Among the most common problems bringing people into doctors’ offices are “medically unexplained illnesses” (Johnson, 2008). Ellen becomes dizzy and nauseated in the late afternoon—shortly before she expects her husband home. Neither her primary care physician nor the neurologist he sent her to could identify a physical cause. They suspect her symptoms have an unconscious psychological origin, possibly triggered by her mixed feelings about her husband. Ellen has a somatic symptom disorder (formerly known as somatoform disorder), in which distressing symptoms take a somatic (bodily) form without apparent physical causes. One person may have a variety of complaints—vomiting, dizziness, blurred vision, difficulty in swallowing. Another may experience severe and prolonged pain. Culture has a big effect on people’s physical complaints and how they explain them (Kirmayer & Sartorius, 2007). In China, psychological explanations of anxiety and depression are socially less acceptable than in many Western countries, and people less often express the emotional aspects of distress. The Chinese appear more sensitive to—and more willing to report—the physical symptoms of their distress (Ryder et al., 2008). Mr. Wu, a 36-year-old technician in Hunan, illustrates one of China’s most common psychological disorders (Spitzer & Skodol, 2000). He finds work difficult because of his insomnia, fatigue, weakness, and headaches. Chinese herbs and Western medicines provide no relief. To his Chinese clinician, who treats the bodily symptoms, he seems not so much depressed as exhausted. Similar, generalized bodily complaints have often been observed in African cultures (Binitie, 1975).
Even to people in the West, somatic symptoms are familiar. To a lesser extent, we have all experienced inexplicable physical symptoms under stress. It is little comfort to be told that the problem is “all in your head.” Although the symptoms may be psychological in origin, they are nevertheless genuinely felt. A rare related disorder, more common in Freud’s day than in ours, is conversion disorder (also known as functional neurological symptom disorder), so called because anxiety presumably is converted into a physical symptom. (As we noted in Module 55, Freud’s effort to treat and understand psychological disorders stemmed from his puzzlement over ailments that had no physiological basis.) A patient with a conversion disorder might, for example, lose sensation in a way that makes no neurological sense. Yet the physical symptoms would be real; sticking pins in the affected area would produce no response. Other conversion disorder symptoms might be unexplained paralysis, blindness, or an inability to swallow. In some cases, the person may seem strangely indifferent to the problem.
As you can imagine, somatic symptom and related disorders send people not to a psychologist or psychiatrist but to a physician. This is especially true of those who experience illness anxiety disorder (previously called hypochondriasis). In this relatively common disorder, people interpret normal sensations (a stomach cramp today, a headache tomorrow) as symptoms of a dreaded disease. Sympathy or temporary relief from everyday demands may reinforce such complaints. No amount of reassurance by any physician convinces the patient that the trivial symptoms do not reflect a serious illness. So the patient moves on to another physician, seeking and receiving more medical attention—but failing to confront the disorder’s psychological root.