Somatization

Somatization is when emotions produce physical symptoms and/or illness

 

 

Dr. Allan Abbass talks about this in the Chronicle Herald, April, 2007

 

You have chest pain — real pain — that sends you to the emergency room. You’ve had it before, along with a collection of other ailments. You’ve made the rounds of specialists, waited months for a series of diagnostic tests and you’ve been offered no explanation.

The situation is hardly unique. Many people who suffer such worrisome symptoms will never get a definitive medical explanation as they’re shuffled through the health-care system.

One in six local emergency room visits and one in 12 hospital stays in metro Halifax are due to medically unexplained symptoms, says Dr. Allan Abbass, a Halifax psychiatrist.

He leads a small group of Halifax health professionals who have shown real success in treating stress and anxiety that underlie many debilitating physical symptoms.

Patients aren’t making up their pain or other complaints, which include ulcers, chronic fatigue, headaches and even psoriasis, he said, adding that doctors must treat symptoms and search for a cause. But many could find answers without surgery, drugs or costly tests by examining their feelings and the way emotions affect their bodies, Dr. Abbass said in a recent interview.

The doctor, who works out of the Abbie J. Lane Building with a half-time colleague and a senior student, said much time, effort and money is spent trying to reduce the time people wait for tests and treatment.

"This is an example of what we can do about it: actually get the people out of the wrong lineups."

His method of treatment, called intensive short-term dynamic psychotherapy, begins with a simple interview and targets the physiology of emotion.

The body has a natural response to various emotions, and when it’s allowed to respond normally, a person usually experiences no ill effects. It’s when emotions come into conflict with one another or a person stifles his physical response to feelings that problems arise.

Dr. Abbass takes cues from the person’s body and tries to draw out the feelings associated with physical complaints when he interviews potential patients.

Some get some relief right away. On average, patients have about 13 sessions over six months, he said.

Many have been able to go off the drugs they’d been prescribed and some can go back to work after having been away a long time due to a disability.

A study of 600 people treated by Dr. Abbass and his colleagues revealed an 83 per cent drop in hospital stays and a 53 per cent decrease in emergency room visits — statistics that were evident five years after treatment.

Another study found the typical patient had seen an average of 11 specialists before being referred for his therapy.

Doctors often aren’t good at identifying when physical ailments may be caused by stress or psychological factors or are reluctant to name it if they do, said Dr. Sam Campbell, a Halifax emergency physician.

"When I was at medical school, we were told we would fail if we called something psychosomatic," he said.

Yet he sees many patients whose problems are clearly brought on by anxiety or other psychological factors.

"Either they’re getting three or five different things going wrong at the same time, or they’ve just got one thing going wrong but it governs all these systems," Dr. Campbell said.

"Understanding what’s going on is very important," he said. "They’re very scary symptoms. And those scary symptoms set off a stress response, which makes you feel more scared. It’s like a vicious cycle."

Doctors often think patients don’t want to hear that there may be psychological factors behind their complaints, he said.

"If you come in with chest pain and I call (it) angina and it turns out not to be angina, no one minds," said Dr. Campbell. "But if you come in with chest pain and I call it somatoform disorder, which is way more common in young people than angina, there’s this perception that patients will be offended because we think they’re putting it on."

A growing number of doctors are referring patients to Dr. Abbass’s clinic, and now there is a year-long waiting list to get in.

Dr. Abbass has made five proposals to the provincial Health Department through the Capital district health authority to expand his service without success.

There’s simply no "loose change" available in the health-care system to try out new things, said the psychiatrist, who began his medical career as a family doctor before becoming frustrated by the high number of patients suffering unexplained conditions.

"They talk about a crack in the system — this is a canyon," Dr. Abbass said. "It’s huge."

His small team has resorted to bartering — training community-based psychologists in the treatment in exchange for them taking on some patients.

"We’re trying to beg, borrow and steal here to get some treatment for these patients."

But the therapy program is not a panacea, Dr. Abbass said. And there have been cases in which a referred patient was found to have a medical condition that was missed.

The health-care system is failing patients when it relentlessly pursues medical explanations for problems that actually have psychological roots, he said.

"When I see someone who’s 65 years old and has had every manner of physical problem for 25, 35 years . . . we’ve missed something. We’ve done a disservice to that person."