THE BODILY COMPLAINT

Abstract

The psychogenic bodily complaint or hypochondriasis has been considered in the various types of psychoneurotic and psychotic patients in which it occurs. The history of hypochondriasis has been briefly reviewed to show the evolution of the concept of a psychogenic, rather than physical body complaint, a concept which occurred first in the non-medical writers on the subject. Hypochondriasis is regarded as a reaction of the individual to a life difficulty rather than as a disease. The incidence of body complaints in the 226 admissions in 1934 to the Phipps Clinic was 45%. The nature and aetiology of the body complaints is discussed in 41 cases showing hypochondriasis in anxiety and obsessional states, hysteria, invalid, schizophrenic and depressive reactions. These body complaints were classified mainly on a basis of affect and attitude to illness into the following groups: 1. Psychoneurotic or merergasic hypochondriasis: 1. Body complaints which are the physiological accompaniments of the anxiety affect in the anxiety states. 2. Body complaints as a substitute for anxiety without the anxiety affect. This type of hypochondriasis is regarded as one of the types of “conversion”. 3. Body complaints in which purposiveness, recognized by dramatization, is a factor. This group comprises the typical invalid reaction chiefly seen in women. These groups frequently occur in mixed forms. In addition, in the production of any form of psychoneurotic hypochondriasis there is often the element of suggestion. 2. Schizophrenic or parergasic types of hypochondriasis: 1. Bizarre bodily complaints, often considered delusions, which are here considered to be on a symbolic basis, representing the various, often sexual difficulties of the patient in the form of more or less indirect symbols. 2. Vague bodily complaints, such as headaches and abdominal discomforts, which are here considered to be expressive of the affect of tensity, suspicion and anxiety. The treatment of these cases of vague complaints on a basis of topical reassurance by finding out the usually trivial cause is emphasized. 3. Depressive hypochondriasis: 1. Bodily complaints consistent with the affect of depression. 2. Bodily complaints inconsistent with the affect, forming a kind of substitute or conversion of the previous depressed affect. 3. Distorted bodily complaints on a symbolic basis, usually referring to death or guilt. A case of diffuse bodily complaints consistent with the affect of fear was described. It is suggested that the course of a depression is prolonged by the hypochondriasis in groups ( b ) and ( c ), but not in ( a ). The application of this classification of hypochondriasis to treatment has been discussed, and the futility of purely physical treatment emphasized. It is felt that a great difficulty of this problem lies in defining the meaning of the emotional states, such as depression, anxiety, fear and tension, and in deciding what are the physical accompaniments. It is probable that the body complaints in all these conditions are related, and some kind of classification is necessary in order to help to understand and treat the psychogenic body complaint, which seems to have as many ramifications and complexities as the physical body complaints, which are the province of organic medicine.