Imaginary Invalid

Can you go one day without correction Of bowels at your doctor’s fool behest? Let’s put it off and take a little rest


When 62-year-old Alicon, referred by her physician, walked into my office complaining of chronic aches and pains, I took her medical history and discovered that there wasn’t anything wrong with her. By the second session I started suspecting that she was suffering from what was called in Freud’s time “hysteria” and what is known today as Somatisation Disorder (SD).

In the Diagnostic Statistical Manual of Mental Disorders ( a mental health clinician’s diagnostic handbook), SD is a somatoform disorder, which means that the physical symptoms have a psychological origin.

Alicon’s unexplained physical complaints began before she was 30, which resulted in her seeking treatment from various doctors, finally impairing not only her ability to work but also her sexual relationship with her husband.

For one to meet the criteria of SD there has to be at least one sexual or reproductive symptom (eg sexual indifference, irregular menses, excessive menstrual bleeding, vomiting throughout pregnancy, and for men erectile or ejaculatory dysfunction).

Alicon’s symptoms met this criterion along others, such as pain in the joints, extremities, head, abdomen, back, and pain during intercourse. She also displayed various gastrointestinal symptoms as well as pseudo-neurological symptoms – in her case, difficulty in swallowing, lump in throat and double vision.

True to her diagnosis, Alicon was a poor historian of her life, giving dramatic and exaggerated descriptions of her physical symptoms and playing down or denying any psychosocial links with her symptoms. She was convinced she had some organic illness, she tended to be irritable to those around her, and she had difficulty expressing emotion.

However, after months in therapy, Alicon is now beginning to open up to the idea that her somatic complaints are psychosomatic, and that they have been her way of avoiding psychological distress. In other words, her SD is her defense against psychological pain.

The more Alicon was willing to look into her family history, the more she was able to come to terms with the inalterability of the past. It was not so much a question of forgiving the verbal and emotional abuse that she had endured growing up, I said to her, but that sooner or later she would have to give up the hope for a better past. This led her to make some peace with her family history.. This new-found peace seems to have contributed to her experiencing lower levels of anxiety and less somatic complaints, allowing her to focus more on her marriage that has gone awry. ( Alicon is not the real name of this patient and some details have been changed in order to conceal her identity.)

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