Abstract
In the letter to the editor by Amad et al. (2016), the authors pointed out that by semantic traditions in clinical practice and medical teaching, psychiatric disorders are often seen as different from somatic disorders. The authors rightly criticise this distinction, because according to natural science concepts, all behaviour and introspective phenomena are based upon processes within the organism and particularly within the brain. Therefore, psychiatric disorders are also somatic disorders. I support the recommendation of the authors that instead of maintaining the dichotomy between psychiatric and somatic disorders, the sole distinction to be made is between psychiatric and non-psychiatric disorders.
How should one respond to patients who ask whether they are suffering from a psychic or somatic illness? In my experience, the metaphor of the two-sided coin has turned out to be helpful.
When observing a patient with a psychiatric disorder, we always have two levels of observation, similar to the two sides of a coin. On the one side, we have the behavioural level, comprising the psychosocial aspects, with all present and past (verbal and non-verbal) environmental experiences. For example, in patients with depression, vulnerability factors (e.g. traumatisation in early life) and triggers of an episode (e.g. life events) may be identified, and psychotherapy can be offered as causal treatment. On the other side of the coin, one can observe what is going on within the organism, the physiological aspects, comprising also the neurobiological processes. Again, we can look for vulnerability factors (e.g. (epi)genetic factors) and triggers (e.g. changes in stress hormones), and antidepressants can be offered as causal therapy.
This metaphor of the two-sided coin supports a disease concept that conceptualises the behavioural and physiological aspects as complementary and not in an either/or relationship. These two sides of the coin are present in all disorders. In diabetes mellitus, for instance, we have the behavioural and psychosocial side that, for example, suggests diet and sport as treatment options and the physiological side that suggests insulin therapy.
See Letter by Amad et al., 50(1): 100–101.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Funding
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