Cairns Aitken

Psychosomatics for all--past, present and future.

It used to be fashionable to begin consideration of psychosomatics about philosophy of mind and body. Nowadays it is a topic about health and practical care of patients--principally about the psychological aspects of any illness. Pathogenesis is becoming understood with some risk factors clearly identifiable. The high incidence of symptoms attributable to emotional disturbance has now been described in so many conditions that it is altering the delivery of health services. The boundaries of psychosomatics are extending. No longer is the topic confined to a few chronic diseases, even including new ones like AIDS, but it now includes support for carers and education about behaviour for health, to name two currently important aspects. The responsibility for the biopsychosocial approach does not lie alone with doctors, and certainly not only psychiatrists, but the many professionals involved in clinical care. The aim is not simply reducing symptoms, but improving functional capabilities and preventing social disadvantage. The more the advance of knowledge, the more intriguing become the questions awaiting answers. The risk factors due to predisposition or unhealthy behaviour and stress still only account for a small contribution to aetiology. Coping mechanisms, whether in personality or social support, still defy enough understanding to predict which patients will develop emotional disturbance, and which patients will respond to appropriate treatment. Perhaps, the most intriguing question is why, when certain relevant facts about unhealthy behaviour are beyond dispute, such as the effect of drinking excessive alcohol, smoking nicotine, having unsafe sex, poor family caring or receiving insensitive treatment, it remains so difficult to bring about improvement.(ABSTRACT TRUNCATED AT 250 WORDS)

Help in the Home Needs of Disabled People

In spite of the economic situation, current government policy is to increase both the quality and quantity of assistance available for the disabled person. However, there is evidence1 of confusion in the knowledge, development, prescription and use of such services. The aim of this project was to ascertain facts on the needs and knowledge of people with mobility problems — regarding aids, appliances, equipment, allowances and services available for the disabled person. This account reports the information obtained relating to help in the home.

Current Psychosomatic Research

An earlier speaker at the conference Dr. Haralambides quoted Sir Douglas Black saying in 1981 that “the greatest enemies of progress in any branch of science are dogmatically held beliefs.... the best protection from a dogmatic cast of mind is some experience in research....” With that sentiment I heartily agree.

Psychosocial Aspects of Disease and Their Management

The pathogenesis of psychosomatic distress is considered. This emphasises interest in aetiology of distress rather than solely of disease. The influence of psychological aspects is as important whether the disease is of known or unknown aetiology, and can be of greater importance in poorer socio-economic circumstances. The doctors role is to tease out the influence of these many factors. Certainly a holistic approach is necessary to assess and manage appropriately patients with disability. There is an important role for psychiatrists within services for management of such patients. Leadership by all doctors and psychiatrists in particular to apply the holistic approach should be encouraged.

Some Remarks about the College and Its Future

Some Remarks about the College and Its Future We are now 13 years old. Proverbally, we have reached our manhood and womanhood. But more likely we have only been thrown into the maelstrom of adolescence. This is our 7th congress and it seems we are in an appropriate identity crisis – who we are, where do we wish to go? We have lost our founding father. We have a membership of 400. We have wandered from Kyoto to Jerusalem. Our attendance has been as high as 1,300 and as low as the current conference. It gives us an opportunity to ask if smaller more focussed congresses are better? Will they get us beyond the platitudes and reiterations of the past toward more mature formulations of integration and synthesis? Perhaps we are establishing an identity. However, there are whole continents in which our presence and our effect is either limited or nonexistent. There is a second and a third world that we have failed to align. We have prestigious vice presidents and councillors, as well as a body of delegates whose use the Administration has tapped limitedly. We are a body without a head in the sense that we have failed in our efforts to establish a journal. The quality of our meetings has been increasingly good, as I am confident this congress will demonstrate. However, the work in their formation has been that of a few. We need to inquire of ourselves of the forwardness of our theories and of the originality of our research. How often do we confuse statistical correlations ofendless variables as proof and substantiation, independent of critical reasoning? Future administrations will need to develop communicative and directive skills in order to tap its officers, as well as its younger members at large to do the job that they have been expected to do. I believe that under the auspices of the Program Committee, with frequent communication, the officers and commitee chairpersons should be responsible for the organization of symposia in the area they share, drawing on their knowledge of the new and seminal work that is under investigation, often outside of our purview. The delegation and tendering of this responsibility will insure the quality ouf our presentations and discussions, allowing our congresses to be more scientific, more communicative, and more conceptual. Several of us believe that our congresses should return to the campus where there is a natural environment for the membership to interact and participate as scholars in a setting conducive for the intimacy of scholarship outside of, as well as within, our more formal sessions. Would this not be a more facile environment in which to bring in our students and associates from other disciplines? Within these settings, there Some Remarks about the College and Its Future 11

Opening Remarks to the 7th World Congress of the International College of Psychosomatic Medicine

Opening Remarks to the 7th World Congress of the International College of Psychosomatic Medicine Standing here, opening our 7th World Congress I am at the same time breaking a very solemn promise – practically an oath -given or sworn 24 years ago. Then – in the spring of 1959 – having been at the Hamburg Clinic for only a year, I watched Jores and Freyberger hosting and organizing the European Congress of Psychosomatic Medicine. What I perceived from my lowly position were hurt vanities of speakers or chairpersons for not having been attributed an adequate position, fights for more speaking time, and delays in the delivery of manuscripts. In my eyes – and this made the whole process simply agonizing – all these troubles seemed fully uncompensated by clear success experiences. As a consequence I gave myself the solemn promise to do anything and everything humanly possible to evade ever hosting an international congress. Having broken my oath with qualms and apprehensions, I can tell you now that the latter were completely unfounded. However, this may be a stroke of luck due to two external but mutually interacting factors. One is the cooperative dedication and zeal of the whole staff of our Psychosomatic Department. It is a very small team, but we managed with only two outside cooperations: Bernd Dahme from the Department of Medical Psychology, and – and this is the second factorthe expert help of the professionals of the Congress Center Hamburg. I am thanking them all for their work and for their dedication. Their cooperation achieved that computer outprints of plenary and symposium speakers were correct, the layout of programs attained expectations, the budget was updated regularly, and the timetable was kept throughout. Thus we have already had our success experiences and our narcissistic support, and therefore we can invite you to feel free of moral obligations and just give vent to your feelings. However, if we are quite honest, we would prefer you to enjoy the V∏th ICPM World Congress and we believe there is an objective albeit predictive reason for this. You certainly never have heard of the Meyer/Freyberger PPWC theorem, because we have only discovered it – independently but convergently – ad hoc of this world congress. PPWC stands for Progressive Pauperization of World Congresses. Its mechanism is an exceedingly simple and easy to understand economic process, one could call it the leverage depression acceleration for certain taxo-nomic subgroups of society (here scientists Opening Remarks 9

Rehabilitation Studies Unit at the University of Edinburgh From Fantasy to Fact

The author was appointed to the Chair of Rehabilitation Studies in the University of Edinburgh in 1974. Since then specialised services in Rehabilitation Medicine have been introduced for locomotor, cardiac, and neurological disorders. These are based on multiprofessional teams, practising the bio-psycho-social approach to tackle the patients problems. Research studies are under way on some aspects of these clinical problems, and on evaluation of rehabilitation services and of equipment for disability. Four Occupational Therapists have had a key role in measurements of outcome, particularly related to the needs of wheelchair users, the mobility of those eligible for Mobility Allowance, morbidity from hand injury, and the role of specialised equipment in assisting severely disabled people to live in the community. Advice and teaching is based on the knowledge and experience gained from those clinical and research studies.