Watch for a repressed anxiety

Somatic symptoms have become very common in Kashmir
Watch for a repressed anxiety
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A year back a male patient visited me. Many people will identify with his story. Some years back due to an extremely stressful event in his life he developed a sense of blockade in his nostrils. He visited some people commonly known as compounders in Kashmir, who gave him medicine ranging from inhalers to anti-allergic. Then somebody advised him to visit a private hospital outside J&K and he was operated upon for DNS, Deviated Nasal Septum. But his troubles were far from gone.

After returning back to valley his symptoms of nasal blockade won't go. In addition, he felt like his stomach is burning, after some months pain in legs and arms started.

In many cases predominant complaint is persistent and distressing pain, like backache or headache. Often patient complains of self-diagnosed sexual weakness and by the time patient reaches a qualified counsellor or psychiatrist, the patient would have spent lakhs of rupees on treatment from magical herbal syrups to pain killers, that give no relief.

These are known as somatic symptoms which have become very common in Kashmir. Other examples are lump in throat, and unexplained vomiting, hyperacidity, unconsciousness and neurological symptoms along with requests from patient for medical investigations in spite of continuous negative findings and suggestions by doctors that symptoms have no physical basis.

What causes them?
The symptom buries an unconscious mental conflict, an unacceptable painful thought is repressed and emotional energy is converted to a physical symptom. In the young, the symptoms often gets the patient something they wanted.

This does not mean all stomach or body aches should be called as somatic symptoms, a good GP carefully rules out physical illness. Some patients with somatoform symptoms require a primary diagnosis of major depression or schizophrenia. The symptom occurs abruptly and frequently follows an acute stress. The disorder usually is seen first during adolescence or in 20s. The patients often have associated moderate anxiety and depression.

Long term psychoanalysis appears to effect real change in many patients, crucial to any therapy is formation of a supportive therapeutic alliance with a mental health professional who helps the patient to ventilate. The counsellor should explore areas of stress in patient's life, and start working with other members of family. Need of the hour is orientation and awareness regarding somatoform disorders among masses, and health professionals.

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