Clinical Psychosomatic Obstetrics & Gynaecology: beyond superficial diagnosis
By Dr. Mira Lal
Image credit: Hand by Aditya Romansa. CC0 Public Domain via Unsplash.
Since ancient times many doctors have taken an approach to medicine that integrates considerations of both body and mind. Despite differences in their underlying medical systems, mind-body (psychosomatic) approaches were not only part of healthcare provision in Greece and Rome but also as far afield as India and China. Furthermore, when the first European medical school was established in Salerno in the 11th century, Latin scholars working there adopted the Greco-Roman principles as part of their teachings.
With the dawn of the Enlightenment in the 18th century, doctors began to place gradually increasing emphasis on the physical aspects of diagnosis, whilst mental factors started to become relatively neglected. Even in this era, the usefulness of selectively applying a psychosomatic approach was documented by Sir William Osler in North America, as well as the British obstetrician, William Smellie, showing that a balanced mind-body perspective could still enhance therapeutic success in some patients. As medicine progressed scientifically, with new technological developments and drugs, physicians focussed increasingly on the body at the expense of the troubled mind, and some patients were driven to seek relief elsewhere. Psychosomatic disease conditions frequently remained unaddressed.
Patients remain dissatisfied when their illness is not diagnosed accurately, as in those presentations requiring a psychosomatic approach (Lal, 2009). This leads patients with psychosomatic clinical conditions to seek medical attention repeatedly; some develop detrimental neuroendocrinological dysfunction, with major financial implications for all involved. This underserved area, which also encompasses clinical psychosomatic obstetrics and gynaecology, requires further exposition for those wishing to better grasp this emerging focus in medical practice.
Since the advent of the new millennium, thanks to the efforts of scientists across a range of disciplines, our understanding of the anatomical and neuroendocrinological interactions underlying the pathophysiology of mind-body connections has progressed considerably. Through this, we are beginning to discern the scientific underpinnings of the benign and malignant psychosomatic conditions that affect women (read this freely available chapter) (including teenagers) from conception to menopause. Besides these, it is recognised that psychosomatic sequelae can follow untreated pelvic infection, which can lead to pelvic pain, infertility and cervical cancer. Similarly, to minimise biopsychosocial illness associated with childbearing, including caesarean births, associated pelvic floor disorders and obesity need a psychosomatic evaluation while the management of endometrial cancer in young adults requires a close scrutiny to minimise negative mind-body interactions.
Postpartum dysphoria and post-traumatic stress disorder after violence, including genital cutting, remain important mental and physical health issues, whilst the selective transgenerational effects of stress and obesity are gaining wider recognition in relation to disease prevention. The worldwide prevalence of clinical scenarios resulting from mind-body interaction confirms a global need for doctors to address these, whether their patients are locals, migrants or refugees.
Two of the primary ethical considerations in medical practice are non-maleficence (to “do no harm”) and beneficence (to heal the patient). Learning when and how to practice the clinical psychosomatic approach appropriately, going beyond mere lip service, would reduce medical error and the associated harm that is often under-recognised.
Dr. Mira Lal is an Obstetrician & Gynaecologist specialising in the physical, mental, and social facets of women's disease and well-being. She was granted Fellowship of the Royal College of Obstetricians & Gynaecologists, in recognition of her attainments, besides invited publications/reviewing, for "advancing the Art & Science of Obstetrics and Gynaecology".
Dr Lal is the author of Clinical Psychosomatic Obstetrics and Gynaecology, which aims to promote ethical practice by bridging the reader’s knowledge gap.
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