There is someone on my ward who is very physically ill, but it’s pretty much being ignored because the doctors aren’t sure whether it’s a general medical condition causing the problem, or if it’s a result of her psychiatric illness. A few months ago, there was a TV show on medical malpractice, and they had a case on it of a woman dying from a lung condition, which was blamed on somatization because of her borderline personality disorder. In my opinion, doctors pretty easily blame patients’ physical complaints on their mental illness.
Obviously, somatization – where mental distress causes physical symptoms – happens. Especially with vague physical ailments, this is a possibility. We all know how we may get headaches or constipation from stress – and this even occurs to mentally healthy people. However, actual physical causes are also possible, and may pose a significant danger to a person’s health and even life, as happened with the woman in the TV show and possibly with the one on my ward. And just because a person has a mental illness, doesn’t mean they can’t get physically ill.
When people without a history of psychiatric illness come into the doctors’office with symptoms, it’s first determined whether a physical condition causes the problems. This is done pretty extensively, and only if the doctors truly cannot find a physical cause for the person’s symptoms, is somatization considered. But this is very different when a psychiatric patient enters the doctor’s office. One of the doctors who were asked to comment on the TV case, an otolagyngologist, admitted that his opinion on possible causes for his patient’s problems is colored when he learns that the patient has a psychiatric illness. I am not sure yet if this is the case with my family doctor – who knew from the beginning on that I have a psychiatric problem, because she prescribed my risperdal -, too. I asked her about four different physical symptoms so far, and she at least did a physical examination for all four. With three of them, she ended up finding a physical cause – nothing serious -, and with one, she suggested stress. I hope, of course, that she will take me and other psychiatric patients in her care seriously when we come in with physical symptoms. Ideally, as with mentally healthy patients, doctors would first rule out physical causes before jumping to conclusions about possible somatization – because it may save the patient’s life.