The mind affects the way the body functions just as the body affects the way the mind functions. Psychosomatic Medicine is the study of this interrelationship. Certain aspects of this field are commonly accepted, such as the role of chronic anxiety on blood pressure; other aspects of it are in dispute or are areas of controversy, such as the role of chronic stress in the development of autoimmune disorders. With rare exceptions, the field of psychosomatic medicine is best addressed by a psychiatrist because psychiatrists are medical doctors. Other specialists such as neurologists and orthopedists, for example, frequently encounter the area of psychosomatic medicine when their patients complain about physical disorders which frequently have a psychological input. Chronic headaches, for example, commonly the purview of the neurologist, may also have a significant anxiety input or depressive input. In my discussion of chronic pain, I discussed the interplay between chronic pain and anxiety and depression. For many years, there has been a great deal of research into the relationship between chronic stress, personality type (type A or type B), and the subsequent development of arteriosclerotic heart disease. The relationships among ASHD (heart disease), chronic stress, personality type, and blood pressure variations are probably explainable on an endocrine level as well as psychological level.

The forensic psychiatrist is generally quite familiar with areas of psychosomatic medicine, including the relationship of acute loss and subsequent development of juvenile diabetes, emotional trauma, the development of certain autoimmune disorders such as Hashimoto’s thyroiditis, the effect of chronic stress on the progression of ulcerative colitis, and the effects of chronic stress on development and progression of chronic headaches or chronic pain. Understanding and appreciating this interface enables the forensic expert to describe its effects to a trier of facts.

See Dr. Raffle’s commentary: “Pain and the Mind,” also “Chronic Pain” and “Malingering