clinical findings, and Dr. English would discuss the psychological and emotional problems that were related. A secretary stenotyped their lectures without their knowledge and presented them with typed copies. Edward Weiss thought these could be published as case discussions, and the editor they contacted countered with the suggestion that they write a book on psychosomatic medicine. Thus began a collaboration that resulted in one ofthe first textbooks in psychosomatic medicine, published in 1943, with two subsequent editions in 1949 and 1957, and translations into many languages.

For Spurgeon English, the psychiatrist, the partnership was comfortable and presented no professional conflicts, but for Edward Weiss, the internist, it was a different story. He held on to his beliefthat there were psychological factors in all medical cases; he talked about it; he lectured about it, in spite of the warnings he received from friends and colleagues that he might endanger his distinguished career in internal medicine. Psychosomatics was a medical no-man's-land at the time, and Edward Weiss never felt accepted as either an internist or a psychiatrist. To those who came to him with an interest in psychosomatic medicine, he always said, "Be a psychiatrist."

Some of the authors ofthe papers from this first Weiss-English Symposium are psychiatrists. Some are not. All share an interest in a holistic approach to medicine and psychiatry. Their papers give an overview ofsome of the current concerns in psychosomatic treatment of coronary heart disease, with thoughts about long-term prevention and abortion ofimpending coronaries. They range from a first-person account ofthe terror and disorientation that can be induced by a coronary attack, by the drugs used to treat it and by the CCU environment, through consideration of the physiology ofstress, the relation of risk factors to life style, and how to advise heart patients on sexual activity.

In presenting these papers from the first Weiss-English Symposium, we honor two pioneers in psychosomatic medicine and invite our readers to take a well-balanced look at one ofthe major psychosomatic diseases ofour age.

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