Presidential Address-1974: From Explanation to Action in Psychosomatic Medicine: The Case of Obesity

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Abstract
Psychosomatic medicine began as a social movement within medicine, designed to counteract the mechanistic and impersonal features that had accompanied the introduction of science into medical education. In its early days, therapeutic inefficacy led to a concentration upon understanding the origins of disorders in which emotional determinants played a role. To a large exten, psychosomatic medicine is still identified with such understanding. Within recent years, however, the development of increasingly effective therapeutic techniques has changed the emphasis in psychosomatic medicine from understanding to action. These developments are particularly well exemplified by the case of obesity. Social investigations have revealed that the prevalence of obesity within populations is determined to a very high degree by social factors, operating in an unplanned and uncontrolled manner. More planned social intervention, particularly by means of behavior modification, has improved the effectiveness of treatment of obesity by a factor of 2. Furthermore, this intervention has been subjected to research whose increasing effectiveness derives from the availability of both a powerful independent variable—specification of the precise behaviors of the therapeutic intervention—and a dependent variable of unprecedented reliability, validity and economy in psychotherapy research—weight change in pounds. Some of the new experimental designs developed in this research are laying the groundwork for a truly cumulative science of psychotherapy. The development of more effective treatment techniques leads to the question of how best to deliver them. The relative merits of medical auspices, patient self-help groups and commercial enterprises are discussed.

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