Lingua Medica: Rethinking Somatization
Authors: Ian R. McWhinney
Journal: Annals of Internal Medicine (1997)

Medical Writings1 May 1997Lingua Medica: Rethinking SomatizationIan R. McWhinney, MD, Ronald M. Epstein, MD, and Tom R. Freeman, MDIan R. McWhinney, MDThe University of Western Ontario, London, Ontario NGA 5C1, CanadaUniversity of Rochester, Rochester, NY 14620Byron Family Medical Centre, London, Ontario N6K 1C7, Canada, Ronald M. Epstein, MDThe University of Western Ontario, London, Ontario NGA 5C1, CanadaUniversity of Rochester, Rochester, NY 14620Byron Family Medical Centre, London, Ontario N6K 1C7, Canada, and Tom R. Freeman, MDThe University of Western Ontario, London, Ontario NGA 5C1, CanadaUniversity of Rochester, Rochester, NY 14620Byron Family Medical Centre, London, Ontario N6K 1C7, CanadaAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-126-9-199705010-00037 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Patients with so-called somatoform disorders are very common, especially in the primary care setting [1, 2]. These disorders are a source of frustration and difficulty for physicians and frequently strain the relationship between physician and patient. We suggest that the unsatisfactory status of the concept of somatization and the assumptions on which it is based contribute to the difficulty.Lipkowski [3] defines somatization as "a tendency to experience and communicate somatic distress and symptoms unaccounted for by pathological findings, to attribute them to physical illness, and to seek medical help for them." He added that this tendency is usually assumed ...References1. Kirmayer LJ, Robbins JM. Three forms of somatization in primary care: prevalence, co-occurrence, and sociodemographic characteristics. J Nerv Ment Dis. 1991; 179:647-55. Google Scholar2. Bridges KW, Goldberg DP. Somatic presentation of DSM III disorders in primary care. J Psychosom Res. 1985; 29:563-9. Google Scholar3. Lipkowski ZJ. Somatization: the concept and its clinical application. Am J Psychiatry. 1988; 145:1358-68. Google Scholar4. McDaniel SH, Campbell TL, Seaburn DB. Integrating the mind-body split: a biopsychosocial approach to somatic fixation. In: Family Oriented Primary Care. New York: Springer-Verlag; 1990:248-62. Google Scholar5. Schur M. Comments on the metapsychology of somatization. The Psychoanalytic Study of the Child. 1955; 10:119-164. Google Scholar6. Kirmayer LJ, Robbins JM. Concepts of somatization. In: Kirmayer LJ, Robbins JM, eds. Current Concepts of Somatization. Washington, DC: American Psychiatric Pr; 1991:1-19. Google Scholar7. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3d ed. Washington, DC: American Psychiatric Assoc; 1980. Google Scholar8. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Assoc; 1994. Google Scholar9. Fabrega H. Somatization in cultural and historical perspective. In: Kirmayer LJ, Robbins JM, eds. Current Concepts of Somatization. Washington, DC: American Psychiatric Pr; 1991:181-99. Google Scholar10. Styron W. Darkness Visible: A Memoir of Madness. 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A new psychosocial/biological model of the psyche. Br J Psychiatry. 1991; 159:97-105. Google Scholar19. Kirmayer LJ, Young A, Robbins JM. Symptom attribution in cultural perspective. Can J Psych. 1994; 39:584-95. Google Scholar20. Tyrer PJ. Relevance of bodily feelings in emotion. Lancet. 1973; Apr:915-6. Google Scholar21. Kirmayer LJ. Mind and body as metaphors: hidden values in biomedicine. In: Lock MJ, Gordon DR, eds. Biomedicine Examined. Boston: Kluwer; 1988:57-93. Google Scholar22. Goodnick PJ, Klimas NG, eds. Chronic Fatigue and Related Immune Deficiency Syndromes. Washington, DC: American Psychiatric Pr; 1993. Google Scholar23. Drossman DA, McKee DC, Sandler RS, Mitchell CM, Cramer EM, Lowman BC, et al. Psychosocial factors in the irritable bowel syndrome. A multivariate study of patients and nonpatients with irritable bowel syndrome. Gastroenterology. 1988; 95:701-8. Google Scholar24. Baron RJ. An introduction to medical phenomenology: I can't hear you while I'm listening. Ann Intern Med. 1985; 103:606-11. Google Scholar25. Engel GL. The clinical application of the biopsychosocial model. Am J Psychiatry. 1980; 137:535-44. Google Scholar26. Stewart M, Brown JB, Weston WW, McWhinney IR, McWilliam CL, Freeman TR. Patient-Centered Medicine: Transforming the Clinical Method. Thousand Oaks, CA: Sage; 1995. Google Scholar Author, Article, and Disclosure InformationAffiliations: The University of Western Ontario, London, Ontario NGA 5C1, CanadaUniversity of Rochester, Rochester, NY 14620Byron Family Medical Centre, London, Ontario N6K 1C7, CanadaAcknowledgment: The authors thank Theodore M. Brown for his helpful suggestions.Grant Support: Dr. Epstein is a Robert Wood Johnson Foundation Physician Faculty Scholar.Corresponding Author: Ian R. McWhinney, MD, Centre for Studies in Family Medicine, The University of Western Ontario, London, Ontario N6A 5C1, Canada.Current Author Addresses: Dr. McWhinney: Centre for Studies in Family Medicine, The University of Western Ontario, London, Ontario N6A 5C1, Canada. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByDeterminants of Frequent Attendance in Primary Care. 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