Patients' perceptions of medical explanations for somatisation disorders: qualitative analysis
BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7180.372 (Published 06 February 1999) Cite this as: BMJ 1999;318:372
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Dear Sirs
Peoples of the Meditteranean region are said to be more emotionally
expressive than others, so it was not with much surprise when I received
late one night a young female patient at the emergency department
complaining of "tongue convulsions". So said her mother, for her daughter
was obviously tongue-tied. Intrigued by this totally new medical symptom,
and the potential for a self-attributed eponym, I proceeded to draw out
from the mother the onset, course and duration of her daughter's
complaint. It was soon obvious that neither of them were taking it quite
so seriously as I was. Now, let it be known that it is customary practice
in Egypt for similar conditions to be managed with a smile, some tact and
... a short spray of ethyl chloride in the left nostril. I am not proud of
this but I have often found it to be a potent cure.
I agree with the authors but I have one comment: my over-riding fear
with patients who have such bizarre somatization symptoms is actually
"making a link"
between physical symptoms and emotional factors; providing "tangible,
physical explanations" that will empower, exculpate and legitimize the
psychological processes that lead to them. And what if the explanations we
give them are unproved, or later disproved: what have I done? Is
explanation always empowerment? Is evasion in this instance not a better
option?
Competing interests: No competing interests
Hazards of the Truth in Somatization Disorder
That was a great article.
Some of our patients with CRPS and related conditions present with
somatization disorders. Explaining the nature of this is hazardous if done
in a clumsy way because it sets up conflict between those parts of
behavior ready to drop symptoms, and those parts needing symptoms for
whatever reason. Empowering explanations are certainly the way to go, and
the importance of professional boundaries cannot be stressed to highly in
this group.
Thanks.
David Flemming
Competing interests: No competing interests