Somatisation is where psychological or emotional factors manifest themselves as physical (somatic) symptoms. Some of our clients who suffer chronic and often debilitating pain are diagnosed with somatic symptom disorder (SSD).
A diagnosis of SSD is met inevitably with a variety of emotions; initially shock, quickly replaced by a combination of anger, frustration and confusion.
“How can he say that?”
“This isn’t all in my mind you know!”
“Doesn’t he understand I’m in pain?”
“He thinks I’m swinging the lead.”
“He should try being me for a day.”
“This is just wrong!”
These are all typical and entirely understandable reactions.
The power of the mind
Many years ago, I acted for an elderly gentleman who had suffered serious injuries in a road traffic accident. On more than one occasion he informed me, politely but firmly, of his philosophy towards dealing with any form of trauma or ailment: “Cut it off, cut it out or blast it with chemicals; just get rid of it and get on with your life.”
Whilst some may applaud his remarkably pragmatic attitude to tackling injury and disease, there are a huge swathe of conditions that are bypassed entirely by such an approach, ie those whose cause is fully or partially psychological or emotional.
If you have had a particularly stressful or emotional day, you may not think it unusual that you have developed a headache or feel fatigued. That headache or fatigue is in all likelihood a physical manifestation of stress or emotion. They are very real; your head IS pounding and you DO feel drained of energy, but there is no underlying physical cause. Remove the stress or emotion and the symptoms should settle down.
Many people suffer from irritable bowel syndrome (IBS), the symptoms of which can include abdominal cramps, pain, bloating, constipation and diarrhoea, all of which are clearly physical symptoms which can severely restrict a person’s life. However, whilst the exact cause(s) of IBS are not entirely clear, it is widely believed that stress and anxiety play a significant role in both causing and maintaining the condition.
These are just very common examples of the power that the mind has over the body, but there are any number of physical symptoms that can arise as a result of psychological or emotional trauma.
Understandably, people suffering SSD will be conscious only of their physical problem(s) and initially seek medical as opposed to psychological assistance. However, even when diagnosed with SSD the biggest obstacle to successful treatment is acceptance; ie that your very real physical pain and/or other symptoms can be treated with psychological therapy. Indeed, people can be extremely hostile to the idea – “just how is a shrink is going to cure my pain?”
A person’s own frustration may be fuelled by an equally unaccepting family. Not only is the whole concept of SSD difficult to understand but for many people, psychological treatment still carries a huge stigma. It’s also difficult to get away from the thought that everyone thinks you’re making the whole thing up; you’re a malingerer.
Of course, the sad reality is that without acceptance, a person is unlikely ever to fully embrace the psychological therapy and therefore the prospect of improvement will be minimal.
Is a certain type of person more likely to develop SSD?
In my experience the answer to this is a resounding ‘no’. Anyone can potentially develop SSD. Over the years, our clients diagnosed with SSD have included the old, the middle aged and the young, men and women, the less educated and the highly educated, manual workers and professionals, people that have never had a day off work sick – nobody is immune.
SSD in the litigation context
Of course, a diagnosis of SSD is at best likely to be met with extreme scepticism by an insurance company. Covert surveillance [LINK] will take place, social media will be trawled through, and every record that the insurance company can get their hands on will be examined forensically. The hatchet men medical experts will be wheeled out, the gloves will come off and the atmosphere is likely to become very tense.
But fear not, if it can be proved on balance that the SSD was caused by the accident in question, there is absolutely no reason why the claim should not succeed.
However, it is vital that the lawyer has significant experience of claims involving SSD, the nature of which throws up its very own particular issues and potential complications. Those must be anticipated from the outset by the lawyer and dealt with appropriately.
This is a link to a case study where our client was diagnosed with SSD following a road traffic accident.