Contemporary physicians often file the study of relations between body and mind under the rubric of psychosomatic medicine, a mid-twentiethcentury movement inspired by a self-conscious desire to counteract what its founders felt to be the profession's dominant mechanistic and reductionist tendencies. Yet interest in the relationship between body and mind is, of course, much older. Physicians have always assumed that emotional factors can induce sickness, undergird health, or – properly manipulated – bring about its restoration. The hypothetical mechanisms used to explain this interdependence have changed during the past few centuries, but the clinical reality they sought to explain has never been in doubt.

This essay was originally delivered as the Benjamin Rush Lecture to the American Psychiatric Association in 1988 – at a moment when the longtime domination of dynamic, intrapsychic models in psychiatry had waned, while somaticism had attained increasing prominence. I tried not only to suggest the antiquity of medical concern with the interaction of body and mind but also to underline a continuing and more general ambiguity. As we concern ourselves increasingly with individual lifestyle as a factor in the pathogenesis of chronic disease – in cancer and circulatory disease, for example, or alcoholism – we underline another aspect of mind: volition and thus responsibility. In that elusive and shadowy terrain between blaming and explaining, the relevance of body-and-mind relationships remains central, especially when we consider choice as well as stress.