Somatism

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From somaticism is spoken when predominantly or exclusively physical aspects for the diagnosis of disease are used. However, this attitude is problematic, especially for the diagnosis of mental illness, insofar as physical and psychological factors usually interact . In medical history, different forms of somatism can be distinguished.

Forms of somatism

The following classification refers to the different physical states of aggregation , but also represents an approximate historical representation of the development of European or Western medicine and the disease concepts it prefers .

Pneumatics

The Greek teaching of the pneumatists is based on the gaseous state of physical substances. Greek doctors already tried to derive all physiological and pathological ideas from the pneuma (ancient Greek air, gas, breath, breath, breath of air). The pneumatics believed that it permeated the whole body. The concept of spirit goes hand in hand with the conceptual history of the theory of pneuma.

The Greek teaching of the pneumatics must be regarded as the most original disease theory - from the point of view of ethnology and comparative psychiatry - as long as there were no well-thought-out and rationally founded concepts of disease. Originally, illness of any kind was mostly viewed as an intervention by higher powers. It has been traced back to the influence of evil spirits, witches and wizards, and the punishments of the gods.

Until the 18th century u. a. also the Greek doctrine of fumes ("vapores") as a cause of disease. Galen (approx. 129–200 AD) distinguished various forms of melancholy , of which he assumed that one originated from the gastrointestinal canal. Vapors arise u. a. by spoilage of the juice. Paracelsus also uses this concept of disease in his treatise on epilepsy , assuming that the "spiritus vitae" is boiling in the organs of origin.

In the 17th and 18th centuries, the “nerve spirits” were explained in the sense of a “spiritus animalis” as mechanical and automatical or as a machine paradigm and not spiritualistic . A pressure wave was assumed, which triggers the sensations in the brain. Other authors who dealt with the "vapors" were Richard Blackmore (1725), Nicholas Robinson (1729), George Cheyne (1733), Pierre Pomme (1763) and Jean-Baptiste Pressavin (1770).

Humoral pathology

According to Erwin H. Ackerknecht (1906–1988), Greek medicine was primarily based on a somatism, as was the theory of temperament , which was a basis for humoral pathology . Humoral pathology is the ancient doctrine according to which all diseases can be traced back to the incorrect composition or mixture ( dyscrasia ) of the blood or other body fluids. The humoralists mainly consider bloodletting and laxatives as therapeutic methods . The teaching is based on the liquid phase of physical substances. These physical theories differed from the teachings of the philosophers who used a four-element doctrine to describe psychic qualities such as those of the sanguine . While in other advanced cultures, such as in Egypt and Mesopotamia, one vacillated between natural and supernatural explanations for the cause of illnesses, Greek doctors were to be consistently regarded as representatives of natural causes of illnesses. B. Hippocrates of Kos (approx. 480-370 BC) and Galen (approx. 129-200 AD). They can therefore be regarded as the forerunners of scientific medicine and psychiatry.

Solidarity Pathology

In connection with the scientific advances of modern times , the humoral pathology that had been common up to that point increasingly turned into a solidarity pathology . She looked for the causes of diseases in solid parts of the body. It was decisive for the development of anatomy and physiology up to the discovery of cellular pathology by Rudolf Virchow (1821–1902). On the other hand, a theory of psychological illnesses developed as a distinction from purely physically justifiable disorders, the beginning of which is regarded as the animism of Georg Ernst Stahl (1659–1734). Mental illnesses can be physically caused, cf. also → psychophysical correlation , but often only show a psychogenic origin.

History of Psychiatry

The dispute between psychics and somatics was significant for the history of psychiatry . This development has proven to be less productive, however, insofar as both sides referred unilaterally and exclusively to psychogenic or somatic facts. Somatism has favored the idea of ​​the theory of diseases to be oriented towards physical and spatial aspects. The history of medicine, and especially psychiatry, has often been shaped by ideological prejudices. Using the example of Franz Josef Gall (1758–1828), Klaus Dörner (* 1933) demonstrates that his somatically based teaching of phrenology required multiple corrections before the idea he advocated of localizing psychological abilities proved to be correct. This was done because a localization theory in the brain could be considered scientifically verifiable. The progress can be seen not only in the concretization of physical facts, but also in the more precise definition of psychological facts, in that the old somatism has been replaced.

Jean-Étienne Esquirol (1772–1840) can be seen as a representative of a somatism in that he incorporated the thoughts of Auguste Comte (1798–1857) and his three-stage law into his own pathology. Accordingly, using the example of suicide, he distinguished three stages of development: suicide subject to religious ethics, then those who are responsible before civil law, and finally those who are subject to medical disease theory. It is similar, according to Esquirol, with melancholy . He regards earlier views of this disease as demonomania. The possessed were persecuted as witches. Such religious ideas, however, would have been exposed as priestly fraud through the Enlightenment and would only now be viewed as a disease. However, Esquirol points to the new fear of the police and their persecutions.

Individual evidence

  1. ↑ a b c d e f g h i Erwin H. Ackerknecht : Brief history of psychiatry. 3. Edition. Enke, Stuttgart 1985, ISBN 3-432-80043-6 ; (a) p. 36 on stw. “various forms of somatism”; (b) p. 1 f. to Stw. “Ethnology, Comparative Psychiatry”; (c) p. 23 to district “Paracelsus”; (d) pp. 10–15, 36 on stw. "Somatism in ancient Greece, solidism, humoralists"; (f) p. 16 on head. “Means of therapy in humoral pathologists”; (f) p. 10 on tax "Greek medicine as the basis of scientific questions"; (g + h + i) p. 36 f. to Stw. "Replacement of the old somatism",
  2. ↑ Pneuma . In: Georgi Schischkoff (Hrsg.): Philosophical dictionary. 14th edition. Alfred Kröner, Stuttgart 1982, ISBN 3-520-01321-5 , p. 544.
  3. ↑ Thomas Willis : Pathologiae Cerebri et Nervosi Generis Specimen . 1667.
  4. ↑ a b c d Klaus Dörner : Citizens and Irre. On the social history and sociology of science in psychiatry. Fischer Taschenbuch, Frankfurt am Main 1975, ISBN 3-436-02101-6 ; (a) p. 35 f. to “spiritus animalis”; (b) pp. 180–185 on resident Franz Josef Gall; (c) pp. 180-189, 287, 291, 295-303, 305, 315, 316, 324 on Stw. "Somatismus, Somatiker"; (d) p. 174 f. to Stw. "Esquirol".
  5. ↑ Richard Blackmore: A treatise of the spleen and vapors . London 1725.
  6. ^ Nicholas Robinson: A new System of the spleen, vapor, and hypochondriack melancholy . London 1729.
  7. ↑ George Cheyne : The English Malady or, A Treatise of Nervous Diseases of All Kinds, as Spleen, Vapors, Lowness of Spirits, Hypochondriacal and Hysterical Distempers with the Author's own Case at large. Dublin 1733. (Facsimile: Eric T. Carlson (Ed.), Scholars' Facsimiles & Reprints, 1976, ISBN 0-8201-1281-X )
  8. ^ Pierre Pomme : Traité des affections vaporeuses des deux sexes . Lyon 1763.
  9. ↑ Jean-Baptiste Pressavin : Nouveau Traité des vapeurs . Lyon 1770.
  10. ↑ a b Norbert Boss (Ed.): Roche Lexicon Medicine. 2nd Edition. Hoffmann-La Roche AG and Urban & Schwarzenberg, Munich 1987, ISBN 3-541-13191-8 ; (a) p. 810 on tax “Humoralpathologie”; (b) 1591 on district “Solidarpathologie”; Gesundheit.de/roche
  11. ^ A b Jean-Étienne Esquirol : The mental illnesses in relation to medicine and state medicine . 2 vols., Berlin 1838. (a) Vol. I, p. 308 on the section “Suizid”; (b) Vol. I, pp. 281-300 on "Melancholie".