You are referring to somatoform disorders, which are conditions where individuals use a somatic idiom for emotional distress.
I'm not sure if you're advocating this particular view of somatoform disorder, but it's one of several--the most fair of which, I think, is
medically unexplained somatic symptoms.
Otherwise, you're taking us back to the 1920s with Stekel's
organsprache--organ speech. Stekel used this word to describe what he said was "the bodily manifestations of deep-seated neuroses." This word was
mistranslated as "somatization"
--literally
, a making of the body--and a concept was born: one that inappropriately intertwined psychoanalysis with a physical phenomenon.
All illness is somatization, literally speaking, because
all illness is a making of the body. Some illness is medically explainable, and some illness isn't. Attaching psychoanalytic concepts to illnesses that aren't medically explainable confuses a psychoanalytic explanation for a more accurate one:
we have no biological clue of what's going on. A psychoanalytic explanation might be
helpful (therapeutically, conceptually, etc.), but we should be careful not to hide our
biological ignorance behind words. I'm sure nobody disagrees, but in the history of medicine--not just psychiatry--doctors have been quick to explain away
their ignorance in terms of
their patient's personal defects, where a failing of medical understanding became a failing of personal character (even the phrase "very real
to them" irks me). Cholera and "moral hygiene" is a great example.
And "somatic idiom" was coined by Kleinman to explain the observation that Chinese patients often presented depressive symptoms as somatic ones. These somatic symptoms, he argued, were culturally-specific
idioms for depressive symptoms. It had to do with cross-cultural diagnosis in psychiatry. But then the phrase was appropriated (wrongly, I think) to conceptualise somatoform disorder in psychodynamic terms.
We've now learned much more about the biological basis of diseases like depression, and I hope we can keep an open mind to learning more about biological basis for somatoform disorders. That doesn't mean Stekel was
wrong. That doesn't mean Stekel was
unhelpful. But we should be very careful to distinguish the different intellectual frameworks we use to approach disease (because, as you've pointed out before, diagnosis is a
semiotic act).
Just because psychological techniques help, doesn't mean there isn't a biological basis, because ultimately
everything is biological, even if everything can't be explained in biological terms.
Lipowski ZJ. Somatization and depression. Psychosomatics. 1990;31(1):13-21.
Kleinman AM. Depression, somatization and the "new cross-cultural psychiatry". Social science & medicine. 11(1):3-10. 1977.
Kind of an overly broad question that requires definitional clarification, but I think you get the picture. The purpose of the question is essentially to discuss whether individuals with fibromyalgia require predominantly psychiatric as opposed to medical treatment.
@cbrons, can you help me understand the difference between psychiatry and medicine?
