Fillers A memorable patient

Suffering in silence

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7283.425 (Published 17 February 2001) Cite this as: BMJ 2001;322:425
  1. Murad Khan, consultant psychiatrist
  1. Dartford

    In less developed societies where poverty, illiteracy, and deeply ingrained cultural beliefs coexist, human distress can take on an unimaginable garb.

    I saw her in the mental health clinic in Orangi, one of the many slum areas of Karachi, Pakistan's largest city. She was barely 5ft tall and, walking with a slight droop of the shoulders, looked shorter still. The doctors could not find any reason for her complaints—headaches, palpitations, weakness, appetite, and weight loss. Various analgesics, vitamins, tranquillisers, and antidepressants had had no effect. X rays, endoscopies, blood and urine tests were all normal.

    Married with two grown up sons, she had no other living relatives. I could not understand the cause of her symptoms.

    I ask about her relationship with her husband. “It's …

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