Somatization—a Plea for an Open Mind

Of late the concept of somatization is receiving great attention. Traditionally considered as the physician's bane and as one of the persistent problems of medical discipline , it b a commonly encountered clinical phenomenon both in psychiatric as well as non-psychiatric medical settings all over the world. In our own country a significant proportion of the precious and scarce medical resources are spent on investigating and treating the somatizing pateints. Being largely dissatisfied they tend to embark on a doctor shopping spree while the physicians in turn finding themselves incapable of solving the patient's somatic complaints often start feeling insecure and this results in their avoiding and scorning the patients as malingerer, adding another dimension to the patient's burden. Historically, somatization had its earliest roots in the Greek medicine where all illness were treated in a holistic manner. Precursors of somatization included entities like 'hypochondriasis', 'hysteria' and some types of'melancholia'all of which were characterized by chronic somatic problems intermixed with behavioural problems. In that era neither were these somatization illness regarded as anomalous nor were they considered to pose special therapeutic enigmas to the contemporary physicians. Thereafter came the great divide when the Western medicine with its focus on compartmentalization, objectivity , concreteness and standardization of disease found that somatization did not conform with the current medical modes and concepts of illness. Somatization illnesses were accorded an anomalous position as they were viewed as not being authentic or real if not totally fictitious. As a result of this unsympathetic approach these patients were not accorded the meliorative privileges of the sick—a state of affairs which continues till date. Psychiatry, which started evolving its fledgling identity as a medical discipline in late 18th and 19th centuries, too tried to objectify and reduce psychiatric illness phenomena to mutually exclusive descriptive categories of disorders. The term somatization was first defined by Steckel in 1943 as a defense mechanism .which indicated a deep seated neurosis. Subsequently somatization was variously denned as "idiom of distress in which patients with psychosocial and emotional problems articulate their distress primarily through physical symptomatology" (K.aton, 1984), "use of somatic symptoms for psychological purposes" (Ford, 1983) or "experience and communication of psychological distress in the form of physical symptoms" (Lipowski, 1987). The generally accepted current definition of somatization emphasises upon the presentation having multiple somatic symptoms with no demonstrable organic pathology and some evidence of psychogenicuy. Unlike the previous classificatory …