Psychosomatics 45:287-290, August 2004
© 2004 The Academy of Psychosomatic Medicine
"Psychosomatic": A Systematic Review of Its Meaning in Newspaper Articles
Jon Stone,
Matthew Colyer,
Steve Feltbower,
Alan Carson, and
Michael Sharpe
Received Aug. 18, 2003; accepted Oct. 1, 2003. From the Department of Clinical Neurosciences, School of Molecular and Clinical Medicine, Western General Hospital, University of Edinburgh; and the Division of Psychiatry, School of Molecular and Clinical Medicine, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, Scotland. Address reprint requests to Dr. Stone, Department of Clinical Neurosciences, Western General Hospital, Crewe Rd., Edinburgh EH4 2XU Scotland; jstone{at}skull.dcn.ed.ac.uk (e-mail).
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ABSTRACT
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In this study, the authors describe the meaning of the word "psychosomatic" in U.S. and U.K. newspaper articles using a systematic text word search and a consensus rating of the contextual meaning of all articles published in 14 U.S. and U.K. newspapers between 1996 and 2002. The survey was limited to broadsheet newspapers. "Psychosomatic" had a pejorative meaning, such as "imaginary" or "made up," in 74 of 215 (34%) of the articles in which the meaning could be judged. Most commonly, "psychosomatic" was used to describe a problem that was psychological or in which the mind affects the body (56%) rather than as a reciprocal interaction (5%). "Psychosomatic medicine" is the new name for the seventh subspecialty of psychiatry. More needs to be done to educate the media about its actual meaning to make it attractive to patients.
Key Words: general topics in psychiatry
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INTRODUCTION
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In March 2003, the American Board of Medical Specialties unanimously approved the creation of a seventh psychiatric subspecialty, "psychosomatic medicine," that defines all of those working in consultation-liaison psychiatry and general hospital psychiatry. This title seems a natural choice, given the appearance of the word "psychosomatic" in four of the five leading journals that serve the subspecialty and in the names of professional associations. In a recent editorial, McIntyre1 outlined the long-running debate over the chosen name for this branch of psychiatry, drawing attention to the different ways in which health professionals have used the word "psychosomatic" over the years.
Surprisingly little consideration, however, has been given to the question of how those outside the medical profession use and understand the word "psychosomatic." Merriam-Webster's dictionary2 offers two meanings of the word: 1) of, relating to, concerned with, or involving both mind and body and 2) of, relating to, involving, or concerned with bodily symptoms caused by mental or emotional disturbance. We have previously studied patients' understanding of "psychosomatic" when applied to the symptom of paralysis and found that, contrary to this definition, nearly half equated it with being "mad" or "making up" or "imagining" symptoms.3 Such lay opinion is likely to be influenced by the popular media, including newspapers. In this study, we examined the meaning of the word "psychosomatic" in American and British newspaper articles published over the last 6 years.
We aimed to 1) describe the meanings of the word "psychosomatic" and 2) test the hypotheses that "psychosomatic" was frequently used with a pejorative or disparaging meaning and that pejorative meanings would be less common in U.S. newspaper articles.
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METHOD
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Search Strategy
We searched newspapers that had both the highest circulation and a capacity for electronic text word searches using the Infotrac4 and Proquest5 databases. The U.S. newspapers searched were The New York Times, The Houston Chronicle, The Los Angeles Times, The Washington Post, and the Daily News (Los Angeles). The U.K. newspapers searched were The Guardian, The Observer, The Mirror, The Sunday Mirror, The Financial Times, The Times, The Sunday Times, The Telegraph, and The Sunday Telegraph. The search identified every appearance of the word "psychosomatic" anywhere in the title or text of articles for the period Jan. 1, 1996, to Nov. 12, 2002, in all articles of the newspaper, excluding advertisements and informational sections (for example, television guides and sports results).
Data Inclusion Criteria, Extraction, and Analysis
We excluded citations in which "psychosomatic" simply referred to a professional specialty or organization (e.g., psychosomatic medicine) or a journal title (e.g., Journal of Psychosomatic Research). Multiple citations of the word "psychosomatic" within a single article were counted only once. Multiple articles by the same author were counted separately.
Data extraction was carried out independently by two reviewers (M.C. and S.F.). Where there was uncertainty or disagreement, the meaning of the word was decided by consensus, with two additional raters (J.S. and M.S.). Data extraction was carried out in two stages.
In stage one, every sentence containing the word "psychosomatic" was examined, and any words or phrases that were used as "equivalent" adjectives or were closely linked in the text were recorded. For example, in the following sentence, the equivalent word in this sentence is "imaginary": "She took refuge in a range of imaginary diseases. Her symptoms were all psychosomatic, but doctors variously guessed at anorexia, constipation, neuralgia, enteritis and ‘catarrh of the intestines.’" In this next sentence, the word "psychosomatic" is linked to the phrase "messed up psychologically": "He'd heard speculation that the rashes might be psychosomatic and resented it. In his view, it implied the children were ‘messed up psychologically.’" At this stage, no interpretation was made of the meaning of the word or phrase associated with "psychosomatic," which was simply recorded verbatim. We excluded citations during this phase in which no equivalent word or phrase or contextual meaning could be obtained from the text.
In stage two, the meanings of "psychosomatic" were grouped by consensus among all reviewers into three broad categories: accepted meanings, pejorative meanings, and miscellaneous. For the analysis, we calculated the relative frequencies of articles in each category, determined the proportion that were pejorative, and compared U.S. and U.K. newspapers using Fisher's exact test.
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RESULTS
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In all, 477 articles containing the word "psychosomatic" were retrieved. Some articles (N=119) were excluded because the word was used simply to describe a medical specialty (N=58), a journal title (N=47), or a professional society (N=14). A further 143 articles were excluded because the word was used to describe an illness (N=75) or a symptom (N=68), and no further meaning could be elicited from the text. This left 215 articles for further analysis.
Table 1 shows the range of meanings identified. In a substantial number (34%), it was used in a pejorative way to describe an illness that was "imaginary," "malingered," or was not important or a person having a character flaw (such as inadequacy). In 56% of the articles, the word was used in an acceptable way, usually to describe a problem that was psychological or in which the mind or emotions affected the body (50%), as an interaction between mind and body (5%), or as a physical problem (1%). There were no substantial or statistical differences in the relative proportions of these categories between U.K. and U.S. newspapers.
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DISCUSSION
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The word "psychosomatic" is used frequently in newspapers to mean an illness that is not important or is imaginary, malingering, a sign of madness, or a character flaw. For the new subspecialty of psychosomatic medicine and for the patients who will use it, this represents a potentially serious problem of acceptability.
The problem reflects the wider issue of the stigma of mental illness—the widespread belief that psychological problems are "not real" and imply a character flaw. Mental illness is generally portrayed in a less positive light than general medical disease by the media, as previous studies of newspaper articles have shown.6
Psychiatric stigma may take on particular importance for patients with physical symptoms. Patients with physical symptoms that are unexplained by disease may feel rejected if they are told that their problems are psychosomatic.7 This sometimes insurmountable level of stigma has led some consultation-liaison psychiatrists to ask whether the patient may be better off attending, for example, a "pain clinic" rather than a "psychosomatic clinic."8 Some have even wondered whether it is ethical to transmit a diagnosis such as "psychosomatic illness," which can have such damaging implications for the doctor-patient relationship.7
We also found that when its use was not pejorative, the word "psychosomatic" was usually used to suggest a psychological problem or the effects of the mind on the body rather than a reciprocal interaction between body and mind. Some patients may find this meaning also stigmatizing.
In this study, we only examined the meaning of the word "psychosomatic" and not other words connected with psychiatric or somatoform illness. We searched mainly in broadsheet newspapers and not in "tabloid" newspapers, mainly because of the relative lack of computerized databases of tabloid newspapers. We also recognize that newspapers are only one type of media that the public is exposed to and that media such as television and the Internet may portray the word differently. In the absence of a standard method for this kind of research, we tried to use a transparent approach with consensus ratings where any doubt over ratings existed. However, we may have underestimated the number of articles in the pejorative category by applying too rigorous criteria for this category. We did not specify whether the pejorative usage arose from doctors, journalists, or the patients themselves. We also did not assess the meaning readers took away from the articles but only those that were implied.
In conclusion, the word "psychosomatic" is frequently used in newspapers to depict illness in a pejorative way. Specifically, it is often used to imply that an illness is not important or is imaginary, malingering, a sign of madness, or a character flaw. If the new speciality of psychosomatic medicine is not to be dogged by stigma, it appears that we must work harder with the media both to rehabilitate the word "psychosomatic" to its proper meaning and to convey the many positive advances in psychosomatic research and treatments.
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ACKNOWLEDGMENTS
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Supported by the Chief Scientists Office, Scotland (Dr. Stone).
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REFERENCES
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- McIntyre JS: A new subspecialty. Am J Psychiatry 2002; 159:1961–1963[Free Full Text]
- Merriam-Webster Online Dictionary. http://www.merriam-webster.com, Apr 30 2003
- Stone J, Wojcik W, Durrance D, Carson A, Lewis S, MacKenzie L, Warlow CP, Sharpe M: What should we say to patients with symptoms unexplained by disease? The "number needed to offend." BMJ 2002; 325:1449–1450[Free Full Text]
- Gale Group Databases: Infotrac. http://www.infotrac.galegroup.com, 2003
- Proquest company: Proquest. http://www.umi.com/proquest/. Ann Arbor, Mich, 2003
- Lawrie SM: Newspaper coverage of psychiatric and physical illness. Psychiatr Bull 2000; 24:104–106[Abstract/Free Full Text]
- Wessely S: To tell or not to tell? The problem of medically unexplained symptoms, in Ethical Dilemmas in Neurology, vol. 36. Edited by Zeman A, Emmanuel L. London, WB Saunders, 2000
- Sullivan MD: Psychosomatic clinic or pain clinic: which is more viable? Gen Hosp Psychiatry 1993; 15:375–380[Medline]
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J. Stone, R. Hewett, A. Carson, C. Warlow, and M. Sharpe
The 'disappearance' of hysteria: historical mystery or illusion?
J R Soc Med,
January 1, 2008;
101(1):
12 - 18.
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V. Starcevic
Somatoform Disorders and DSM-V: Conceptual and Political Issues in the Debate
Psychosomatics,
August 1, 2006;
47(4):
277 - 281.
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ABSTRACT
INTRODUCTION
