[Mechanisms of somatization in psychosomatic pathology]

The notion of psychosomatic disorder will be given preference over that of disease as we believe it most important to identify the mechanism of somatization which underlies and commands the formation of polyvalent and polymorphic symptoms. The practitioner's first task is not to mistake the different mechanisms of somatization. This relies on the quality of the physical examination and the appositeness of the organic workup. It rests on demonstration of the psychosomatic connection by painstaking elicitation of the case history. The purpose is to make the patient himself aware of the psychosomatic nature of his distress and capable of an understanding attitude towards his own symptoms. It is this process that will allow the patient to turn towards a specific mechanism, rather than the clinical presentation of the symptom strictly speaking, or even the identifiable personality characteristics which in many cases are only suggestive. Similarly, it is this identification of mechanisms which will enable the practitioner to implement the appropriate therapeutic strategy.