Understanding somatic complaints

Until two decades ago, it was generally considered standard psychiatric wisdom that emotional distress, especially in non-Western patients, was primarily somatic in character; and that, because of their dominant expression of suffering through somatization, these patients were not psychologically minded, making them incapable of participating in psychotherapy or counseling. Extensive clinical experience and scientific studies with refugee patients throughout the world have led to a revision of these previously dominant professional attitudes. While it may be valid that refugees primarily present their emotional suffering through somatic complaints, it has also been found that it is fairly easy for the medical practitioner to obtain from refugee patients deeper insights into their feelings and their beliefs as to the causes of their emotional distress. Of course, because of their severe victimization, refugees as a group will not readily share their experiences of trauma and related medical and psychiatric injuries if they are not in a highly confidential environment where it is clear that the medical team can be trusted. In fact, the ability of refugee patients to extend themselves beyond their initial somatic complaints, as well as participating in clinical dialogue with the psychiatric practitioner as to the nature of their mental distress, is more the rule than the exception and is a major goal of assessment.^4)

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