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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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Re: Patients' perceptions of medical explanations for somatisation disorders: qualitative analysis

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

08 February 1999
Ramy Daoud
SHO
Police Force Hospital, Cairo, Egypt