Epigenetic Interactions and the Brain-Body Communication.

and rehabilitation of medical disease, and (4) multidisciplinary organization of health care that overcomes the artificial boundaries of traditional medical specialties’. They note that the concepts of ‘allostasis’ and ‘allostatic load and overload’ [3–6] have played a major role in the new version of the practice of psychosomatic medicine. This Editorial discusses the links of psychosomatic medicine to neuroscience and systemic physiology and their growing importance. A starting point is the ambiguity of the word ‘stress’, which can refer to ‘good stress’, ‘tolerable stress’, or ‘toxic stress’ (http://developingchild.harvard.edu/science/national-scientific-council-on-the-developing-child/). This 3-part terminology is helpful because it recognizes that the sense of control and mindset [7] determines whether or not the response to experiences can have a successful outcome or may lead to disease. However, this terminology ignores health-damaging and health-promoting behaviors that people adopt in a stressful lifestyle, as well as factors like circadian disruption, loneliness, noise, pollution, and crowding. What is also overlooked in the conventional view of ‘stress’ is the recognition that the body releases mediators of the neuroendocrine, autonomic, metabolic, and immune systems in response to all experiences in a changing physical and social environment (whether or not we call them ‘stress’) and that these mediators help us adapt to and survive the changing conditions. Yet the same mediators, when overused or dysregulated amongst themselves, can cause wear and tear on the body called allostatic load, or allostatic overload in its most extreme form, which contributes to disease [5, 6, 8] . There is a saying ‘it’s all in your head’ that is used dismissively to someone complaining about feeling badly but without a clear illness and intended to imply that the problem is not important or ‘real’. The article by Fava et al. [1] contradicts this outdated attitude and describes psychosomatic medicine as a vital and growing field. With the recognition that the brain is the master controller of systemic physiology as well as a vulnerable and plastic organ that responds to signals from the body, ‘it’s all in your head’ takes on new meaning. Because of new knowledge from neuroscience and systemic physiology, psychosomatic medicine has taken on new significance and provides particularly important details about the individual personality that can lead to more effective interventions. Indeed, in an era of medicine where silos based on organ systems or disciplines predominate, the individual needs are often overlooked, and interventions on one organ system often do not consider the consequences for other organ systems and for the whole person [2] . In their article ‘Current psychosomatic practice’, Fava et al. [1] state that ‘psychosomatic medicine is a wide interdisciplinary field that is concerned with the interaction of biological, psychological, and social factors in regulating the balance between health and disease. It provides a conceptual framework for (1) scientific investigations on the role of psychosocial factors affecting individual vulnerability, course, and outcome of any type of medical disease; (2) a personalized and holistic approach to the patient, adding psychosocial assessment to the standard medical examination; (3) integration of psychological and psychiatric therapies in the prevention, treatment, Received: August 12, 2016 Accepted after revision: August 16, 2016 Published online: November 25, 2016