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Somatization and the Social Construction of Illness Experience

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Illness Behavior

Abstract

Somatization has been defined as the tendency to experience or express psychological states as somatic symptoms (Lipowski, 1968) or the use of somatic symptoms for psychological purposes (Ford, 1983). People who might be expected to complain of depression, anxiety or marital conflict are found instead to suffer from headaches, fatigue, indigestion and a myriad of other physical symptoms. The assumption that physical symptoms can be caused by social difficulties and amplified by attention is basic to psychological medicine. What somatization adds to this picture is a focus on the discrepancy between patients’ experiences of their problems as somatic, and the belief of health-care providers that the problem is psychological or social in nature.

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References

  • American Psychiatric Association. (1980). Diagnostic and statistical manual (3rd ed.). Washington: American Psychiatric Association.

    Google Scholar 

  • Anderson, C. D. (1981). Expression of affect and physiological response in psychosomatic patients. Journal of Psychosomatic Research, 25, 143–149.

    PubMed  Google Scholar 

  • Bennett, R. M. (1981). Fibrositis: Misnomer for a common rheumatic disorder. Western Journal of Medicine, 134, 405–413.

    PubMed  Google Scholar 

  • Blackwell, B. (1967). Upper middle class adult expectations about entering the sick role for physical and psychiatric dysfunctions. Journal of Health and Social Behavior, 8, 83–95.

    PubMed  Google Scholar 

  • Block, A. (1981). An investigation of the response of the spouse to chronic pain behavior. Psychosomatic Medicine, 43, 415–422.

    PubMed  Google Scholar 

  • Blumer, D., & Heilbronn, M. (1982). Chronic pain as a variant of depressive disease. Journal of Nervous and Mental Disease, 170, 381–406.

    PubMed  Google Scholar 

  • Bohman, M., Cloninger, C. R., von Knorring, A. L., & Sigvardsson, S. (1984). An adoption study of somatoform disorders: III. Cross-fostering analysis and genetic relationship to alcoholism and criminality. Archives of General Psychiatry, 41, 863–871.

    PubMed  Google Scholar 

  • Buck, R. (1980). Nonverbal behavior and the theory of emotion: The facial feedback hypothesis. Journal of Personality and Social Psychology, 38, 811–824.

    PubMed  Google Scholar 

  • BĂĽrsten, B. (1985). Medication nonadherence due to feelings of loss of control in “biological depression”. American Journal of Psychiatry, 142, 244–246.

    PubMed  Google Scholar 

  • Cadoret, R., Widmer, R. B., & Troughton, E. P. (1980). Somatic complaints: Harbinger of depression in primary care. Journal of Affective Disorders. 2, 61–70.

    PubMed  Google Scholar 

  • Cannon, W. B. (1929). Bodily changes in pain, hunger, fear and rage (2nd ed.). New York: Harper & Row.

    Google Scholar 

  • Carlson, G. A., & Cantwell, D. P. (1980). Unmasking masked depression in children and adolescents. American Journal of Psychiatry, 137, 445–449.

    PubMed  Google Scholar 

  • Carver, C. S. (1979). A cybernetic model of self-attention processes. Journal of Personality and Social Psychology, 37, 1251–1281.

    Google Scholar 

  • Cloninger, C. R., Sigvardsson, S., von Knorring, A. L., & Bohman, M. (1984). An adoption study of somatoform disorders: II. Identification of two discrete somatoform disorders. Archives of General Psychiatry, 41, 863– 871.

    PubMed  Google Scholar 

  • Crandell, D. L., & Dohrenwend, B. P. (1967). Some relations among psychiatric symptoms, organic illness, and social class. American Journal of Psychiatry, 123, 1527–1537.

    PubMed  Google Scholar 

  • Davidson, R. J., & Schwartz, G. E. (1976). The psychophysiology of relaxation and related states: A multi-process theory. In D. I. Mostofsky (Ed.), Behavior control and modification of physiological activity (pp. 399–442). Englewood-Cliffs, NJ: Prentice-Hall.

    Google Scholar 

  • DeGood, D. E., Buckelew, S. P., & Tait, R. C. (1985). Cognitive-somatic anxiety response patterning in chronic pain patients and nonpatients. Journal of Consulting and Clinical Psychology, 53, 137–138.

    PubMed  Google Scholar 

  • De Marco, R. (1984). Relationships between physical and psychological symptomatology in the 22-item Langner’s scale. Social Science and Medicine, 19, 59–65.

    PubMed  Google Scholar 

  • Dolce, J. J., & Raczynski, J. M. (1985). Neuromuscular activity and electromyography in painful backs: Psychological and biomechanical models in assessment and treatment. Psychological Bulletin, 97, 502–520.

    PubMed  Google Scholar 

  • Eisenberg, L. (1977). Disease and illness: Distinctions between professional and popular ideas of sickness. Culture, Medicine and Psychiatry, 1, 9–23.

    PubMed  Google Scholar 

  • Ekman, P. (1972). Universals and cultural differences in facial expressions of emotion. Nebraska symposium on motivation. Lincoln: University of Nebraska Press.

    Google Scholar 

  • Engel, G. L. (1959). “Psychogenic” pain and the pain-prone patient. American Journal of Medicine, 26, 899–918.

    PubMed  Google Scholar 

  • Fenigstein, A., Scheier, M. F., & Buss, A. H. (1975). Public and private self-consciousness: Assessment and theory. Journal of Consulting and Clinical Psychology, 43, 522–527.

    Google Scholar 

  • Flor, H., Turk, D. C., & Birbaumer, N. (1985). Assessment of stress-related psychophysiological reactions in chronic back pain patients. Journal of Consulting and Clinical Psychology, 53, 354–364.

    PubMed  Google Scholar 

  • Ford, C. V. (1983). The somatizing disorders: Illness as a way of life. New York: Elsevier.

    Google Scholar 

  • Fordyce, W. E. (1978). Learning processes in pain. In R. A. Sternbach (Ed.), The psychology of pain. New York : Raven Press.

    Google Scholar 

  • Good, B. J. (1977). The heart of what’s the matter: The semantics of illness in Iran. Culture, Medicine and Psychiatry, 1, 25–58.

    PubMed  Google Scholar 

  • Good, B. J., Good, M. J. (1980). The meaning of symptoms: A cultural-hermeneutic model for clinical practice. In L. Eisenberg, & A. Kleinman (Eds.), The relevance of social science for medicine (pp. 165–196). Dordrecht, Holland: Reidel.

    Google Scholar 

  • Goodwin, D. VJ., & Guze, S. B. (1983). Psychiatric diagnosis (3rd ed.). Oxford: University Press.

    Google Scholar 

  • Greden, J. F., Genero, N., & Price, H. L. (1985). Agitation-increased electromyogram activity in the corrugator muscle region: A possible explanation of the “omega sign”? American Journal of Psychiatry, 142, 348–351.

    PubMed  Google Scholar 

  • Grings, W. W., & Dawson, M. E. (1978). Emotions and bodily responses: A psychophysiological approach. New York: Academic Press.

    Google Scholar 

  • Hall, R. C. W., Gardner, E. R., Stickney, S. K., et al. (1980). Physical illness manifesting as psychiatric disease. Archives of General Psychiatry, 37, 985–989.

    Google Scholar 

  • Hanback, J. W., & Revelle, W. (1978). Arousal and perceptual sensitivity in hypochondriasis. Journal of Abnormal Psychology, 87, 523–530.

    PubMed  Google Scholar 

  • Harre, R., Clarke, D., & De Carlo, N. (1985). Motives and mechanisms: An introduction to the psychology of action. London: Methuen.

    Google Scholar 

  • Hesse, P., & Cichetti, D. (1982). Perspectives on an integrated theory of emotional development. In D. Ciccheti & P. Hesse (Eds.), Emotional development. San Francisco: Jossey Bass.

    Google Scholar 

  • Hudson, J. I., Hudson, M. S., Pliner, L. F., Goldenberg, D. L., & Pope, H. J. Jr. (1985). Fibromyalgia and major affective disorder: A controlled phenomenology and family history study. American Journal of Psychiatry, 142, 441–446.

    PubMed  Google Scholar 

  • Jefferson, J. W., & Marshall, J. R. (1981). Neuropsychiatric features of medical disorders. New York: Plenum Press.

    Google Scholar 

  • Kaminsky, M. J., & Slavney, P. R. (1983). Hysterical and obsessional features in patients with Briquet’s syndrome (somatization disorder). Psychological Medicine, 13, 111–120.

    PubMed  Google Scholar 

  • Katon, W., Kleinman, A., & Rosen, G. (1982). Depression and somatization: A review. I & II. American Journal of Medicine, 72, 127–135 & 241–247.

    PubMed  Google Scholar 

  • Kellner, R. (1985). Functional somatic symptoms and hypochondriasis. Archives of General Psychiatry, 42, 821–833.

    PubMed  Google Scholar 

  • Kellner, R., & Sheffield, B. F. (1973). The one week prevalence of symptoms in neurotic patients and normals. American Journal of Psychiatry, 130, 102–105.

    PubMed  Google Scholar 

  • Kenyon, F. E. (1976). Hypochondriacal states. British Journal of Psychiatry, 129, 1–14.

    PubMed  Google Scholar 

  • Kirmayer, L. J. (1984). Culture, affect and somatization. I & II. Transcultural Psychiatric Research Review, 21, 159–188 & 21, 237–262.

    Google Scholar 

  • Kirmayer, L. J. (in press). Mind and body as metaphors: Hidden values in biomedicine. In M. Lock & D. Gordon (Eds.), Knowledge and practice in medicine. Dordrecht, Holland: D. Reidel.

    Google Scholar 

  • Kleinman, A. (1977). Depression, somatization and the “new cross-cultural psychiatry”. Social Science and Medicine, 11, 3–10.

    Google Scholar 

  • Kleinman, A. (1980). Patients and healers in the context of culture. Berkeley: University of California Press.

    Google Scholar 

  • Kleinman, A. (1982). Neurasthenia and depression: A study of somatization and culture in China. Culture, Medicine and Psychiatry, 6, 117–190.

    PubMed  Google Scholar 

  • Kleinman, A., & Kleinman, J. (1985). Somatization: The interconnections among culture, depressive experiences, and the meanings of pain. A study in Chinese society. In A. Kleinman & B. Good (Eds.), Culture and depression. Berkeley: University of California Press.

    Google Scholar 

  • Lakoff, G., & Johnson, M. (1980). Metaphors we live by. Chicago: University of Chicago Press.

    Google Scholar 

  • Lanzetta, J. T., Cartwright-Smith, J., & Kleck, R. E. (1976). Effects of nonverbal dissimulation on emotional experience and autonomic arousal. Journal of Personality and Social Psychology, 33, 354–370.

    PubMed  Google Scholar 

  • Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.

    Google Scholar 

  • Lesse, S. (1974). Hypochondriasis and psychosomatic disorders masking depression. In S. Lesse (Ed.), Masked depression (pp. 53–74). New York: Aronson.

    Google Scholar 

  • Lesser, I. M., Ford, C. V., & Friedmann, C. T. H. (1979). Alexithymia in somatizing patients. General Hospital Psychiatry, 1 ,256–261.

    PubMed  Google Scholar 

  • Lesser, I. M., & Lesser, B. Z. (1983). Alexithymia: Examining the development of a psychological concept. American Journal of Psychiatry, 140, 1305–1308.

    PubMed  Google Scholar 

  • Leventhal, H. (1979). A perceptual-motor processing model of emotion. In P. Pliner, K. R. Blankstein, & I. M. Spigel (Eds.), Perception of emotion of self and others. New York: Plenum Press.

    Google Scholar 

  • Leventhal, H., Nerenz, D. R., & Straus, A. (1982). Self-regulation and the mechanisms for symptom appraisal. In D. Mechanic (Ed.), Symptoms, illness behavior and help-seeking (pp. 55–86). New York: Watson.

    Google Scholar 

  • Levi-Strauss, C. (1966). The savage mind. Chicago: University of Chicago Press.

    Google Scholar 

  • Lipkin, M., & Lamb, G. (1982). The couvade syndrome: An epidemiologic study. Annals of Internal Medicine, 96, 509–511.

    PubMed  Google Scholar 

  • Lipowski, Z. J. (1968). Review of consultation psychiatry and psychosomatic medicine. III. Theoretical issues. Psychosomatic Medicine, 30, 395–422.

    PubMed  Google Scholar 

  • Lock, M. (1978). East Asian medicine in urban Japan. Berkeley: University of California Press.

    Google Scholar 

  • Mandler, G. (1984). Mind and body. New York: Norton.

    Google Scholar 

  • Marsella, A. (1981). Depressive experience and disorder across cultures. In H. C. Triandis, & J. W. Berry (Eds.), Handbook of cross-cultural psychology, Vol. 6. Boston: Allyn & Bacon.

    Google Scholar 

  • Mathew, R. J., Weinman, M. L., & Mirabi, M. (1981). Physical symptoms of depression. British Journal of Psychiatry, 139, 293–296.

    PubMed  Google Scholar 

  • Mechanic, D. (1972). Social psychologic factors affecting the presentation of bodily complaints. New England Journal of Medicine, 286, 1132–1139.

    PubMed  Google Scholar 

  • Miller, L. C., Murphy, R., & Buss, A. H. (1981). Consciousness of body: Private and public. Journal of Personality and Social Psychology, 41, 397–406.

    Google Scholar 

  • Minuchin, S., Baker, L., Rosman, B., Leibman, R., Milman, L., & Todd, T. A. (1975). Conceptual model of psychosomatic illness in children. Archives of General Psychiatry, 32, 1031–1038.

    PubMed  Google Scholar 

  • Morakinyo, O. (1980). A psychophysiological theory of a psychiatric illness (the brain fag syndrome) associated with study among Africans. Journal of Nervous and Mental Disease, 168, 84–89.

    PubMed  Google Scholar 

  • Morakinyo, O. (1985). Phobic states presenting as somatic complaint syndromes in Nigeria: Socio-cultural factors associated with diagnosis and psychotherapy. Acta Psychiatrica Scandinavia, 71, 356–365.

    Google Scholar 

  • Nelson, J. C., Charney, D. S. (1981). The symptoms of major depressive illness. American Journal of Psychiatry, 138, 1–13.

    PubMed  Google Scholar 

  • Nemiah, H. (1985). Somatoform disorders. In H. I. Kaplan, & B. J. Sadock (Eds.), Comprehensive textbook of psychiatry (pp. 924–942). (4th ed.). Baltimore: Williams & Wilkins.

    Google Scholar 

  • Nichter, M. (1981). Idioms of distress: Alternatives in the expression of psychosocial distress: A case study from South India. Culture, Medicine and Psychiatry, 5, 379–408.

    PubMed  Google Scholar 

  • Neilsen, A. C., & Williams, T. A. (1980). Depression in ambulatory medical patients: Prevalence by self-report questionnaire and recognition by nonpsychiatric physicians. Archives of General Psychiatry, 37, 999–1004.

    Google Scholar 

  • Ohnuki-Tierney, E. (1984). Illness and culture in contemporary Japan: An anthropological view. Cambridge University Press.

    Google Scholar 

  • Pennebaker, J. W. (1982). The psychology of physical symptoms. New York: Springer.

    Google Scholar 

  • Pennebaker, J. W. (1985). Traumatic experience and psychosomatic disease: Exploring the roles of behavioural inhibition, obsession, and confiding. Canadian Psychology, 26, 82–95.

    Google Scholar 

  • Pennebaker, J. W., & Skelton, J. A. (1978). Psychological parameters of physical symptoms. Personality and Social Psychology Bulletin, 4, 524–530.

    Google Scholar 

  • Perley, & Guze, S. (1962). Hysteria -the stability and usefulness of clinical criteria. New England Journal of Medicine, 266, 421–426.

    PubMed  Google Scholar 

  • Pilowksy, I. (1967). Dimensions of hypochondriasis. British Journal of Psychiatry, 113, 89–93.

    Google Scholar 

  • Prince, R. (1960). The “brain fag” syndrome in Nigerian students. Journal of Mental Science, 106, 559–570.

    PubMed  Google Scholar 

  • Quill, T. E., Lipkin, M., & Lamb, G. S. (1984). Health-care seeking by men in their spouse’s pregnancy. Psychosomatic Medicine, 46, 277–283.

    PubMed  Google Scholar 

  • Robins, L. N., & Heizer, J. E. (1982). Diagnostic interview schedule. (Reply to a letter to the editor.) Archives of General Psychiatry, 39, 1443–1445.

    Google Scholar 

  • Robins, L, N., Heizer, J. E., Croughon, J., & Ratcliff, K. W. (1981). National Institute of Mental Health diagnostic interview schedule. Archives of General Psychiatry, 38, 381–389.

    PubMed  Google Scholar 

  • Romano, J. M., & Turner, J. A. (1985). Chronic pain and depression: Does the evidence support a relationship? Psychological Bulletin, 97(1), 18–34.

    PubMed  Google Scholar 

  • Ross, E. D., & Rush, A. J. (1981). Diagnosis and neuroanatomical correlates of depression in brain damaged patients: Implications for a neurology of depression. Archives of General Psychiatry, 38, 1344–1354.

    PubMed  Google Scholar 

  • Schwartz, G. E., Davidson, R. J., & Goleman, D. J. (1978). Patterning of cognitive and somatic processes in the self-regulation of anxiety: Effects of meditation versus exercise. Psychosomatic Medicine, 40, 321–328.

    PubMed  Google Scholar 

  • Shapiro, M. F., & Lehman, A. F. (1983). The diagnosis of depression in different clinical settings: An analysis of the literature on the dexamethasone suppression test. Journal of Nervous and Mental Disease, 17, 714–720.

    Google Scholar 

  • Shields, S. A., & Stern, R. M. (1979). The perception of bodily change. In P. Pliner, K. R. Blankstein, & I. M. Spigel (Eds.), Perception of emotion in self and others (pp. 85–106). New York: Plenum Press.

    Google Scholar 

  • Shultz, T. R. (1982). Rules of causal attribution. Monographs of the Society for Research in Child Development. 47, 1–51.

    Google Scholar 

  • Shweder, R., & Bourne, E. (1982). Do conceptions of the person vary crossculturally? In A. Marsella, & G. White (Eds.), Cultural conceptions of mental health and therapy (pp. 97–137). Dordrecht, Holland: Reidel.

    Google Scholar 

  • Sicherman, B. (1977). The uses of a diagnosis: Doctors, patients and neurasthenia. Journal of the History of Medicine and Allied Sciences, 32, 33–54.

    PubMed  Google Scholar 

  • Sifneos, P. E. (1973). The prevalence of ’alexithymic’ characteristics in psychosomatic patients. Psychotherapy and Psychosomatics, 22, 255–262.

    PubMed  Google Scholar 

  • Sigvardsson, S., von Knorring, A. L., Bohman, M., & Cloninger, C. R. (1984). An adoption study of somatoform disorders. Archives of General Psychiatry, 41, 853–859.

    PubMed  Google Scholar 

  • Spence, N. D., Pilowsky, I., & Minniti, R. (1985). The attribution of affect in pain clinic patients: A psychophysiological study of the conversion process. International Journal of Psychiatry in Medicine, 15, 1–11.

    PubMed  Google Scholar 

  • Tollefson, G., & Straud, L., Hughes, E., & Garvey, M. G. (1984). The functional-organic dichotomy in new patient evaluations by residents in family practice. Comprehensive Psychiatry, 25, 419–425.

    PubMed  Google Scholar 

  • Turk, D. C., & Salovey, P. (1984). “Chronic pain as a variant of depressive disease”: A critical reappraisal. Journal of Nervous and Mental Disease, 172, 398–404.

    PubMed  Google Scholar 

  • Vaughn, K. B., Lanzetta, J. T. (1980). Vicarious instigation and conditioning of facial expressive and autonomic responses to a model’s expressive display of pain. Journal of Personality and Social Psychology, 38, 909–923.

    Google Scholar 

  • Wells, J. A., & Strickland, D. E. (1982). Physiogenic bias as invalidity in psychiatric symptom scales. Journal of Health and Social Behavior, 23, 235–252.

    PubMed  Google Scholar 

  • Wheaton, B. (1982). Uses and abuses of the Langner Index: A re-examination of findings on psychological and psychophysiological distress. In D. Mechanic (Ed.), Symptoms, illness behavior and help-seeking (pp. 25–54). New York: Prodist.

    Google Scholar 

  • White, G. (1982). The role of cultural explanation in “psychologization” and “somatization”. Social Science and Medicine, 16, 1519–1530.

    PubMed  Google Scholar 

  • Whybrow, P., Akiskal, H, & McKinney, W. T. (1983). Mood disorders. Plenum Press.

    Google Scholar 

  • Widmer, R. B., & Cadoret, R. J. (1978). Depression in family practice: changes in pattern of patient visits and complaints during a developing depression. Journal of Family Practice, 7, 293–302.

    PubMed  Google Scholar 

  • Widmer, R. B., & Cadoret, R. J. (1979). Depression in family practice: Changes in pattern of patient visits and complaints during subsequent developing depression. Journal of Family Practice, 9, 1017–1021.

    PubMed  Google Scholar 

  • Winner, E., Rosenstiel, A., & Gardner, H. (1976). The development of metaphoric understanding. Developmental Psychology, 12, 289–297.

    Google Scholar 

  • Winstead, B. A. (1984). Hysteria. In C. S. Widom (Ed.), Sex roles and psychopathology (pp. 73–100) New York: Plenum Press.

    Google Scholar 

  • Young, A. (1981). When rational men fall sick. Culture, Medicine and Psychiatry, 5, 317–335.

    PubMed  Google Scholar 

  • Zajonc, R. (1982). On the primacy of feeling. American Psychologist, 39(2), 117–123.

    Google Scholar 

  • Zajonc, R. B. (1985). Emotion and facial efference: A theory reclaimed. Science, 228, 15–21.

    PubMed  Google Scholar 

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  1. Department of Psychiatry, McGill University, USA

    Laurence Kirmayer

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  1. University of Toronto, Toronto, Canada

    Sean McHugh  & T. Michael Vallis  & 

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Kirmayer, L. (1986). Somatization and the Social Construction of Illness Experience. In: McHugh, S., Vallis, T.M. (eds) Illness Behavior. Springer, Boston, MA. https://doi.org/10.1007/978-1-4684-5257-0_7

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