O processo de somatização: conceitos, avaliação e tratamento
... De acordo com Berrios e Munford, (1995), o conceito do autor para o termo poderia ser um equivalente a compreensão da Conversão. Mas devido ao seu uso impreciso e variado, fez-se necessário esforços para a redefinição da somatização, que ocasionou em diferentes modos de compreensão do conceito, e corrobora com o posto por Quartilho (2016), para o qual, a somatização ainda tem provado ser um conceito não unitário, complexo, ambíguo e polissêmico. ...
... Para (Quartilho, 2016) que são confrontados com as dificuldades associadas à compreensão integral e alívio eficaz dos sintomas do seu paciente, um processo intricado que demanda esforços conjuntos de toda a equipe multiprofissional. ...
Despite being an important clinical phenomenon and with a strong prevalence in primary health care, the somatization still has a complex character and is poorly understood by health professionals. Therefore, the objective of this study is characterize the perception of residents of the multidisciplinary team, about this phenomenon, the formation about the theme and the care offered to the child patient that manifests a frame of this nature. This is a qualitative, exploratory and descriptive study. Using semi-structured interviews as a way of obtaining data and information on the subject. A total of 8 subjects participated in this study. Data were analyzed with the aid of the IRAMUTEQ textual analysis software using the thematic content analysis technique. It was concluded that these professionals feel unprepared to deal with the somatic in childhood, both for its complexity, which challenges the biomedical model, and for the lack of theoretical and practical foundation in their academic education, characterizing the Health Residency as the opportunity to know and learn to deal with this phenomenon already in practice as a professional.
... A leitura de Bernardo Soares, no Livro do desassossego, ou as cartas de Fernando Pessoa a Mário de Sá-Carneiro, ajudam-nos a compreender a fenomenologia do tédio e da depressão, a confluência sofrida do mal-estar físico e psicológico. Os trabalhos de Marcel Proust (À la recherche du temps perdu), Gustave Flaubert (Madame Bovary) ou Jane Austen (Sense and Sensibility) convocam também a literatura (e a história) ao iluminarem a experiência psicossomática de uma "literatura de sensibilidade", característica da época vitoriana (Quartilho, 2016). ...
Recognizing the state of “permanent crisis” in the Humanities, considerations are made about the social and political fractures in post-war Western societies. The crisis of democracy, together with online social media, are associated with both an impairment to the common good and a “chaos” conditioned by the absence of control over information flows and the mechanisms of persuasion in an open society. Given this context, humanities and liberal education programs seem potentially useful for improving democracy. In addition, the role of medical humanities is highlighted in the construction of an ethically vigilant, reflective, resilient and intervening health professional. Finally, the present article presents critical references to the ideology of meritocracy of neoliberal societies, with negative effects in the processes of quantification and anonymous evaluation in Academics, as well as in the health of the professionals being discussed.
... A leitura de Bernardo Soares, no Livro do desassossego, ou as cartas de Fernando Pessoa a Mário de Sá-Carneiro, ajudam-nos a compreender a fenomenologia do tédio e da depressão, a confluência sofrida do mal-estar físico e psicológico. Os trabalhos de Marcel Proust (À la recherche du temps perdu), Gustave Flaubert (Madame Bovary) ou Jane Austen (Sense and Sensibility) convocam também a literatura (e a história) ao iluminarem a experiência psicossomática de uma "literatura de sensibilidade", característica da época vitoriana (Quartilho, 2016). ...
Recognizing the state of “permanent crisis” in the Humanities, considerations are made about the social and political fractures in post-war Western societies. The crisis of democracy, together with online social media, are associated with both an impairment to the common good and a “chaos” conditioned by the absence of control over information flows and the mechanisms of persuasion in an open society. Given this context, humanities and liberal education programs seem potentially useful for improving democracy. In addition, the role of medical humanities is highlighted in the construction of an ethically vigilant, reflective, resilient and intervening health professional. Finally, the present article presents critical references to the ideology of meritocracy of neoliberal societies, with negative effects in the processes of quantification and anonymous evaluation in Academics, as well as in the health of the professionals being discussed.
... Despite the historical importance of Psychoanalysis, especially for the understanding of stress-related symptoms (Quartilho, 2016), studies on the efficacy of treatments based on this theory are scarce (Ben-Itzhak et al., 2012). As consequence of the lack of research, we have witnessed the gradual marginalization of psychoanalytic therapies. ...
Psychoanalysis is indispensable when writing and discussing traumatic stress, but in the treatment of these conditions it is ultimately disregarded. Since they are considered long-term treatments, therapies derived from psychoanalysis, such as Psychodynamic Psychotherapy (PDT), are not the first choice in health centers and clinics, which may be also a reflection of a scarcity of publications on its effectiveness. Through a literature review, focused on the effect size of PDT in the treatment of Posttraumatic Stress Disorder (PTSD), we have confirmed this scarcity. However, in the few studies conducted on this topic, findings have shown similarities between PDT and other therapies in reducing PTSD symptoms, both in post-therapy and follow-up assessments. The time of psychoanalytic psychotherapies is often pointed out as an obstacle, although studies have indicated that patients treated through these techniques present a continuous state of improvement.
... Thus, suffering and a wide plurality of meanings interact in processes with a looping effect. As an example, fibromyalgia and other somatoform disorders seem to be, at least initially, sufferings in search of repertoires of symptoms by means of which the suffering individuals seek to construct a performativity capable of eliciting the recognition of their suffering by others (namely, by experts) (Greco, 1998;Quartilho, 2016). Yet, despite this close interdependence, it seems possible to differentiate two areas of problems: the emergence of illness experiences in the life of individuals, and the work undertaken by authorized experts to identify the underlying health issue, restore health or help coping with the illness (or disease). ...
This article analyses some of the emerging problems in the field of social studies at the juncture of the domains of health and science. Building on critical perspectives, namely those hailing from social history, postcolonial studies and collaborative research, it argues for the need to ground investigation on concrete historical forms of social suffering. This implies a multi-scale approach which considers: 1) individual suffering and illness experienced in social interactions; 2) the institutionalised expert translations of suffering into disease; and 3) the political rationales, developed by both local and global stakeholders, which assist in the creation of social environments of health and illness. While illustrations of the theoretical proposals derive mostly from the particular field of mental health, it is argued that their implications may apply to a wider range of themes dealing with health and science issues.
Stress is a multidimensional and multifaceted phenomenon that reflects and conditions individual and organizational quality of life. However, given specific work contexts in which there are disproportionate demands, lack or reduced support from the organizational structure, dull treatment of employees, lack of recognition, and the existence of a conflictual environment, it leads to relatively high levels of organizational stress. In turn, burnout arises from the crisis in relationships with work. Its main manifestations are emotional and physical exhaustion, cynicism, and professional ineffectiveness, arising from feelings of exhaustion, energy depletion, increased apathy with work, reduced effectiveness, and negativism with the professional routine. In this follow-up, a bibliometric analysis between 1980 and 2022 was conducted to explore the most relevant authors, documents, and journals, the trends identified in the publications, and the collaborations between countries in the field of study.
For more than 150 years, traumatic stress has been a recurrent topic of medical and psychological studies, in which war-related experiences remain to be addressed. Although veterans have been considered a high-risk group for the development of stress-related diseases, the impact of aging on the trauma process is an unexplored field. This study aimed to analyze the aging-related factors that may influence the emergence of traumatic stress symptoms in war veterans. The clinical data of 29 Colonial War Portuguese veterans were verified in order to identify the main diagnoses, and the frequency of health service use. Through thematic analysis of the transcripts of 10 interviews with veterans diagnosed with Post Traumatic Stress Disorder (PTSD), the main symptoms and factors that led them to mental health services were identified. In addition, a literature review on mental health and psychological trauma was conducted to provide an overview of the knowledge on this topic. Aging seems to be an opportunity to face conflicts which have been kept hidden throughout veterans’ lives. Social stigmatization and the non-recognition of traumatic stress as a disease influenced the Portuguese veterans’ silence, which could be broken with the aging process. Retirement, physical illness, death of close friends or family members, and loss of autonomy may contribute to the onset of trauma-related symptoms.
(1) Background: Functional somatic symptoms (FSS) are physical symptoms that cannot be fully explained by medical diagnosis, injuries, and medication intake. More than the presence of unexplained symptoms, this condition is associated with functional disabilities, psychological distress, increased use of health services, and it has been linked to depressive and anxiety disorders. Recognizing the difficulty of diagnosing individuals with FSS and the impact on public health systems, this study aimed to verify the concomitant incidence of psychopathological symptoms and FSS in Portugal. (2) Methods: For this purpose, 93 psychosomatic outpatients (91.4% women with a mean age of 53.9 years old) and 101 subjects from the general population (74.3% women with 37.8 years old) were evaluated. The survey questionnaire included the 15-item Patient Health Questionnaire, the 20-Item Short Form Survey, the Brief Symptom Inventory, the Depression, Anxiety and Stress Scale, and questions on sociodemographic and clinical characteristics. (3) Results: Increases in FSS severity were correlated with higher rates of depression, anxiety, and stress symptoms. The findings also suggest that increased rates of FSS are associated with lower educational level and female gender. (4) Conclusion: Being aware of the relationship between FSS and psychopathological symptoms and the need to explore psychosocial issues during clinical interviews may favor early detection of these cases. The early detection of mental disorders is essential for individuals’ adherence to treatments, reflecting on healthcare costs.
Cambridge Core - Sociology of Science and Medicine - A Handbook for the Study of Mental Health - edited by Teresa L. Scheid
Discusses the social constructionist movement in modern psychology, noting that social constructionism views discourse about the world not as a reflection or map of the world but as an artifact of communal interchange. Both as an orientation to knowledge and to the character of psychological constructs, constructionism presents a significant challenge to conventional understanding. Although the roots of constructionist thought may be traced to long-standing debates between empiricist and rationalist schools of thought, constructionism moves beyond the dualism of these traditions and places knowledge within the process of social interchange. Although the role of psychological explanation is problematic, a fully developed constructionism could furnish a means for understanding the process of science and invites the development of alternative criteria for the evaluation of psychological inquiry. (100 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
There is currently a great deal of interest in patients with functional somatic symptoms - physical complaints which are not explained by organic findings - but until now there has been little information available on the principles and practical methods of management. This book covers all the main themes in the management of somatic disorders, and will be invaluable both as a comprehensive academic reference and as a practical clinical guide. The authors cover problems specific to children and the elderly, and organization of care, as well as the clinical syndromes such as hypochondriasis and chronic pain, chronic fatique, and low back pain. Treatment of functional somatic symptoms is the first comprehensive, authoritative and practical guide on the management of a wide variety of medically unexplained symptoms which are very frequent in all areas of primary and hospital care. The book will be useful to clinicians and to research workers as a source book and clinical manual.
There are certain phenomena, such as hypnosis, hysteria, multiple personality disorder, recovered memory syndrome, claims of satanic ritual abuse, alien abduction syndrome, and culture-specific disorders that, although common, are difficult to explain completely. The purpose of this volume is to apply a model of social relations to these phenomena in order to provide a different explanation for them. Wenegrat argues that they are socially constructed illness roles or purposive behavior patterns into which patients fall while receiving either unintentional or intentional cues during interactions with caretakers and authority figures. The application of the social-relations model raises some important, yet previously overlooked, questions about these phenomena. It also illustrates some important aspects of human nature and consciousness, places illness behaviors in their larger, cultural context, and shows the way to a new and different view of mental life.
There is currently a great deal of interest in patients with functional somatic symptoms - physical complaints which are not explained by organic findings - but until now there has been little information available on the principles and practical methods of management. This book covers all the main themes in the management of somatic disorders, and will be invaluable both as a comprehensive academic reference and as a practical clinical guide. The authors cover problems specific to children and the elderly, and organization of care, as well as the clinical syndromes such as hypochondriasis and chronic pain, chronic fatique, and low back pain. Treatment of functional somatic symptoms is the first comprehensive, authoritative and practical guide on the management of a wide variety of medically unexplained symptoms which are very frequent in all areas of primary and hospital care. The book will be useful to clinicians and to research workers as a source book and clinical manual.
There is currently a great deal of interest in patients with functional somatic symptoms - physical complaints which are not explained by organic findings - but until now there has been little information available on the principles and practical methods of management. This book covers all the main themes in the management of somatic disorders, and will be invaluable both as a comprehensive academic reference and as a practical clinical guide. The authors cover problems specific to children and the elderly, and organization of care, as well as the clinical syndromes such as hypochondriasis and chronic pain, chronic fatique, and low back pain. Treatment of functional somatic symptoms is the first comprehensive, authoritative and practical guide on the management of a wide variety of medically unexplained symptoms which are very frequent in all areas of primary and hospital care. The book will be useful to clinicians and to research workers as a source book and clinical manual.
The Loss of Sadness argues that the increased prevalence of major depressive disorder is due not to a genuine rise in mental disease, but to the way that normal human sadness has been 'pathologised' since 1980. That year saw the publication of the landmark third edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-III), which has since become a dominant force behind our current understanding of mental illness overall. As concerns at least major depression, the authors argue that the DSM's definition of the condition is too broad and that as a result virtually all research and clinical approaches to the condition have been based on a flawed understanding about it. The social, political, and scientific implications of this are far-reaching - from the overselling of antidepressants to treat ordinary sadness, as Big Pharma exploits the DSM for its own purposes; to intrusive and expensive depression screening programs at all levels of society, as well-meaning but misguided initiatives translate the DSM into simple terms to catch any whiff of depressive pathology in our midst; and funded research into the 'epidemic' of depression, which advances the field very litttle and the public even less. Ultimately, the definition of depression that is in operation today has formed the basis for an entire system of social control (e.g. community-wide screening initiatives, intrusive public health policy) that benefits psychiatry, primary care providers, and the pharmaceutical and insurance industries by turning everyone else into a potential consumer of services, needed or not. The authors do recognise that depression is a devastating illness that affects some people. Their chief concern is with the use of this diagnosis as a catch-all for anyone who has experienced sadness for more than a few weeks at a time. The result is a pointed yet nuanced critique of modern psychiatry that will stir controversy of the sort that will reacquaint us with sadness as a primary human emotion and that could productively influence the way that depression the actual illness is characterised in the future.
The pursuit of happiness is a defining theme of the modern era. But what if people aren't very good at it? This and related questions are explored in this book, the first comprehensive philosophical treatment of happiness in the contemporary psychological sense. In these pages, Dan Haybron argues that people are probably less effective at judging, and promoting, their own welfare than common belief has it. For the psychological dimensions of well-being, particularly our emotional lives, are far richer and more complex than we tend to realize. Knowing one's own interests is no trivial matter. As well, we tend to make a variety of systematic errors in the pursuit of happiness. We may need, then, to rethink traditional assumptions about human nature, the good life, and the good society. Thoroughly engaged with both philosophical and scientific work on happiness and well-being, this book will be a definitive resource for philosophers, social scientists, policy makers, and other students of human well-being.
We become ill in ways our parents and grandparents did not, with diseases unheard of and treatments undreamed of by them. Illness has changed in the postmodern era—roughly the period since World War II—as dramatically as technology, transportation, and the texture of everyday life. Exploring these changes, this book tells the story, or stories, of what goes into making the postmodern experience of illness different, perhaps unique. Even as it decries the overuse and misuse of the term “postmodern,” it shows how brightly ideas of illness, health, and postmodernism illuminate one another in modern culture. Modern medicine traditionally separates disease—an objectively verified disorder—from illness, a patient's subjective experience. Postmodern medicine, the book says, can make no such clean distinction; instead, it demands a biocultural model, situating illness at the crossroads of biology and culture. Maladies such as chronic fatigue syndrome and post-traumatic stress disorder signal our awareness that there are biocultural ways of being sick. The biocultural vision of illness not only blurs old boundaries but also offers a new and infinitely promising arena for investigating both biology and culture. In many ways, the book leads us to understand our experience of the world differently.
About one American in five receives a diagnosis of major depression over the course of a lifetime. That's despite the fact that many such patients have no mood disorder; they're not sad, but suffer from anxiety, fatigue, insomnia, or a tendency to obsess about the whole business. "There is a term for what they have," writes Edward Shorter, "and it's a good old-fashioned term that has gone out of use. They have nerves." In How Everyone Became Depressed, Edward Shorter, a distinguished professor of psychiatry and the history of medicine argues for a return to the old fashioned concept of nervous illness. These are, he writes, diseases of the entire body, not the mind, and as was recognized as early as the 1600s. Shorter traces the evolution of the concept of "nerves" and the "nervous breakdown" in western medical thought. He points to a great paradigm shift in the first third of the twentieth century, driven especially by Freud, that transferred behavioral disorders from neurology to psychiatry, spotlighting the mind, not the body. The catch-all term "depression" now applies to virtually everything, "a jumble of non-disease entities, created by political infighting within psychiatry, by competitive struggles in the pharmaceutical industry, and by the whimsy of the regulators." Depression is a real and very serious illness, he argues; it should not be diagnosed so promiscuously, and certainly not without regard to the rest of the body. Meloncholia, he writes, "the quintessence of the nervous breakdown, reaches deep into the endocrine system, which governs the thyroid and adrenal glands among other organs." In a learned yet provocative challenge to psychiatry, Shorter argues that the continuing misuse of "depression" represents nothing less than "the failure of the scientific imagination."
Traumatic Pasts, originally published in 2001, offers a variety of perspectives on mental trauma in war, medicine, culture and society in modern European and American history. Its primary goals are: to provide a generous sampling of the best of the historical scholarship about trauma; to indicate the empirical, analytical and methodological scope of this work; and to present some of the conceptual and methodological issues inherent in writing about the subject. The book operates on the premise that the historical humanities have something crucially important to say about trauma; its essays may be read, in part, as attempts to introduce a deep historical dimension into ongoing debates and controversies. However, it is important to stress that these essays are not simply addressed the concerns; rather, they reflect a shared conviction that trauma opens up fresh perspectives in the study of social and cultural history.
With thorough coverage of inequality in health care access and practice, this leading textbook has been widely acclaimed by teachers as the most accessible of any available. It introduces and integrates recent research in medical sociology and emphasizes the importance of race, class, gender throughout. This new edition leads students through the complexities of the evolving Affordable Care Act. It significantly expands coverage of medical technology, end-of-life issues, and alternative and complementary health care-topics students typically debate in the classroom. Many new textboxes and enhancements in pedagogy grace this new edition, which is essential in the fast-changing area of health care.
In this companion volume to their widely acclaimed Perspectives of Psychiatry, Phillip R. Slavney, M.D., and Paul R. McHugh, M.D., argue that the discontinuity of brain and mind is the source of much of psychiatry's discord, for it leads psychiatrists to think about their discipline in terms of polar opposites: conscious or unconscious; explanation or understanding; paternalism or autonomy. Psychiatric Polarities brings together the history of ideas and such clinical issues as suicide and bipolar disorder to identify, describe, and debate these and other polar oppositions that arise from psychiatry's inherent ambiguity. There is no single conceptual perspective that is sufficient for all of psychiatry's concerns, Slavney and McHugh observe, yet it is both possible and necessary to transcend the denominational conflicts that plague the field. In Psychiatric Polarities, their examination of these conflicts demonstrates how a methodological approach can help to resolve disagreements rooted in partisan commitments. © 1987, 2016 Johns Hopkins University Press All rights reserved.
Objective. To evaluate the relationship between sexual and/or physical abuse and health care usage in patients with fibromyalgia (FM) and identify variables that may influence this relationship. Methods. We assessed history of sexual/physical abuse, health care utilization, and medication usage, as well as related variables in 75 women with FM using standardized questionnaires, structured interviews, and laboratory pain perception tasks. Results. Fifty-seven percent of FM patients reported a history of sexual/physical abuse. Compared to nonabused patients, abused patients reported significantly greater utilization of outpatient health care services for problems other than FM and greater use of medications for pain (P ≤ 0.025). Consistent with our expectations, abused patients also were characterized by significantly greater pain, fatigue, functional disability, and stress, as well as by a tendency to label dolorimeter stimuli as painful regardless of their intensities (P ≤ 0.05). Additional analyses suggested that the high frequency of sexual/physical abuse in our patients was associated primarily with seeking health care for chronic pain rather than the FM syndrome itself or genetic factors. Conclusion. There is an association in FM patients between sexual/physical abuse and increased use of outpatient health care services and medications for pain. This association may be influenced by clinical symptoms, functional disability, psychiatric disorders, stress, and abnormal pain perception. The relationships among these variables should be further tested in prospective, population-based studies.
The loss of reason, a sense of alienation from the commonsense world we all like to imagine we inhabit, the shattering emotional turmoil that seizes hold and won't let go-these are some of the traits we associate with madness. Today, mental disturbance is most commonly viewed through a medical lens, but societies have also sought to make sense of it through religion or the supernatural, or by constructing psychological or social explanations in an effort to tame the demons of unreason. Madness in Civilization traces the long and complex history of this affliction and our attempts to treat it. Beautifully illustrated throughout, Madness in Civilization takes readers from antiquity to today, painting a vivid and often harrowing portrait of the different ways that cultures around the world have interpreted and responded to the seemingly irrational, psychotic, and insane. From the Bible to Sigmund Freud, from exorcism to mesmerism, from Bedlam to Victorian asylums, from the theory of humors to modern pharmacology, the book explores the manifestations and meanings of madness, its challenges and consequences, and our varied responses to it. It also looks at how insanity has haunted the imaginations of artists and writers and describes the profound influence it has had on the arts, from drama, opera, and the novel to drawing, painting, and sculpture. Written by one of the world's preeminent historians of psychiatry, Madness in Civilization is a panoramic history of the human encounter with unreason.
This book explores the connection of functional pain syndromes (e.g., irritable bowel syndrome and fibromyalgia) with anxiety, depression, chronic fatigue syndrome, and posttraumatic stress disorder. The authors address possible common pathophysiologies and review a range of treatment options, from antidepressants to cognitive-behavioral therapy. Who should buy this book?. Whether you are a general practitioner, specialist, or scientist, this book is essential reading. It sheds new light on the complex links between various painful syndromes and disorders.
Is it possible that all of the social sciences could employ a common methodology? If so, what would it be? This article adresses these questions. It takes off from James Coleman’s recent book, The Foundations of Social Theory. Coleman’s social theory is built on the postulate that individuals are rational actors, the same postulate that most of modern economics is built upon. This article critiques the use of this postulate in economics, and thus questions whether it is a useful building block for the methodological foundations of social science research. It proposes an adaptive view of human behavior as an alternative in which preferences are conditioned by past experience. The work of Joseph Schumpeter is discussed as an exemplar of the methodology advocated here.
Ideas about illness and what to do when ill vary with culture. That is obvious. A doctor might find the special interests of the medical anthropologist most helpful to him in work with patients from different cultural backgrounds from his own. Mixture of social class and ethnic origin is common in cities. But there are some aspects of an anthropological approach to illness behavior which have, I think, more general interest than just the appeal of the exotic. These aspects derive partly from the particular character of anthropological research and the way it may provoke us to question or reflect on what we accept as normal or natural behavior. We may see that it is customary rather than natural to behave in that way. We become concerned to discover the social reasons for such customary acts or responses.