心身醫學與照會聯商精神醫學之演進

Evolutions of Psychosomatic Medicine and Consultation-Liaison Psychiatry

本文旨在介紹心身醫學(psychosomatic medicine)的概念演進，及照會聯商精神醫學(consultation- liaison psychiatry)內涵。西元1818年德國Heinroth教授首度使用psychosomatic一詞，然現代心身醫學理論，則起源自20世紀初佛洛伊德的精神分析學說，同時期美國約翰霍普金斯大學Adolf Meyer教授則提出精神生物學(psychobiology)及常識精神醫學(commonsense psychiatry)；1930年代至60年代，心身醫學理論蓬勃發展，2位領軍人物Franz Alexander及Helen Flanders Dunbar，分別提出「特異理論(specificity theory)」及「性格特質組成(personality constellation)」學說。二戰戰後，紐約西奈山醫院M. Ralph Kaufman與羅徹斯特大學George Engel各自建置堪稱照會聯商精神醫學服務典範，Engel教授於1977年歸結出迄今對心身醫學影響深遠的生物心理社會模式。照會聯商精神醫學可謂心身醫學的臨床實踐，都希望能打破影響現代醫學發展的心身二元論，提供全人照護。

This article aims to introduce the concept evolution of psychosomatic medicine and the meaning of consultation-liaison psychiatry. The term, psychosomatic, was coined by Heinroth a German professor of psychiatry, in 1818. However, the theory of modern psychosomatic medicine was originated from Freud’s psychoanalysis in the early 20th century when Adolf Meyer, a professor of psychiatry at Johns Hopkins University advocated psychobiology and commonsense psychiatry. From 1930s to 1960s, Franz Alexander and Helen Flanders Dunbar, two leading figures during this period of a rapid growth of psychosomatic theory, proposed specificity theory and personality constellation, respectively. After the World War II, M. Ralph Kaufman at New York’s Mount Sinai Hospital and George Engel at the University of Rochester Medical Center established two of the best consultation-liaison psychiatry service models, the latter of whom proposed the biopsychosocial model in 1977 with significant influence on psychosomatic medicine to the present. Consultation-liaison psychiatry could be regarded as a clinical embodiment of psychosomatic medicine, both of which serve the goal of holistic care by breaking the mind-body dualism.