At the dawn of the 21st century, the aim is to provide a vision of Integrative Psychosomatics as taught and practiced within the Society of Integrative Psychosomatics (SPI) by and based on the work of Prof. Jean Benjamin Stora(1).
A press release concerning a study of patients with Covid long was recently published and caught our attention. (6 )
This press release is of interest to us for two reasons:
On the one hand - as we informed you - because the SPI has started a study on this same theme of the long Covid and on the other hand because the term "psychosomatic" has been mentioned several times in this release.
In my capacity as President of the SPI and on behalf of my colleagues, I am delighted to welcome this opening to our discipline and I take the opportunity offered to us to shed light on the question raised:
Psychosomatic ?
Integrative Psychosomatics, which stems from the work of Professor Jean Benjamin Stora, creator and developer of this discipline, starts from the postulate of the existence of a psychic system linking mental representations, behaviors and emotions. By stating a new paradigm, contrary to that of Anaxagoras, which splits the mind and the body, namely: "the human being is a psychosomatic unit.
Let's go back to the etymology of psychosomatics: the mind and the soma.
The spirit or psychic system, the soma or the whole of the sexual and non-sexual cells of a living being. Psycho soma are therefore inseparable.
The history of patients and the history of illnesses are at the very foundation of the integrative psychosomatic approach.
It all starts with the story of the patients and their diseases.
A little history, science and medicine .... to enlighten our approach
A succession of approaches since Anaxagoras (in the 4th century B.C.) through S. Freud, F. Alexander (School of Chicago), Pierre Marty (School of Paris) then
the neuro-psycho-physiological approaches of Pr Jean Benjamin Stora.
https://www.spi-int.com/histoire-de-la-spi
This approach -scientific- is also integrative because it is based on the interrelation between the development of the psychic system and all the systems that constitute the soma:
the central nervous system,
the autonomic nervous system,
the genome and
the immune system.
This discipline is based on the following paradigm: the human being is a psychosomatic unit.
A modern and global approach: the alpha model of the psyche, medicine and neuroscience that goes beyond biological variables.
Consequently, there are no psychosomatic illnesses, all illnesses are psychosomatic with reference to multi-causality as an explanatory factor of somatization processes. (2)
Whether the disease begins at the neuronal, functional or organic level, the psychic apparatus is always more or less solicited and in interrelation with the psychosomatic unit, even when we think that it is only organic.
The part of the contribution of the psychic apparatus varies considerably according to the components:
Genetics, personal and individual history, the history of different diseases, family situations, professional situations with which the individual is confronted, the nature of the environment, the origin and/or the cultural influence.
The work of clinical investigation will consist in establishing the structuring of the psychic apparatus and its possible insufficiencies just like that of an organ or a somatic function, according to the principle of somatizations (2) whose psychic component extends from the intra-uterine life to the genital stage.
Different steps constitute the approach of the integrative psychosomatician:
The first is to evaluate the psychosomatic risk according to an analysis method (3) that determines the fragilities and deficiencies of the psychic and neuronal self, the resources to be taken into account in the energetic balance of human beings; and whatever his or her primary training the psychosomatician always works alongside his or her medical colleagues to restore the integrity of the psychosomatic unit.
The principle of somatization - was defined by Pr Jean Benjamin Stora from his work on stress (4) undertaken since 1980.
Every day we are subjected to external sensory and mental excitations which have as sources
- Either a stress of minor intensity
- or a major stress of a sequential or permanent nature.
The endo psychic excitations are an internal stress creating a work requirement to the psychic apparatus which, if it is overflowed, is transmitted to the various systems.
The central nervous system, in its axis :
hypothalamic-pituitary-adrenal
interprets excitations to ensure the survival of the organism.
In order to re-establish homeostasis, all defense systems are mobilized.
The progressive disorganizations indicate the disappearance of the psychic defenses in parallel with the abrasion of the immune system defenses.
The excitations transit by the neuronal systems in case of failure of the psychic system.
The neuronal systems treat the excitations by activating the different levels of the living being connected to this system.
We distinguish 4 neuronal circuits of transmission of excitations when the psychic system is overloaded and no longer ensures the regulation!
We are not equal when it comes to the stresses of everyday life and trauma. The perception of stress depends on many internal and external factors.
We build ourselves from the different stages of life which determine our strengths and weaknesses resulting from our experiences, our environment, our culture, the deficiencies of our childhood which constitute the weaknesses and deficiencies of the self.
The perception of an emotion relative to a particular phenomenon depends on the subjectivity of the perception of the phenomenon in question. This determines our ability to adapt or not.
Discoveries of the biochemical mechanisms of stress reveal that adaptation reactions are both psychological and somatic.
During the psychosomatic clinical examination, in addition to age, family situation, history and any other factors to be considered, the psychosomatist completes the epistemological study with the following criteria
- Psychological processes and mechanisms
- Resources available to the patient
- The prevalence of behaviors
- The capacity to express affects
- Somatic risk, the body, organs and functions (biological parameters/medical record)
- Risk related to the family, social, professional and cultural environment
These components will allow:
1. to define an evaluation of the psychosomatic risk whose scale (from 1 to 5) varies from a stable subject reached by a temporary overflow, to a high risk of a disorganized unit;
2. to make a preliminary diagnosis (according to the dynamic psychosomatic nosography) essential to the possible implementation of a psychosomatic therapy.
These are weekly sessions lasting about 45 minutes, face to face, during which the therapist's speech and relationship will be privileged, as well as the strengthening of internal resources.
The approach is individual and its effects cannot be generalized. The duration of the treatment depends on the individual, varying from 18 months to 3 years.
This is a very brief summary of the Integrative Psychosomatics approach.
I hope that this article will allow many of our readers to gain insight into integrative psychosomatics so that this term can be updated at the dawn of the 21st century, for an approach to medicine that serves the sick and not just the sick.
Elisabeth Jouan
President of SPI
August 25, 2021
(1) Jean Benjamin Stora, psychoanalyst and psychosomatician (IPSO), is honorary dean of the HEC faculty. President of the Pierre-Marty Institute of Psychosomatics from 1989 to 1992 and of the French Society of Psychosomatic Medicine from 2000 to 2002, he created the psychosomatic consultation from 1993 to 2015 at the Pitié-Salpêtrière University Hospital. Honorary President of the SPI
He has conducted numerous research projects on occupational stress and clinical research. He is the current director of the Institute of the Society of Integrative Psychosomatics.
He is the creator of the scientific discipline of Integrative Psychosomatics
(2) Pr J.B.Stora Faculty of Medicine of the Pitié-Salpétrière: D.U. of Integrative Psychosomatics 2006-
2015 and IPSI from 2015 to present. The Principle of Somatization - Model of J.B.Stora
"Course of Psychosomatics, theory and clinic" Faculty of Medicine of the Pitié Salpétrière and Institute of Integrative Psychosomatics from 1993 to date, Pr. Jean Benjamin Stora. Unpublished course.
(3) Review number 3 downloadable https://www.spi-int.com/revues and two recent books:
Stora, J.B., (2019) "15 cases of Psychosomatic Therapies, treating patients, not just their illnesses" Editions Hermann, Paris.
Stora, J.B. (2013) "La Nouvelle Approche Psychosomatique, 9 cas cliniques", MJW- Féditions, Paris.
(4) Stora, J.B.,( 1991/2010), Le stress, Presses Universitaires de France, collection "Que sais-je ?" n° 2575, Paris,1991; 10th edition, 2019; editions in Spanish, Portuguese, Turkish, Arabic, Romanian, Greek, Italian.
Stora, J.B. (2007) " When the body displaces the mind, stress, trauma and somatic disease, (foreword by Mark Solms), London: Karnac Books Ltd.
Conferences and Colloquia :
Stora, J.B. (1999) " Stress, psychopathology and dependence, what philosophy of management in the XXI° century?", Congress of the Institute Psychoanalysis and Management, Lyon, June 1999.
Stora, J.B. (1999) " Conséquences psychosomatiques du stress traumatique, stress, traumatismes et maladies somatiques ", Congrès international de psychiatrie et du système nerveux central, Cité des Sciences et de l'Industrie, Paris, collection of abstracts
(5) Implementation of the bio-chemical mechanisms of stress, table P.75 and following, (9th edition) Stora, J.B.,( 1991/2010), Le stress, Presses Universitaires de France, collection "Que sais-je?"
Find all the information on our website https://www.spi-int.com
As well as the bibliography on the page https://www.spi-int.com/bibliographie
(6) Excerpt from the research release:
Professor Dominique Salmon-Céron, Hotel Dieu, ETUDE COVID long Dr Marc Gielen @_MarcGielen_
The Hôtel-Dieu Hospital in Paris conducted a study on 70 of these patients. And the caregivers were able to draw up a profile of the "long Covids": they are generally young people, mainly women (psychosomatic???) who have contracted a benign form of the virus, without going to hospital.
( but in which psychological situation are they or
(but in what psychological situation are they? What material distress? What kind of professional activity?) (so what treatment at home? Prescribed by whom? Or treatment without prescription?).
But months after their infection, they continue to suffer from three types of symptoms
( psychosomatic ???)
"First, an often overwhelming fatigue, which sometimes forced them to interrupt their work again when they had resumed it," says Professor Dominique Salmon-Céron, who coordinated the study, to Europe 1. "Then, we have neurological signs of concentration problems, memory, headaches (typical of depression or chronic stress) Finally, we have cardiothoracic signs, that is to say cough, pain, variations in heart rate. Symptoms to which are sometimes added a loss of smell again, digestive disorders or skin problems (typical psychosomatic).
On their side, some "Covid longs" did not wait to regroup. This is how the association "AprèsJ20 Covid-long en France" was born last October, an association that aims to federate and better inform patients and their relatives about this long form of the coronavirus. The association is also working on the implementation of a multidisciplinary pathway.
