Christoph Herrmann-Lingen, MD, APS President
Sometimes I feel disturbed by things going on in the world during these days: Armed and verbal violence appears to be affecting more and more peoples’ lives. Or it even takes their lives away. Politicians talk of closing borders or actually do close borders. Scientists are prohibited from visiting other countries. Separation seems to become more promising than collaboration, and illusions of total security increasingly seem to trump freedom: Freedom of travel, freedom of speech, even freedom of science. War is getting more and more into brains and political language as a supposedly legitimate strategy of solving economic and political problems. A desire for strong leaders is growing in many parts of the world and those already in place have to fear little opposition.
One example that concerns us here in Europe is our friend and ally Turkey. After the recent failed military coup, over 1500 deans have been removed from Turkish universities, over ten thousand citizens have been arrested, among them judges, teachers, scientist, and journalists. Many scientists are prohibited from leaving the country and those working abroad are required to return home, including a few colleagues working at our university.
A German journalist who had been working in Istanbul had to leave even months before the failed military coup, because the Turkish government didn’t renew his accreditation. He had been living there for a few years and loves the country. In a recent commentary he mentioned that some friends had called him happy for no longer having to live in Turkey. And he summarized his mixed feelings by stating that “for all of us to see, democracy is dying over there - or what has been left of it. The world just stands on the sidelines. And I feel sad for having to be happy not to live in Turkey.”
“Feeling sad for having to be happy” - these are strong and touching words. And they sound quite healthy, showing an impressive ability to consciously perceive and express complicated emotions. There are far too many emotions in this world that are neither perceived in such a differentiated way nor expressed appropriately. With emotions being strong drivers for human behavior, unfelt, suppressed or misnamed emotions seem to produce many of the odd things that are currently going on in the world. Affective agnosia or emotional numbing resulting from early or later life trauma, hatred and xenophobia arising out of fear, shame and feelings of humiliation in people who perceive themselves as disadvantaged and often are, all prepare the ground for political extremism and violence from various sides. "Anger kills”, as APS past president Redford Williams and his wife Virginia say in their influential book. From the beginning of APS it has been widely acknowledged that strong emotions don’t only kill through openly violence but also through more subtle ways of self-harming behavior and through physiological processes that may have been adaptive in our prehistoric ancestors but are less so or frankly maladaptive in today’s societies.
Most emotions are closely related to interpersonal relationships and many are related to adverse health outcomes, especially strong or chronic negative emotions. It has been a merit of APS and its members to scientifically demonstrate and characterize these associations. However, many questions are still unanswered. This may in part have to do with the fact that we are still not particularly good at identifying emotions, especially if they cannot be easily expressed.
The young man who recently shot dead nine mainly young people in Munich before killing himself had obviously seen a psychiatrist before and was diagnosed with a depressive disorder and social phobia. He may have had a positive Beck Depression Inventory and Liebowitz Social Anxiety Scale but in the background there must have been other, possibly missed emotions that made him a gunman on rampage. We miss a lot of unexpressed or unfelt affect also in patients with somatic symptoms. Many of my patients, whether they have organic heart disease or mainly functional somatic symptoms, find few if any words for what they feel beyond the physical pain or discomfort. This may be due to alexithymia or affective agnosia. It may also be culturally unacceptable or personally embarrassing to express “soft” emotions such as sadness, fear or shame. But what we and many others typically observe is that when people learn to feel and express the whole variety of (both negative and positive) emotions, the physical symptoms and maladaptive behavior patterns tend to improve.
APS is in the ideal position to bring together such clinical experience with cutting edge neuroscience and psychophysiology. Our recently adopted strategic initiative to foster affect science in medicine focuses on these core competencies of our membership. It is also a great opportunity for collaborations with like-minded societies: For the 2017 Annual Meeting in Sevilla (Spain) we are working with the European Association for Psychosomatic Medicine (EAPM) in preparing a full-day preconference workshop on “Emotions, Somatic Symptoms and Bodily Distress Syndromes”. The 2017 special topic meeting is planned together with the Society for Affective Science (SAS) and will focus on Emotions in Social Relationships and their Implications for Health and Disease.
If we deepen our understanding of the biological processes linking emotions and physiology this may help extend our treatment options for several conditions that contribute substantially to the global disease burden and ever-increasing expenses for the health care systems worldwide.
To further increase international collaborations in psychosomatic and biobehavioral research we have recently decided to partner with the International Society of Behavioral Medicine (ISBM) to offer an international lab exchange program on a competitive basis. Please see the announcement in this newsletter.
As a member society of ISBM, APS has nominated former APS Secretary Treasurer Urs Nater (Marburg, Germany) for the ISBM Outstanding New Investigator Award this past spring and I am very happy to announce that the ISBM has followed our recommendation to award Dr. Nater this prestigious award for his groundbreaking research on biobehavioral associations, including the role of salivary amylase as a stress indicator. Congratulations to Urs!
Technological progress will be of high relevance for getting a fuller understanding of how the variety of emotions occurring during everyday life affects our physiology and health. Equally, technology may help in delivering conventional therapies, such as CBT, to patients who have insufficient access to in-person medical or mental health care. It may help to cross borders and computerized CBT programs have, for example, been used successfully to support traumatized victims of war in Arabic countries. Technology may also help us to fine-tune interventions and may even generate completely new therapeutic paradigms. I feel excited and proud about the many possibilities our area of research is promising and can hardly await our 2017 Annual Meeting specifically addressing the great opportunities technology may provide for our field.
However, as a clinician I also feel somewhat concerned about the future of healthcare, where technology can do a lot to increase our therapeutic armamentarium but should not (and cannot) replace a trustful provider-patient relationship. Transfer of technological advances into healthcare should always place the patients' needs first. These are not limited to technical cures for physical ailments but also include needs for personal contact with an opportunity to experience and express uncertainty and - sometimes existential - fears arising in the face of serious illness, need for privacy of sensible health data also in times of ever-present mobile health applications, need for guidance in the abundant market of medical “products”, and many more. Also in times of thriving technology development, ethical reflections on the changes and challenges associated with technological progress and “old-fashioned” physician-patient communication remain timely issues.
APS members have been active during all of APS' history in educating healthcare providers about psychosocial consequences of new medical treatments and about helpful provider-patient communication. In one recent initiative we are planning to increase visibility for such efforts. Our idea is to share through our website and other channels links to educational materials developed by our members. Hence, if you have educational materials to publicize, please contact the APS national office or the Professional Education Committee, so we can make other members and the broader public aware of them.
Since space is limited here, I cannot elaborate more on all ongoing activities in today's message, so why don't you visit our website from time to time or attend this year's high-profile special topic meeting on Neuroscience of Pain held on October 15 at the New Marriott Downtown Hotel? Besides cutting-edge keynote lectures there will be sufficient room for inspiring scientific exchange, including - for the first time during a fall meeting - an attractive poster exhibition. Space is limited for this outstanding event but registration is still open.
And don't forget to submit your best recent work for the 2017 Annual Meeting!
I hope to see many of you at the upcoming events and to celebrate APS' 75th anniversary with you next year. It is a wonderful feeling to be connected to the energetic, diverse, and dedicated group of colleagues that make up the APS membership. However, it will become more and more important to stand together and to actively maintain our diversity. So bring your colleagues for the next meeting you are planning to attend! We especially welcome those involved in both research and patient care, because they are so vital for connecting our basic research to the practice of healthcare.
And raise your voices wherever the freedom of science and the freedom of international collaborations get under pressure. There are so many disturbing things going on in our world in these days - and this is not limited to Turkey and the Middle East. So, when thinking of the journalist I mentioned above, I hope there will be no need for me to be happy that my presidency for the American Psychosomatic Society ends next year. However, the political scene might change in such a way and that would really frighten me and make me sad. I can do little about this but explore and express my feelings (which is at least more than just ignoring them) but those of you living in the US can do more. I am wondering how you all feel about the home country of APS in these days and what each of us and we as a group could do to keep your great country on track. Any ideas?