Lacey, fifty-seven, insists that no physician can determine the cause of her multiple somatic complaints. Lacey, a physician herself, no longer practices medicine, as she feels disabled by her symptoms which she struggles to explain to others. She is not exactly tired, she says, but she does feel fatigue. She does not have headaches, but she does feel discomfort in her head. Her stomach is not quite right, although she eats a healthy diet and she maintains a healthy weight. She has consulted multiple tertiary care medical centers, all of whom, express confusion over her symptoms. She comes to me, not because she considers her symptoms secondary to her mental state, but because she is despairing that no physician can give her a diagnosis. George Vaillant MD in his article entitled “The Beginning of Wisdom is Never Calling a Patient a Borderline,” speculates that hypochondriacs need to be understood, in terms of their subjective suffering, and through this understanding, their personal trauma will eventually unfold, yielding a platform in which to work through childhood pain. In essence, primary care physicians need to entertain the notion of a hypochondriac as someone who is crying out to be heard, but patience and empathy must be present for a long time, before this will pay off with insight and symptom relief. Psychiatrists often cannot be helpful, as the hypochondriac will feel further dismissed and thereby get more angry. My job with Lacey is to work with her and her primary care physicians, mostly to help her other physicians understand how to work with her. My direct work with Lacey is to help her deal with her frustrations, while cracking the door open, that her symptoms, indeed very distressing, might be as a result of a painful internal mental state which reaches back to childhood trauma and the need to be heard and understood. Sad as it is, Lacey acts as if the only way people will listen to her is if she has medical complaints. It is as if she believes that if she were to say she were sad, anxious or scared, then she would be ignored, but if she insists that she has a serious medical problem, then her friends and family will attend to her. This pathological belief, likely stems from a childhood in which only physical problems yielded nurturing, whereas emotional issues were neglected. Maybe Lacey will come to understand that, but for now, the job is to give her the space to feel heard and understood, with the sensitivity to know that the slightest suggestion that her mind is producing these bodily complaints, will be heard with anger and despair.
Shirah Vollmer MD 