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Somatizations

Nearly all the patients presented one or more complaints for which no organic cause was demonstrable and which proved to be art expression of the psychological problem. The very rare exception was the patient who came explicitly for an interpersonal or situational problem with his anxiety relatively well-circumscribed by the problem. Both sexes of all age groups illustrated the readiness with which somatization is utilized in emotional conflict. Thus the majority of patients had at one time or another visited a doctor to obtain relief for these symptoms. Some, with simpler symptoms, had tried self-medication. Many had been subjected to various physical examinations and laboratory procedures. Several had been hospitalized in the process of determining the illness and it was not unusual for the first interview to occur while the patient was still in the hospital. A few had consulted “herbolarios” (quack doctors who, interestingly enough often prescribed medications similar to the doctor’s.)

Symptomatology

This chapter will describe and discuss the outstanding and most common symptoms encountered in patients and other clinical features, which were observed in lesser numbers. The common diagnostic categories given in Chapter II mentioned some of these features.

More attention will be given to symptoms rather than diagnoses. As is every clinical psychiatrist’s experience, discussions revolving around diagnostic possibilities are not particularly rewarding in the search for understanding of the patient and of his illness. Diagnostic labels tend to evoke built-in or preconceived notions about the illness which often discourage further study of the patient. Diagnoses are also apt to be arrived at in different ways by different psychiatrists, causing at times a good deal of non-constructive dissonance. Symptoms are less likely to be attended by these disadvantages. However, subjective differences between different workers in the elicitation, description, and interpretation of symptoms are not, by any means, totally absent.

The Matter Of Cultural Reality

Making a diagnosis is making an evaluation and, at times, a value judgment. When a Western system of labeling mental or emotional illness is utilized, it is presumed that the system is loaded with certain cultural norms and values. There are certain illnesses, notably those organically caused, which present nearly identical and recognizable manifestations wherever they are encountered. Cultural factors bear little on the form of the symptomatology. In the functional disorders, cultural realities play a bigger role in shaping the patients’ reactions. In some patients in this study, these cultural factors spelled the difference between a diagnosis of a malignant disorder and that of a more benign nature.

Transient Situational Personality Disorder

A diagnosis of transient situation personality disorder is applied to a patient who seems to be reacting to some overwhelming environmental stress. “Classified under this heading are certain personality responses of a more or less acute nature which occur in a relatively well-integrated individual under situations of acute stress or strain. In order to qualify in this category the patient must have a reasonably well-developed personality with a good adaptive capacity and revert to his original normal adjustment with the passage of the stressful situation” (English 1964).

Neurasthenia And Hypochondriasis

The diagnostic categories of neurasthenia and Hypochondriasis have been deleted from the standard nomenclature of the American Psychiatric Association. These terms have been the subject, of varying opinions with regard to their suitability in a system of classification and diagnosis. There were about ten patients in this study, mostly women, whom the writer felt would fit well into the old descriptions of syndromes covered by these two terms. To maintain consistency, and since their number was not very large, they were classified instead under other diagnostic categories, based on the underlying pathology. Thus, if the patient had strong depressive trends, he was classified under “depression”; if there was undue rumination about a certain body organ or body function, he was placed under the category of an obsessional neurosis.

 

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