[Psychosocial and psychosomatic medicine as well as psychotherapy in Switzerland -- developments over the past fifty years].

The development of psychosocial and psychosomatic medicine in Switzerland is as diverse as the country itself with its four official languages and 26 cantons. Psychosomatic medicine of the past and present can be seen in three phases: Psychogenesis of somatic diseases ( phase 1: from about 1930-1960), bio-psycho-social medicine (phase 2: from 1960-1990) and psychobiology in medicine (phase 3: since 1990). In Switzerland the first phase scarcely noticeable, whereas active development in all fields of psychosomatic medicine and psychotherapy has taken place since 1960. The main tendencies of this development are described. The current situation for patients with psychosomatic and somatopsychic disorders is quite good in the outpatient setting. For inpatient treatment there are only about 400 beds in 19 small departments for the whole country. The strengths of the psychosomatic service system are well-established cooperation of doctors and psychotherapists and only few reactions by health insurance companies. Weaknesses are too few inpatient treatment facilities with long waiting times for patients and a lack of specialized treatment for migrants with psychosomatic disorders. Future prospects are not rosy due to the financial situation in the healthcare system, but neither are they bleak, since patients are emphatically asking for more narrative-based medicine and a partnership-based doctor-patient relationship.