Somatization and Medicalization

To the Editor. —While Drs Barsky and Borus¹ make a number of pointed observations about somatizing patients, they ultimately succumb to the same process of "medicalization" they criticize. Their pejorative comments about somatization "defined as the propensity to experience and report somatic symptoms that have no pathophysiological explanation" are just another kind of labeling, no better than the diagnoses that patients seek to legitimize their suffering.

It's true that physicians are trained to think in terms of diagnoses and that reimbursement systems cannot function without diagnosis codes.² But we need to understand that patients, whatever label physicians pin on them, most of all want to feel better. It's time to stop basing treatment on labels ("somatizer," "lung cancer," "tension headache") and start basing therapy on making "connexions," ie, first understanding what the illness means to the patient.³

The primary goal of clinicians should be to keep patients