New Name for Psychosomatic Medicine?

I guess it’s about time that leaders in various psychiatric organizations should be rethinking the name of the psychiatry subspecialty, Psychosomatic Medicine. After all it’s been around for 13 years. It’s high time for a change to a name that’s been controversial since it’s inception when the American Board of Psychiatry and Neurology (ABPN) gave it to us when the subspecialty was approved in 2003. The reasons some experts give are:

(1) It does not clearly or accurately define the clinical practice in the field;

(2) The name can be confusing and ambiguous, which may complicate our efforts toward collaborative care;

(3) The term “psychosomatic” is commonly perceived as a pejorative because it is generally considered to refer to illnesses with no physiological basis or to patients who are feigning symptoms.

No kidding, I got word of this a few days ago from the Academy of Psychosomatic Medicine (APM). Will that name have to change too? I searched the Psychosomatics journal (another name that ought to change?) and found an interesting article about the name that everyone was arguing against back in the early 1990s–“Consultation-Liaison Psychiatry.”

Back when I began this work it was called General Hospital Psychiatry here at Iowa. Thompson sent out a survey and the best alternative names anyone could come up with were [1]:

  • Medical-Surgical Psychiatry
  • Psychiatry in Medicine and Surgery
  • Consultation-Liaison Psychiatry

Psychosomatic Medicine didn’t make the final cut; however, it was one of several other choices favored which included Consultation Psychiatry and Psychiatric Medicine. Of course, we can ask whether a name change will substantially change what we do. Probably not; it would be similar to what was done with the names of a few diagnoses in the Diagnostic and Statistical Manual (DSM)-5. A good example of that is Somatic Symptom Disorder, which replaced the DSM-IV Somatization Disorder. Clinical management has not changed but it might be more acceptable to patients. In that sense, a name change might be more of an effort to enhance the image of the profession.

One of the more descriptive terms considered was “Psychiatry of the Medically and Surgically Ill.” It’s a bit long, isn’t it?

I suspect one of the reasons that practitioners didn’t argue with the ABPN about the name “Psychosomatic Medicine” when they approved the subspecialty finally was the fear that if they challenged it, they might suffer yet another rejection. In fact, APM had first applied for subspecialty status in 1992 (a year prior to Thompson’s paper) and it was denied by the ABPN, partly because of concerns expressed by the American Psychiatric Association about balkanizing psychiatry, or breaking it up into too many subspecialties (I think there are 7 now).

The name thing was huge at the time Dr. Thomas Wise wrote his paper “The journey to subspecialization…” in 2003 [2]. He mentioned all of the names Thompson collected in his survey 10 years earlier, and documents the choice which the ABPN made and which was adopted, Psychosomatic Medicine.

And here we are, history repeating itself as far as the name neurosis goes. We’re not satisfied with Consultation Psychiatry or Psychosomatic Medicine and I’m not sure the other choices will fare much better.

Maybe Freedland and colleagues’ suggestions for a new name for the journal Psychosomatic Medicine might help, ranked in order of preference [3]:

  1. Biobehavioral Medicine
  2. Biopsychosocial Medicine
  3. Psychosomatic Medicine (believe it or not)

Maybe we should quit worrying about the balkanization of psychiatry. Here’s my Top Ten Names:

  1. Internal Obturator Muscle and Melancholia Medicine
  2. Operating Room Retractor Anxiety Psychiatrists
  3. Anatomical Snuffbox Neurosis Neuropsychiatrists
  4. Tibial Plateau Panic Providers
  5. Epididymal Ennui Interventionists
  6. Plantar Fasciitis Fellowship
  7. Herniated Hippocampus Adventurers
  8. Factitious Foramen of Magendie Engineers
  9. Psychofrenetic Tympanic Cavity Cavaliers
  10. Sternal Manubrium Medicine

What’s your list?

References:

  1. Thompson, T. L., 2nd (1993). “Should we shift the name for “consultation-liaison” to “medical-surgical” psychiatry, “psychiatry in medicine and surgery,” or some other term?” Psychosomatics 34(3): 259-264.
  2. Wise, T. N. (2003). “The journey to subspecialization in psychosomatic medicine (or consultation liaison psychiatry): a United States experience.” Seishin Shinkeigaku Zasshi 105(3): 325-330.
  3. Freedland, K. E., et al. (2009). “What’s in a name? Psychosomatic medicine and biobehavioral medicine.” Psychosom Med 71(1): 1-4.
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