Question

what do you believe about clients who have physical complaints but no demonstrated physiologic reasons for them

Answer 1

Many psychologists see clients who are worried about physical symptoms with no clear organic cause, whether they are headaches, abdominal pain or more vague complaints such as fatigue or simply feeling unwell. Depending on the severity and chronicity of the complaints, they present a conundrum: To what extent should you be concerned that a serious medical condition underlies the complaints, and how much should you assume the problem is psychological and tailor treatment accordingly.

  

Physicians often see symptoms without a definitive organic diagnosis as psychosomatic — a modern if less dramatic version of the 19th-century tendency to label neurological symptoms "hysteria," says Michael Sharpe, MD, a University of Oxford psychiatrist who studies the psychological aspects of medical illness.

"There has been an unfortunate split in our thinking between what's physical and what we think of as ‘real,' and what is mental, and what we think of as imaginary or blameworthy," says Sharpe. "What we really don't have, and what we need, is better integration and understanding of conditions that may have both physical and psychological components."

In fact, because of this split, the area is highly controversial, with physicians and researchers sometimes butting heads with patient advocates who are unwilling to accept that their conditions may be partly or completely psychologically based.

  

"You don't have to see evidence of pain to see that someone is in pain, or fatigued, for that matter," Galper explains.

Thanks to these insights and our growing knowledge of the complex ways the brain affects the body, practitioners and researchers are developing more nuanced ways of treating such patients. Some are tailoring cognitive behavioral strategies specifically to address physical symptoms, while others are creating and testing models that see poorly understood or unexplained conditions as multifactorial, the result of complex biopsychosocial factors.

No matter what the ultimate cause of a client's physical symptoms, however, psychologists' main focus should be on helping patients cope with their symptoms and develop a better quality of life, just as they would with a firm organic diagnosis, says Ellen Dornelas, PhD, a health psychologist who sees patients with cancer and other medical conditions at Hartford Hospital in Hartford, Conn.

"The body and mind work together in mysterious ways, and there are a lot of permutations in why people develop physical symptoms," Dornelas says. "I strive for a dialectic that acknowledges both the person's physical and emotional symptoms, and then work on helping people make positive changes."