Goldberg D P, Bridges K
Department of Psychiatry, University of Manchester, Withington Hospital, U.K.
J Psychosom Res. 1988;32(2):137-44. doi: 10.1016/0022-3999(88)90048-7.
We have tried to describe somatisation, not as a disease, but as a common and important human mechanism involving both doctor and patient. It is the single most common reason why psychiatric illness goes undetected in general medical settings, and it often occurs in conjunction with physical disease processes. The association with dysphoric affect has been recognised at least since George Cheyne 250 years ago, and the reason for this is that both anxiety and depression serve to amplify pains. However, it seems likely that somatisation can occur in the absence of dysphoria. Once it has been established, it is easy to see how it continues: it secures advantages from spouse, family and employers; and it tends to be encouraged by doctors--who differentially reward somatic symptoms. But why does it occur in the first place? We have argued that it seems to have three functions: First, it allows people who are unsympathetic to psychological illness, or who live in cultures where mental illness is stigmatised, to nonetheless occupy the sick-role while psychologically unwell. Second, it is blame-avoiding: instead of being responsible for the mayhem, one is cast in the role of the suffering victim. Finally, by reducing blame, it appears to save patients from being as depressed as they might otherwise have been.
我们试图将躯体化描述为一种常见且重要的人类机制，涉及医生和患者双方，而非一种疾病。它是在普通医疗环境中精神疾病未被察觉的最常见单一原因，且常与躯体疾病过程同时发生。至少自250年前乔治·切恩以来，人们就已认识到它与烦躁情绪的关联，原因在于焦虑和抑郁都会加剧疼痛。然而，躯体化似乎也可能在没有烦躁情绪的情况下发生。一旦它形成，就很容易理解其持续存在的方式：它能从配偶、家人和雇主那里获得好处；而且往往会受到医生的鼓励——医生会对躯体症状给予不同程度的奖励。但它最初为何会发生呢？我们认为它似乎有三个功能：其一，它让那些对心理疾病缺乏同情心的人，或者生活在精神疾病被污名化文化中的人，在心理不适时仍能扮演病人角色。其二，它有助于避免指责：不是对混乱负责，而是扮演受苦受害者的角色。最后，通过减少指责，它似乎能使患者不至于像原本可能那样抑郁。
