'Does the doctor think I'm Crazy?: Stories of low-income Cape Town women receiving a diagnosis of somatic symptom disorder and their subsequent referral to psychological services

[摘要] ENGLISH ABSTRACT : Within the health system there is a group of patients who appear destined to remain at the borderline between medicine and mental health. They fail to fit into either discipline with any degree of comfort and so, to some extent, become marginalised by both. The presenting symptoms of these patients fall under the general rubric of 'medically unexplained symptoms (MUS), 'medically unexplained physical symptoms (MUPS), or 'somatic symptoms disorder. The physical manifestation of symptoms which have no known underlying organic cause creates confusion for the medical practitioner. Conversely, patients with apparent medical pathology superficially may appear to lie outside of the ambit and expertise of mental health.The fear and uncertainty which is ubiquitously generated by illness and pain, appears to be complicated and exacerbated in patients with MUS. I attempted to explore the meaning and experience of these conditions 'fraught with uncertainty in the context of twenty female participants and their lives. As poor women of colour in South Africa, a country with a racialised and gender-weighted discriminatory history, these participants represent marginalisation on many fronts: socio-politically, economically, and medically – and who by their presence challenge the status quo of rendering them invisible.This study explored and described the way in which this specific cohort of patients experienced and understood their medical management and subsequent referral to psychology. To this end, over a period of a year, I interviewed two groups of low-income women who presented to the state hospital system at two separate district level hospitals with unexplained physical symptoms. Ultimately, after varying periods of investigation these women were referred to psychological services in the respective hospitals.I adopted a qualitative research approach, with an emphasis on foregrounding of the experiences of the women. I wished to obtain the rich and layered narratives of the women and their sense of identity within hospital and wider context. All the participants I interviewed had been referred to me as a psychologist by the medical officers after no organic aetiology for their symptoms had been evidenced. While qualitative research frequently relies on the semi-structured interview, my research was particular in that it was conducted in circumstances which necessitated the accommodation of both clinical and research components. The aspect of maintaining the dual role became an important component of consideration and negotiation. This requirement impacted on the interview process. In this particular setting a formal clinical interview initiated the research process to accommodate the possibility of participants progressing to therapy.Conclusions: Poor communication and misunderstanding of the role and function of psychology provide impediments to effective use of both medical and mental health services in low-income communities. Where knowledge is facilitated and patient participation encouraged the positive outcomes of referral to psychological services may possibly increase. Collaboration between mental and medical practitioners with patients with medically unexplained symptoms has the potential to alleviate distress and improve respectful and more effective management of these vulnerable and marginalised patients.

[发布机构] Stellenbosch University