Psychosomatic illnesses are not “all in the mind”

Abstract

Patients, doctors, and even judges are perplexed by conditions of uncertain existence or etiology, which may affect both and body [1]. Psychosomatic conditions such as irritable bowel syndrome, premenstrual syndrome, chronic fatigue syndrome, repetitive strain injury, and other chronic pain syndromes are common, but do not easily fit into a medical philosophy of a separate and divisible and body. In this schema, patients suffer from either physical disease or mental illness. The stigma attached to mental illnesses understandably leads many patients to seek a physical diagnosis. Physical diseases will be excluded perhaps by referral to a general physician. The patient may then be told that there is nothing physically wrong. This explanation may be angrily rejected, especially if the physician suggests that the symptoms are all in the mind and that the patient should see a psychiatrist. The patient feels accused of either madness or malingering. If he or she then overcomes the stigma and receives psychiatric intervention, they may be told that there is formal mental illness present. The patient and general practitioner are back to where they started, with no adequate explanation, diagnosis, or treatment. The frustration and heart-sink felt by both patient and doctor is understandable. A rational approach to understanding and treating these conditions can only come when preconceptions about etiology are set aside, and there is a readiness to examine both physiological and psychological components at the same time [2]. Attempts to find physical explanations for psychosomatic illnesses have often failed. For instance, gut motility studies do not always distinguish irritable bowel syndrome subjects from healthy controls [3]. The etiological evidence for viral or immune disorders in chronic fatigue syndrome is inconsistent [4]. Hormonal abnormalities do not provide a comprehensive explanation of premenstrual syndrome [5]. On the other hand, psychiatric disorders often fail to provide comprehensive answers. Although psychiatric disorders often present with physical symptoms [6, 7], and there are past and current associations between psychosomatic and psychiatric disorders [8, 9], a significant number of patients with psychosomatic disorders are