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Dr. L. NACCACHE Algologist, Psychosomatician.

A large number of physicians agree with their patients in the following observation: the approach to the somatically ill individual tends to be based on the paradigm of the "body detached from man", or equally of the "man detached from his body" as elegantly formulated in the book "L'homme douloureux" (Simonet G. Laurent B. Le Breton D., "L'Homme douloureux", Paris, Ed. Odile Jacob; 2018). "The disease is posed as a biological species detached from the singular man who suffers from it and studied separately on a body dissociated from the man".

We would like to share some of the thoughts of this book in order to defend the multidisciplinary extension of the investigation and management of somatic patients to the Integrative Psychosomatic approach proposed and developed by Prof. J.B. Stora at the Pitié-Salpêtrière University Hospital.

Indeed, the "epistemological basis of contemporary medicine is based on the rigorous study of the body, but of a body isolated from the person, and perceived as the receptacle of a disease. The methodological dualism that separates the individual from his or her body still feeds the practices and research of the medical establishment today, as it continues to refine its mechanistic approach to molecular biology and brain imaging.

"To better understand it, medicine reduces the disease to biology, it depersonalizes it. It is not perceived as linked to the heritage of the individual adventure of a situated and dated man, but as the fault of a function or an organ. The man is reached of an alteration which concerns only his organism (...) it is not the human who is sick but the organism ".

These guiding principles undeniably constitute "the limit of a medicine that is not centered on the subject but resorts to a knowledge of the body that forgets the suffering man and considers his complaint with indifference because it does not directly concern the diagnosis".

"In the gradual elaboration of its knowledge and know-how, medicine has neglected the subject and his history, his social environment, his relationship to desire, to anguish, to death, to others, the conditions of his emergence, the meaning of the disease in the eyes of the individual who is affected by it.

However, the authors of the book consider "the psychosomatic idea ... as a conceptual cover for a remnant of dualism that psychologizes the symptom".

However, this last reflection is notoriously refuted by the Integrative Psychosomatics model (IPH) which has nothing to hide but rather to make itself known. And which seeks to think of the sick man in the paradigm of a body-mind or soma-psyche continuum.

To pose a non cleaved individual necessarily passes by the fact of thinking it as a psychosomatic unit where the psyche is integrated in the economy of the global homeostasis. It is precisely the framework of the Theory of the five systems, elaborated by Pr J.B. Stora.

For re-attaching man to his sick body requires at least two axes of thought.

The first concerns the search for mediating agents that "biologize" and "mentalize" the continuity relationships between psychic and somatic phenomena. And particularly the interrelations between the central nervous system and the psychic system.

The second axis concerns the possibility of thinking subjectivity in a way that is not reduced to its cognitive and behavioral aspects. This certainly requires integrating it in its metapsychological, as well as biological, sociological, cultural and biographical aspects. It is a matter of extending the subject in its affective, imaginary, conflictual, relational and traumatic dimensions as well as those of its beliefs and resources.

By proposing an investigation grid of the mental functioning, the PSI allows the multidisciplinary extension of the evaluation of the somatic patient; and if necessary offers the possibility of a complementary psychosomatic psychotherapeutic care. Since it is a question of "treating the sick and not only their illnesses" according to the appropriate expression of Pr J.B. Stora in the subtitle of his book "15 cases of Psychosomatic Therapies", Paris, Editions Hermann, 2019.