PSYCHOSOMATIC ILLNESS:
Dear Sumner,
I am sending you Jocelyn Brent, a 42 year old woman with complaints of lower abdominal pains for the past 5 years. She has been a vice president of an advertising firm for about 10 years and is under constant pressure in her job. While she recognizes that her symptoms are more severe while at work, she, nonetheless, is certain that there is something seriously wrong with her kidneys. She has already been evaluated by a gynecologist, gastroenterologist, endocrinologist, general surgeon as well as an urologist, and no obvious cause for her symptoms has been found thus far. I have advised a psychological evaluation but she resents any suggestion that her problems are based in her head. Quite frankly, I am at my wit’s end in dealing with her. I would be most grateful if you would see her, and, hopefully, if not render a cure, at least calm her down.
Dear Brenda,
As I know you are well aware, Jocelyn is convinced that she has a real problem. The bulk of my time with her (about an hour) involved a rather extended discussion re the anatomy, physiology and psychology of the genitourinary tract. We went over in some detail the “negative” results from her previous evaluations, as well as those from my exam. We spoke quite openly about the fact that the body can definitely be influenced by emotional factors and even if her symptoms are caused, or exacerbated, by her mental state, the symptoms themselves are still very real for her. I mentioned to her that although we (the physicians) did not come up with a diagnosis, in the process of the evaluation, no serious underlying problem was revealed. (REASSURANCE IS A POWERFUL THERAPEUTIC MODALITY.) I felt that, apropos of your last request in your referral letter, Jocelyn left my office in a much calmer state than when she arrived!
