Biopsychosocial Medicine

Almost two-and-a-half millennia have passed since Hippocrates, in his Airs, Waters and Places,1 noted the importance of the social milieu in disease aetiology, and a millennium since Ibn Sina (Avicenna) examined the interrelation between psyche and soma.2 In one memorable case a person in the royal household sought Ibn Sina's advice during an attack of acute lumbago. Suspecting a psychosomatic aetiology, the great man asked an aide to publicly remove her scarf. Seeing that this did not produce the intended outcome he then raised the stakes—to the horror of others present—and ordered the aide to remove the patient's trousers. Faced with this threat the patient immediately jumped from the couch and ran out of the room. In a second case he was asked to see a young man whose affliction had baffled the most brilliant medical minds in his area. Ibn Sina talked at length with the young man about his day-to-day habits, carefully monitoring his pulse as they spoke. He noted how the young man's pulse began to race when the subject turned to the local baker's shop, to which it transpired he made regular visits. Once on the scent, Ibn Sina quickly observed that the pulse quickened yet further when mention was made of the baker's sister. The diagnosis was love sickness, and his prescription of marriage (fortunately acceptable to all concerned) proved effective. Ibn Sina was thus able to demonstrate that important criterion of a causal association, reversibility.3