The European Network on Psychosomatic Medicine (ENPM) – history and future directions

It is obvious that in the last century medicine has detected several mechanisms of the etiology of different diseases along with new treatments. The scope of psychosomatic medicine has grown and been spread into new dimensions. Psychosomatic scientists need all the power and support they can get from research institutions and from collaboration with each other. In this way they can maintain a high research level in this field, which has changed dramatically during the last 50 years.

Mental disorders are highly prevalent in Europe and impose a major burden on individuals, society and the economy [2]. About twenty years ago the diagnosis of emotional disorders and psychosomatic disturbances was rare. Now, individual expectations in terms of quality of health and the phenomenon of progressive, scientific, psychosomatic understanding of diseases has increased and led to a demand for practical use of psychosomatic medicine. Acceleration in the development of significant technological advances in the field of medical science has created hope for radical improvement in life expectancy and quality of health. While life expectancy has been extended, the progress in the quality of health is unsatisfactory, mainly due to chronic, persistent emotional disorders and psychosomatic symptoms.

This new interdisciplinary setting is a challenge for practitioners – physicians, psychologists, nurses, social workers and others - and for scientists in the psychosomatic field. Many of these professionals have their own scientific societies, not only in special research fields, but also in medical specialities and sub specialities. For this reason, over the course of time different international and national societies have been formed. Compared to specialist societies like gastroenterology or psychiatry, psychosomatic or behavioural societies have a broader scope. They focus on psycho-social conditions and mechanisms according to origin and course of all somatic, somatoform and psychological diseases and want to influence their conditions by psycho-social or other interventions.

Communication between all professions in the field seems useful. The idea was born that different international and European psychosomatic/behavioural societies should be able to communicate in special research, health care, and psychosomatic training questions. This could be facilitated through special networks for scientific exchange. All medical/psychological societies involved in a special psychosomatic issues should be able to cooperate to maximize their strengths (and their ability to write research proposals for grants) in the competition with genetic, biochemical, pharmaceutical, cardiologic and other powerful research groups. This article describes an attempt to increase communication between the professions involved in psychosomatic medicine. Beginning with the history of ECPR, following with a description of the ENPM aims and development, the combining of ENPM and EACLPP and the limited success of this cooperation (see below), future directions of the aims and ideas of ENPM are outlined at the end of this paper.

The European Network on Psychosomatic Medicine was founded during the joint 25^th ECPR- EACLPP meeting held in Berlin 2004 as a forum for 21 delegates of many psychosomatic/behavioural/psychiatric/internists national societies to present their work*.

*Members of the ENPM initiative 2004/2005 were: Gunta Ancane (LV), Margarita Beresnavaite (LIT), Antonio Barbosa (PT), Hans-Christian Deter (GER), Dan Dumitrascu (ROM), Kristina Dropowa (POL), Christian Facekas (AU), Giovanni Fava (IT), Per Fink (DK), Maria Kopp┼(HUN); Ulrik Malt (NOR), Gabriele Moser (AU), Kristina Orth-Gomér (SE), Carl Scheidt (GER), Gerhard Schüssler (AU), Tatjana Sivik (SE), Wolfgang Söllner (GER), Törres Theorell(SE), Ramiro Verissimo (PT), Ad Vingerhoets (NL), Bohdan Wasilewski (PL)

An important task was to promote scientific exchange and collaboration between members of different societies and medical fields. One impressive example of such cooperation was the “Task Force for European Guidelines in prevention of cardiovascular disease”. This was concerned with the formulation of rules and recommendations on how to prevent recurrences in heart patients. The group consisted of representatives of several different societies - Cardiology, Atherosclerosis, Diabetes, Hypertension, Behavioural Medicine, Family Medicine etc. The psychosomatic contribution of the organized work group for these Guidelines was truly international and interdisciplinary. Another form of activity, centered mainly in the area of Eastern Europe, was the activity appointed by ENPM in 1994 - European Training Centre (ETC) on psychosomatic medicine, acting in Warsaw. In cooperation with the Polish Psychosomatic Society and Psychosomatic Institute, ETC has implemented educational projects in cooperation with the Polish Ministry of Labour and Social Policy - a semester program of postgraduate training for more than 600 social workers. They were trained to recognize emotional and psychosomatic disorders and to participate in comprehensive treatment.

The forerunner and important model for the ENPM was the European Conference on Psychosomatic Research (ECPR); the first of which took place in London in 1955. These conferences brought together individuals from European countries interested in psychosomatics [3]. The first three Conferences took place annually; in London, Amsterdam, and Copenhagen (Fig. 1). Then there were two bi-annual conferences in Hamburg and Madrid; after which there were conferences every three years, until 1970, with venues in Athens, Rome and Knokke in Belgium (Table 1). Elected four years earlier among the community of European researchers, a well-known European researcher was the president and organizer of each conference. Interestingly, 60 years later we recognize distinguished psychosomatic scientists who were among these successive organizers of the ECPR’s meetings o.g. Johannes J. Groen, Archibald Denis Leigh, Lennart Levi. A formal society did not seem necessary in those days, when communication was a very individualized process. The main goal of these meetings was to modernize the psychosomatic medicine focus from literature and philosophy into comprehensive research oriented toward acquiring better and sounder knowledge in psychosomatics. It seemed necessary by then to come forward with evidence-based findings obtained through experimental research and studies on the psychosomatic underpinnings of different diseases. Of relevance to this matter were the London group, D. Leigh, psychiatrists from Madrid, J. J. López Ibor and Italy, Ferrucio Antonelli, as well as internists from Amsterdam and Hamburg, J. Groen, Henk Pelser, Arthur Jores. From the 1950′s, the group was able to present, discuss and promote their own studies in the scientific journals “Psychotherapy and Psychosomatics” (1953) and “Journal of Psychosomatic Research” (1957).

At the time ENPM was founded five other societies were already involved in the “Psychosomatic field”:

There is little distinct difference in content of the various societies, they all try to integrate body and mind, but there are clear differences in methods, aims, objectives, and health care practice.

While two of the five international psychosomatic societies mentioned above were founded in the United States, the others had a European traditional background. The different developments of these international psychosomatic societies probably are an expression of the conceptual and psychotherapeutic (psychodynamic, psychiatric or behavioural) way of thinking of their members (Table 2). However, in the middle of the first decade of 2000, the time had come for a common interdisciplinary perspective and practice, free of ideological and professional “blind spots”.

The “European Network of Psychosomatic Medicine” (ENPM), dedicated to the integration of psychological, social and biological factors in health care”, was established, after a first meeting in 2004, by colleagues from European countries participating in the European meeting held in Berlin in 2005 (July 8/9). It was open to all national and international psychosomatic societies and colleges, ECPR-organizers, EACLPP, ICPM, ISBM and others.

This network was meant to be open to all European and international scientists and clinicians, as well as psychosomatic, psychiatric and behavioural societies also interested and working in this field. The founding members attending this meeting were, in one way or another, also involved with the Psychosomatic Societies from Sweden, Poland, Latvia, Hungary, Romania, Portugal, Austria and Germany; all other European and International Societies were then invited to join the European Network for Psychosomatic Medicine (ENPM).

Communication among scientists was anchored in an ENPM Homepage (http://​www.​enpm.​eu), which included hypertext links to the web-pages of all European Psychosomatic societies. The management of the Network website as well as the commitment of proposing a logo was assigned to R. Verissimo, from Porto University, Portugal. RV and HCD conducted the developmental work on computer tools and soft ware, which have enabled us to implement the ideas of free and integrative scientific exchange of ideas, concepts, thoughts, results, and conclusions. An important aim was not to engage the members in any unnecessary administrative tasks. A new model of free scientific integration that will directly benefit the quality of our scientific work and personal competence is practised. The model of psychosomatic medicine did not differ from those presented by other psychosomatic societies or associations, but the focus on communication over society borders was new.

The German College of Psychosomatic Medicine assumed in turn to host an internet discussion forum on their homepage involving all members of the ENPM, and C. Scheidt was appointed as the first manager of this forum.

Perspectives of collaboration in education and research [16]:

The need for common European actions in the field of Psychosomatic Medicine

Research in psychosomatic medicine is often conducted in collaboration with somatic colleagues, but to demonstrate psychosomatic interactions involved in some diseases we need good empirical background data in all medical domains. We have to provide evidence that special psychosomatic strategies of treatment are better for dealing with biological, psychological, and social aspects involved in these complex diseases; and we have to demonstrate, through randomized clinical trials, that the efficacy of these treatments is, at least, comparable to other commonly used treatments. Only in this way will it be possible to bring psychosomatic experiences and knowledge into a level of widely accepted national and international guidelines for these complex diseases. This seems to be a program that can be independently adopted by many psychosomatic research centres. The interdisciplinary communication and integration of important ongoing studies that the European Network on Psychosomatic Medicine intended to foster combined ideas and actions and made the acquired psychosomatic knowledge available to the health care systems across Europe.

Aims of the network

Actions, that promote the efficacy the integration of the ENPM:

Discussions at the homepage: http://​www.​enpm.​eu

Topics for action

Meetings which took place with ENPM participants, presentations, symposia, work-shops and business meetings between 2004 and 2015 were held at European, national and international Psychosomatic Conferences in Cavtat, Croatia, 2006; Zaragoza, Spain, 2008; Innsbruck, Austria, 2010; Aarhus, Denmark, 2012 (European Conferences on Psychosomatic Research (ECPR); and Sibiu, Romania, 2014 (EAPM). National meetings of the German College of Psychosomatic Medicine were held in Nuremberg, Freiburg, Mainz, Essen, Munich, Heidelberg, Berlin and of the Polish Psychosomatic society (English language in international sessions).

In 2008 a broad vision was presented. It was general and wide enough to include the aims of the ENPM and other psychosomatic/behavioural societies in Europe for the next 20 years (Table 3). The development of the ENPM was a practical organization process to frame those different and overwhelming aims. It seemed unrealistic and out of reach to manage those aims without a proper structure of its own society.

In Innsbruck 2010, the ENPM decided to found a new society, the European Federation of Psychosomatic Medicine, with a president, treasurer, and secretary, to foster interaction between individual members and different European Psychosomatic societies that would include the above-mentioned basics. After the founding meeting in Innsbruck, the idea came up of merging the ENPM - an informal network of scientists and friends - with the much more structured society EACLPP. This was done after many, partly intense discussions, among colleagues and board members of ENPM and EACLPP at the meetings in Aarhus 2012 and Cambridge 2013. The election of a European Association of Psychosomatic Medicine board took place. Since then three annual EAPM conferences (Sibiu, Nuremberg, Lulea) have been organized.

There are many national and international scientific societies active within the psychosomatic field (Table 2). As compared to primary care, gastroenterology [20] or cardiology, where one powerful society is active (e.g. the European Society of Cardiology, with more than 20,000 participants at the annual meetings), the field of psychosomatic/behavioural medicine is broader. It is in contact with all societies that represent the different medical disciplines and sub-disciplines [21]. The psychosomatic interest area (psychosomatic medicine, behavioural medicine) is also spread throughout many different scientific groups oriented or devoted to special aspects: psychosocial care/intervention, primary care or even special sub-disciplines like medical/clinical communication, psychophysiology, psycho-neuro-immunology, psychosomatic public health, health psychology, and others. All these scientists are innovative and are working in important fields of psychosomatics, but mostly without cooperation with other members of different psychosomatic sub-disciplines. The scientific journals of each society give important and new information for psychosomatic scientists about progress and new events in a special field. But, it seems necessary to intensify and combine the activities of these diverse societies involved in psychosomatic medicine. In fact this is a very diverse field. The debates on its value for clinical aspects of diagnosis and treatment are so controversial that it was necessary to promote more intense collaboration and discuss the different scientific questions raised in many groups, but also within a European Network on Psychosomatic Medicine.

This idea may be in conflict with the engagement of the individual professional groups, involving different disciplines. The structure of each group is crucial for the aims, ideas, and self-confidence of the individual members of these groups. But the situation now may be good for the field of psychosomatic medicine and its researchers. The example of the 3^rd Task force of European Guidelines on cardiovascular disease prevention, where eight societies worked together for scientifically based high level recommendations for clinical practice, is instructive in that it encouraged us to organize a communication platform for psychosomatic and behavioural medicine in Europe [10, 22].

The question for the newly founded society EAPM was which way to go. This was not only a network activity for European researchers on the same level, but included now also a president, vice president, board, the EAPM members, and the associated societies of EAPM. What should be the targets and challenges of the new society in the area of European psychosomatic medicine (Table 2)?

Firstly, a clear definition:

In psychosomatic practice, a tendency to focus on special aspects of clinical care, e.g. C/L psychiatry, psychotherapeutic medicine applied by physicians, or behavioural therapy in medicine, can be identified. Such limitations are not necessary and will not be widely accepted by others (e.g. ICPM, ISBM), they do not present the whole field. For the challenges of psychosomatic medicine, mentioned above, it seems important to focus on crucial points.

Our goal was to foster international and European psychosomatic/behavioural societies. How should they communicate and cooperate in special research, health care and psychosomatic training questions? We saw the importance of establishing networks to combine the strengths of all societies working in the psychosomatic field.

What happens with the aims of the former ENPM after the decision has been made to cooperate in one single society (Table 4)? EAPM started a really good process in developing by-laws and an exemplary administration, having now at the annual meetings delegates from 23 European countries, integrating ten national societies of C-L-psychiary and psychosomatics (5) and Psychosomatic Medicine (5) as members; which was one of the goals in ENPM. EAPM could cooperate in the conferences 2014, 2015 and 2016 in common satellite symposia with ICPM or ISBM.

The founding of EAPM stimulated new ideas in the former EACLPP (to be more integrative, more interdisciplinary, and multi-professional), but the three main targets of the former ENPM (see above) could not be activated and stimulated. Additionally the communication among scientists (4) was anchored in the ENPM-homepage, which included links to the web pages of all European Psychosomatic societies. But the cooperation with other somatic medical societies, e.g. European Guidelines in different somatic diseases (5), giving support for psychosomatics in primary care (6), developing a psychosomatic diploma in European countries (7), or support European exchange programs for students, postgraduates and other research fellows (8) were not intended. ENPM-perspectives of collaboration in communication, research, care, and education and the results within the EAPM after four years of co-working are described in Table 4.

However we have to accept that the EAPM is a standard society with common ways of thinking and acting, which was unfortunately impossible to discuss and address in an adequate way.

We want to propose target areas for EAPM activity, according to our earlier ENPM ideas. Different aspects require different solutions. One intervention that works for one target group may not work for another group. One reason is that at least three different professions are involved in psychosomatic care and research. They are psychiatrists, psychologists, and specialists in internal medicine or other specialties.

Researchers have different interests and agendas: E.g.some research has a bias towards psychological-psychotherapeutic and psycho-physiological aspects of diseases, others focus their research primarily on co-morbid mental and somatic diseases and how to- intervene, including drug treatment [27]. This implies that some will want to attend “somatic” and psycho-physiological meetings, while others may tend to attend psychiatric meetings. It is by no means obvious that a network at the beginning will include all those aspects, so these suggestions must be seen and developed much more specifically and focused. “One size fits all” will not work, but it seems important that a first step focus on co-working between groups and overcoming barriers between individuals and organizations.

In our experience, this is not an easy way. After an intense discussion of these thoughts, the EAPM board minimized or declined (March 2016) to build an ENPM-discussion forum at the EAPM-website (free part) with separate platforms for interested scientists in working and special interest groups and with links to European national and international psychosomatic societies or to elect one or two EAPM delegates/board members who would be responsible for continuous cooperation with the different psychosomatic and behavioural scientific groups/societies in Europe.

Perhaps some of the EAPM members want to communicate with others, but it may be questioned to what extent they can succeed. The main difference between ENPM and EAPM remains the society structure, which was focused on the their own conditions/by laws and their own membership and which tried to built a closed shop (not only on the web site). A specialist society for psychosomatic medicine should be the basis of EAPM. Members should inform “physically oriented care givers” in different specialties about the existence, origin, and treatment of psychosomatic disturbances (see above). EAPM members - CL psychiatrists/psychosomatic physicians- are seen as specialists (it remains unclear if for all diagnoses mentioned above in all specialties of bio-psycho-social medicine or only for the limited diagnoses of anxiety, depression, somatoform disorders in C/L-psychiatry or in the psychosomatic specialty). In this sense psychosomatic medicine is not the same as behavioural medicine [8] and the main focus of this society certainly does not represent the “art of healing” applied by all physicians [28].