Ian R. McWhinney, MD; Ronald M. Epstein, MD; Tom R. Freeman, MD
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McWhinney IR, Epstein RM, Freeman TR. Reply: Rethinking Somatization. Ann Intern Med. 1997;127:1133-1134. doi: 10.7326/0003-4819-127-12-199712150-00031
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Published: Ann Intern Med. 1997;127(12):1133-1134.
Dr. Loveman takes us to task for not discussing the association between child abuse and chronic symptoms in adult life. However, this evidence would not have altered our argument. We do not doubt that, in many patients, chronic unexplained illness has its origins in the embodied effects of traumatic past experience. We argued that the embodiment of the emotions is normal and that the problem lies in the chronicity of the symptoms. In the etiology of any chronic illness, it is important to distinguish between the initial and the perpetuating causes. The factors triggering the onset are not necessarily the same as those maintaining the illness. As Dr. Wallace reminds us, nociceptive response is one such factor. Failure of the emotion to enter consciousness is another. Success in therapy requires us to attend to the causes of chronicity, directing our efforts to those in each patient that are most amenable to change. The approach described by Dr. Patil is in accordance with this thinking, although cognitive and psychobehavioral approaches do not exhaust the possibilities.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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