The mind's role comes into focus

"They were convinced that I was going to tell them, 'It's all in your head,' " said Feldman, a psychiatrist now practicing in Birmingham, Ala.

That was the late 1980s. Since then, patients and doctors alike have come to better understand how the mind and emotions affect physical illness, a field known as psychosomatic medicine. In March, the American Board of Medical Specialties will decide whether to create a medical subspecialty in it. The designation would lead to more specific training, easier identification of experts and improved insurance reimbursement.

Hundreds of psychiatrists have asked for the designation, which they say is a first step in helping patients get appropriate treatment. "When you make a specialty official, you increase the likelihood of people finding you," said Dr. Nina Stotland, a professor of psychiatry and obstetrics-gynecology at Rush Medical College in Chicago.

And Kaiser Permanente, the state's largest HMO with millions of members, has launched a program that uses mind-body techniques to help people with chronic health conditions. It has proved so effective it will be made available free to Kaiser members and some nonmembers beginning in spring.

"I'm surprised it has taken medicine so long to recognize what is obvious; how single-minded and relentless we've been in reducing and separating mind and body in medicine," said Dr. David S. Sobel, director of patient education at Kaiser Permanente.

The barriers separating the treatment of physical illness from thoughts, feelings and attitudes haven't fallen entirely, however. Many people still don't understand psychosomatic medicine, often mistaking it for imaginary illnesses; few hospitals and doctors know where to send patients who may need it; insurers often don't pay for it; and even experts aren't sure what methods work best for specific illnesses.