Somatisation : Nosology to Biology

Respected Chairperson, distinguished guests, members of the Indian Psychiatric Society, ladies and gentlemen. It is a matter of great privilege and honour for me to deliver the Tilak Venkoba Rao Oration on the occasion of ANCIPS2000. lam highly grateful to the Indian Psychiatric Society for bestowing me with this honour. As you know, this oration was instituted by Prof. A. Venkoba Rao and Prof. Parvathi Devi in the memory of their beloved son Tilak Venkoba Rao who lost his life in prime youth. I pay my humble respect to late Tilak. I would also like to pay my respect to my teachers, Prof. VK. Varma, Prof. P. Kulhara and Prof. Savita Malhotra, from whom I learnt psychiatry and basic principles of research. I am grateful to my earlier colleagues, Dr. M.S. Bhatia and Dr. Sabita Shome, who were also involved in my research on somatisation. I would also like to express my gratitude to the late Prof. Z.J. Lipowski, whose review paper on somatisation in Nov., 1988 issue of American Journal of Psychiatry initiated my interest in somatisation, the topic I have chosen for this oration. Patients presenting with physical symptoms without any organic basis have always remained an enigma for the physicians. These patients have been recognised for more than two millennia. The illnesses have received a wide variety of names like hysterike pnix by Plato in 427 BC, hysterika given by Galen in the second century AD, English malady by Cheynes in 1789, neurasthenia by Beard in 1868, conversion hysteria, hypochondriasis, psychosomatosis, etc. The term 'somatisation', which was introduced by Stekel in 1911 for the illness, has become quite popular in the last two decades, especially after the formal recognition of somatisation disorder as a diagnostic entity by DSM-III in 1980. Somatisation can be defined as a tendency to experience and communicate somatic distress and symptoms in response to psychosocial stress, unaccounted for by pathological findings, to attribute them to physical illness, and to seek medical help for them (Lipowski, 1988). Somatisation is neither a discrete clinical entity, nor the result of a single pathological or psychological process, and cuts across diagnostic boundaries (Kellner,1994). It is not an equivalent of somatisation disorder or somatoform disorders. The patients usually present in primary care settings and to physicians in general hospitals. They are often misdiagnosed and wrongly treated as suffering from physical illnesses. The phenomenon is responsible for significant distress and disability in the sufferers. It is estimated that a large pan of physicians' time and effort is spent on investigating and treating somatising patients and between 10-20% of the medical budget is spent on patients who somatise or have hypochondriacal concerns (Ford, 1983; Kellner,1991). In this oration, I shali be discussing about evolution of the concept of somatisation. clinical presentation of somatisation, related nosological issues and biological research in somatisation.