The Generalist and Psychosomatic Medicine THOMAS
C.
KALKHOF,
In this era of an impending "future shock" society, the family, physician, or generalist is surrounded with emotional illness in his practice as a primary physician. Many such physicians are running scared because they are not prepared to handle this avalanche of patient problems. Yet they cannot rely on their psychiatric colleagues and psychologists to carry this additional load. No professional today can practice medicine or dentistry without becoming involved in the emotional aspects of each illness. Each individual should at least have a working knowledge of psychosomatics if one is going to be successful in the overall treatment of the patient. The problem is finding an educational source that is not totally psychiatric. Psychosomatic medicine is the practice of medicine and dentistry relating to the interaction of mind, body and environment. It encompasses the total and comprehensive care of the patient in the everyday practice of the healing arts. Therefore, it should require the input of the majority of medical disciplines, psychology and dentistry. Whenever we prefix a term with the work "psycho", we tum off many physicians. The mystic quality of the work makes it apprehensible to many in the main stream of medicine. Psychiatry has developed a mystic jargon that adds to its untouchable subjectivity, and many people relate the practice of psychosomatic medicine to psychiatry. Perhaps this group should show the most concern, but there are many psychiatrists who do not have an understandable knowledge of psychosomatic medicine and therefore confuse the issue. Yet those of us who have more than a casual acquaintance with psychosomatic medicine are aware that it cannot be owned by anyone specialty for its basic philosophy concerns all modalites of the health care field. Psychosomatic medicine explains more clearly everyday emotional illness better than Freud or other analysts, and it can be popular among other branches of medicine and allied health professional fields. The generalist and internist can accept its philosophy and formulations because they relate well to everyday practice. Both have been exposed to a certain basic Presented at the 21st Annual Meeting, Academy of Psychosomatic Medicine, Scottsdale, Arizona-Nov. 17-20, 1974. Dr. Kalkhof is President (1975) of the Academy of Psychosomatic Medicine and Medical Director, Iroquois Medical Center, Erie, Pa. 12
M.D.
understanding of psychiatry and this combined with their general medical knowledge should acquaint them with the roles emotions play in human relationships, confrontations, and illness. The majority of these situations or conditions do not require deep psychotherapy, so that with a moderate amount of training, they can master the comprehensive care needed by such patients. Naturally, there will be cases which may need the consultation and cooperation of a psychiatrist, but these should be the exception rather than the rule. Today's statistics show that less than 25 % of all generalists are presently interested or trained in emotional illness-diagnosis and therapy. Over sixty-five percent ( 65 %) of these physicians consider such cases as "hot potatoes" and quickly refer them to the psychiatrist. If ever a patient needed his physician, it is when he is suffering from an emotional somatic illness. He naturally will turn to his personal physician for help for he may fear approaching a psychiatrist. If his physician sloughs him off without trying to help him, he may move rapidly up the psychodynamic scale and even cross that imaginary barrier into the land of psychosis. How much better would it be if his physician was knowledgeable about psychosomatic illness and psychoneuroses, and was able to help him as his primary physician, or at least listen to him and then decide on the therapeutic course to travel. The patient may well need a psychiatrist, but he will be more agreeable if his doctor, his friend, listens to him and then discusses the therapeutic possibilities. This leads us to the sixty-four dollar question, where does the family physician get this information or training? Psychosomatic medicine has been growing like topsy. Take it from one who has been interested in it for many years. You can learn a little here-a little there, but few have really put it all together. I have been searching for the Holy Grail of psychosomatic medicine. I have traveled the highways of conventional psychiatry, transactional analysis and clinical psychology, but have found only bits and pieces of the psychosomatic picture puzzle. I have attended special symposia on psychosomatic medicine like the one offered by the Hahnemann Medical College in Philadelphia. The purpose of this particular symposium was to bring together a cross section of various scientific disciplines which had been making worthwhile contributions to the broad field of psychosomatic medicine. They hoped that this symposium would provide an initial step and a more integrated multi-disciplinary approach to psychosomatic medicine in the future. It was a beautiful program atVolume XVI
THE GENERALIST-KALKHOF
tended by representatives of all the major medical disciplines including psychiatrists and psychoanalysts. It was there I learned that many psychiatrists who should have most of the answers were also students of the symposium. This revelation really gave my ego a lift. I was convinced that I was traveling on the right road with such illustrious company, toward my quest for knowledge of psychosomatic medicine. My greatest fortune was realized when I attetnded my first meeting of The Academy of Psychosomatic Medicine held at the Hotel Commodore in New York City in 1964. I was impressed by the quality of the scientific program and its presentation. There was something for everyone who attended. The mysticism of psychiatric jargon was minimal. The discussion periods were alive. Friends or colleagues of the speaker did not hesitate to debate certain issues raised in his paper or offer a personal comment that would strengthen it. The meeting was never dull scientifically or socially. One had the feeling of belonging, and before it finished, I was a candidate for membership. Throughout the following years, I have shared the same relationship at our annual scientific meeting and have grown in my understanding of psychosomatic medicine. The Academy has offered some excellent programs during these years, but I must confess they have at times been beamed more toward knowledgeable participants than the neophyte. The latter may be confused or deluded with some of the complex terminology that has peppered the presentations. Speaking as a former neophyte, I recall an incident during my medical school training concerning our Professor in Anesthesiology. Once he had finished the theory, he devoted one lecture entitled "How
Far to Tip the Can". A former student had made that request and he thought it was a worthy one. Our new neophyte in psychosomatic medicine also wants to know, "How Far to Tip the Can". In my judgment, there is no better place to learn the facts and art of psychosomatic medicine than in the Academy. However, we must re-adjust our educational format so that sufficient time or journal pages will be allotted to the education of the Neophyte. I see this position as a major responsibility of the Academy. At present we have two major sources of such information. Our educational scientific meetings-Regional and Annual and our Journal-"Psychosomatics". I am confident that the present membership and governing body can through a group dynamic effort offer physicians and allied health professionals an excellent current primary understanding of psychosomatic medicine as well as providing for the educational needs of the more advanced members. It is here within the Academy that one has the opportunity to learn from each other as well as playing mental ping pong with the giants in discussion of cases with a personal viewpoint. The Academy is, and I trust will always be made up of individuals or groups who share rather than dominate the educational policies and membership. No one group owns the Academy, and our varied membership is living proof. If we can develop a continuing program for the neophyte as part of our scientific meetings and Journal publications, we will be able to interest more physicians and allied health professionals in this interesting field. Thomas Kalkhof, M.D., 3815 Field St., Erie, Pa. 16511
Sexual Dysfunction Seminars The Institute for Comprehensive Medicine is sponsoring seminars on NEWER APPROACHES TO YOUR SUCCESSFUL TREATMENT OF MARITAL AND SEXUAL DYSFUNCTIONS utilizing Hypnosis, Behavior Modification, Transactional Analysis, Conditioned Reflex Therapy and Biofeedback, to be held March 22-23, 1975-Royal Sonesta Hotel - New Orleans, La. April 5-6, I975-Sheraton-L.A. Airport Hotel - Los Angeles, Cal. May 10-11, 1975-MGM Grand Hotel - Las Vegas, Nev. for physicians, psychologists, residents, marriage counselors and paramedical workers. This continuing medical education course is acl:eptable for credit hours in Category 2 for the Physicians Recognition Award of the American Medical Association. Contact: Karnie Starret, 10840 Queensland St., Los Angeles, CA 90034.
January / February/March, 1975
13
C.
KALKHOF,
In this era of an impending "future shock" society, the family, physician, or generalist is surrounded with emotional illness in his practice as a primary physician. Many such physicians are running scared because they are not prepared to handle this avalanche of patient problems. Yet they cannot rely on their psychiatric colleagues and psychologists to carry this additional load. No professional today can practice medicine or dentistry without becoming involved in the emotional aspects of each illness. Each individual should at least have a working knowledge of psychosomatics if one is going to be successful in the overall treatment of the patient. The problem is finding an educational source that is not totally psychiatric. Psychosomatic medicine is the practice of medicine and dentistry relating to the interaction of mind, body and environment. It encompasses the total and comprehensive care of the patient in the everyday practice of the healing arts. Therefore, it should require the input of the majority of medical disciplines, psychology and dentistry. Whenever we prefix a term with the work "psycho", we tum off many physicians. The mystic quality of the work makes it apprehensible to many in the main stream of medicine. Psychiatry has developed a mystic jargon that adds to its untouchable subjectivity, and many people relate the practice of psychosomatic medicine to psychiatry. Perhaps this group should show the most concern, but there are many psychiatrists who do not have an understandable knowledge of psychosomatic medicine and therefore confuse the issue. Yet those of us who have more than a casual acquaintance with psychosomatic medicine are aware that it cannot be owned by anyone specialty for its basic philosophy concerns all modalites of the health care field. Psychosomatic medicine explains more clearly everyday emotional illness better than Freud or other analysts, and it can be popular among other branches of medicine and allied health professional fields. The generalist and internist can accept its philosophy and formulations because they relate well to everyday practice. Both have been exposed to a certain basic Presented at the 21st Annual Meeting, Academy of Psychosomatic Medicine, Scottsdale, Arizona-Nov. 17-20, 1974. Dr. Kalkhof is President (1975) of the Academy of Psychosomatic Medicine and Medical Director, Iroquois Medical Center, Erie, Pa. 12
M.D.
understanding of psychiatry and this combined with their general medical knowledge should acquaint them with the roles emotions play in human relationships, confrontations, and illness. The majority of these situations or conditions do not require deep psychotherapy, so that with a moderate amount of training, they can master the comprehensive care needed by such patients. Naturally, there will be cases which may need the consultation and cooperation of a psychiatrist, but these should be the exception rather than the rule. Today's statistics show that less than 25 % of all generalists are presently interested or trained in emotional illness-diagnosis and therapy. Over sixty-five percent ( 65 %) of these physicians consider such cases as "hot potatoes" and quickly refer them to the psychiatrist. If ever a patient needed his physician, it is when he is suffering from an emotional somatic illness. He naturally will turn to his personal physician for help for he may fear approaching a psychiatrist. If his physician sloughs him off without trying to help him, he may move rapidly up the psychodynamic scale and even cross that imaginary barrier into the land of psychosis. How much better would it be if his physician was knowledgeable about psychosomatic illness and psychoneuroses, and was able to help him as his primary physician, or at least listen to him and then decide on the therapeutic course to travel. The patient may well need a psychiatrist, but he will be more agreeable if his doctor, his friend, listens to him and then discusses the therapeutic possibilities. This leads us to the sixty-four dollar question, where does the family physician get this information or training? Psychosomatic medicine has been growing like topsy. Take it from one who has been interested in it for many years. You can learn a little here-a little there, but few have really put it all together. I have been searching for the Holy Grail of psychosomatic medicine. I have traveled the highways of conventional psychiatry, transactional analysis and clinical psychology, but have found only bits and pieces of the psychosomatic picture puzzle. I have attended special symposia on psychosomatic medicine like the one offered by the Hahnemann Medical College in Philadelphia. The purpose of this particular symposium was to bring together a cross section of various scientific disciplines which had been making worthwhile contributions to the broad field of psychosomatic medicine. They hoped that this symposium would provide an initial step and a more integrated multi-disciplinary approach to psychosomatic medicine in the future. It was a beautiful program atVolume XVI
THE GENERALIST-KALKHOF
tended by representatives of all the major medical disciplines including psychiatrists and psychoanalysts. It was there I learned that many psychiatrists who should have most of the answers were also students of the symposium. This revelation really gave my ego a lift. I was convinced that I was traveling on the right road with such illustrious company, toward my quest for knowledge of psychosomatic medicine. My greatest fortune was realized when I attetnded my first meeting of The Academy of Psychosomatic Medicine held at the Hotel Commodore in New York City in 1964. I was impressed by the quality of the scientific program and its presentation. There was something for everyone who attended. The mysticism of psychiatric jargon was minimal. The discussion periods were alive. Friends or colleagues of the speaker did not hesitate to debate certain issues raised in his paper or offer a personal comment that would strengthen it. The meeting was never dull scientifically or socially. One had the feeling of belonging, and before it finished, I was a candidate for membership. Throughout the following years, I have shared the same relationship at our annual scientific meeting and have grown in my understanding of psychosomatic medicine. The Academy has offered some excellent programs during these years, but I must confess they have at times been beamed more toward knowledgeable participants than the neophyte. The latter may be confused or deluded with some of the complex terminology that has peppered the presentations. Speaking as a former neophyte, I recall an incident during my medical school training concerning our Professor in Anesthesiology. Once he had finished the theory, he devoted one lecture entitled "How
Far to Tip the Can". A former student had made that request and he thought it was a worthy one. Our new neophyte in psychosomatic medicine also wants to know, "How Far to Tip the Can". In my judgment, there is no better place to learn the facts and art of psychosomatic medicine than in the Academy. However, we must re-adjust our educational format so that sufficient time or journal pages will be allotted to the education of the Neophyte. I see this position as a major responsibility of the Academy. At present we have two major sources of such information. Our educational scientific meetings-Regional and Annual and our Journal-"Psychosomatics". I am confident that the present membership and governing body can through a group dynamic effort offer physicians and allied health professionals an excellent current primary understanding of psychosomatic medicine as well as providing for the educational needs of the more advanced members. It is here within the Academy that one has the opportunity to learn from each other as well as playing mental ping pong with the giants in discussion of cases with a personal viewpoint. The Academy is, and I trust will always be made up of individuals or groups who share rather than dominate the educational policies and membership. No one group owns the Academy, and our varied membership is living proof. If we can develop a continuing program for the neophyte as part of our scientific meetings and Journal publications, we will be able to interest more physicians and allied health professionals in this interesting field. Thomas Kalkhof, M.D., 3815 Field St., Erie, Pa. 16511
Sexual Dysfunction Seminars The Institute for Comprehensive Medicine is sponsoring seminars on NEWER APPROACHES TO YOUR SUCCESSFUL TREATMENT OF MARITAL AND SEXUAL DYSFUNCTIONS utilizing Hypnosis, Behavior Modification, Transactional Analysis, Conditioned Reflex Therapy and Biofeedback, to be held March 22-23, 1975-Royal Sonesta Hotel - New Orleans, La. April 5-6, I975-Sheraton-L.A. Airport Hotel - Los Angeles, Cal. May 10-11, 1975-MGM Grand Hotel - Las Vegas, Nev. for physicians, psychologists, residents, marriage counselors and paramedical workers. This continuing medical education course is acl:eptable for credit hours in Category 2 for the Physicians Recognition Award of the American Medical Association. Contact: Karnie Starret, 10840 Queensland St., Los Angeles, CA 90034.
January / February/March, 1975
13
