I would like to make clear from the start that I believe that psychosomatic disorders are genuine ‘problems’ and that they are real to the sufferer (see post on objective and subjective experience).
The biomedical model doesn’t seem overly interested in this disorder. Given its complexity and that symptoms are so varied medicine would be hard pressed to put even a vaguely compelling biological explanation to it.
I haven’t seen DSM 5’s interpretation or classification of it yet, but to me, it kinda seems like a cross between dissociation and anxiety. Dissociation of mind and body (physical sensations and psychological interpretations as to causation) and the out of kilter anxiety it causes.
But, I was reading about certain syndromes recently. And, my god, has the clock not been wound back a century? One in particular, that I won’t name, the symptom list reads JUST like hysteria. And, consistent with this interpretation, the more depressed and anxious you are the more pain you feel. And the best treatment can be exercise. Pain meds have little effect but CBT can help.
Freud might have been a shit scientist and clinician, and he certainly got plenty of things wrong, but he also had some very insightful things to say about human behaviour. We seem to have washed our hands of him and see him as a quack.
But, if a century ago, he described exactly the same syndrome, why are we re-labelling it with something more vaguely medical sounding? And denying that they may actually be the same thing?
I think it is because of the issue that I spoke of before, in subjective vs objective experience. Medics just don’t understand subjective experience. It isn’t measurable. It isn’t important. Psychosomatic disorders are all in your head therefore they are irrelevant.
There are a number of ‘syndromes’ over the years that have been suggested as psychosomatic. Sufferers get bent out of shape about the suggestion because, unfortunately, them, the public and medics, think that psychosomatic = not real. It shouldn’t be this way. To YOU it FEELS REAL. That should be important.
The whole DSM is built on subjective experience. We believe that someone with a diagnosis of depression or schizophrenia are having a genuine experience despite many of the symptoms not being directly observable. Why should we see psychosomatic disorders differently?
This is important because it changes how you approach treatment. If there is no known biological cause you have to assume the cause is psychological. Therefore, the person needs referred for psychological treatment. You shouldn’t be giving them opiate based painkillers, anti-epileptics being prescribed off label, anti-depressants, mood stabilizers, or anything else. Especially, in the case of certain ‘syndromes’ were these treatments have no effect but psychological treatment, and simple exercise, can help.