Psychosocial aspects of disease and their management.

The pathogenesis of psychosomatic distress is considered. This emphasises interest in aetiology of distress rather than solely of disease. The influence of psychological aspects is as important whether the disease is of known or unknown aetiology, and can be of greater importance in poorer socio-economic circumstances. The doctor's role is to tease out the influence of these many factors. Certainly a holistic approach is necessary to assess and manage appropriately patients with disability. There is an important role for psychiatrists within services for management of such patients. Leadership by all doctors and psychiatrists in particular to apply the holistic approach should be encouraged.