Psychiatry and Psychosomatic Medicine in Germany: Lessons to be Learned?

Objective: To describe the reshaping of the German system of psychiatric services in the wake of the international social psychiatric movement and the beginnings of separate consultation–liaison (C-L) psychiatry and C-L psychosomatics services, to outline the differences and similarities of these two disciplines, and to see whether there are lessons to be learned from this unique development that may be relevant to other countries. Method: The author draws on material published in German and international publications, and on his experience as co-chair of the Section of Behavioral Medicine and Consultation Liaison Psychiatry of the German Society for Psychiatry, Psychotherapy and Neurology. Results: Consultation–liaison psychiatry services are provided in virtually all German general hospitals, mainly by the medical specialty of psychiatry and psychotherapy and to a lesser extent by the specialty of psychosomatics and psychotherapeutic medicine, exclusively so in 5%. The latter specialty includes non-psychiatric physicians. The unique history of combined neurology and psychiatry training until 1992, and of mandated psychotherapy training in both specialties shapes the service provided but also sets up tensions. Conclusions: Lack of empirical evidence prevents objective assessment of the advantages and/or shortcomings of this two-stranded system, but its existence may sharpen the ongoing debate about how C-L services should be structured in other countries.