In the West, we naturally think of illness as either physical or mental. In most circumstances, this works fine: a person with a broken leg is cared for in the orthopaedic ward, and a person with an acute psychotic episode is seen by psychiatric services.

In other circumstances, this physical/mental distinction is less helpful. For example, the condition of a patient who has symptoms such as pain when no physical disease can be found is sometimes referred to as somatization, on the basis of a presumption that the symptoms can represent a manifestation of underlying psychological distress. Medically unexplained symptoms is a more neutral alternative term.

Another instance of the physical/mental distinction being less helpful is when a patient has both a physical disorder, say, cancer, and a symptom such as depression of mood. The doctrine of mind-body dualism (usually attributed to Descartes) can lead here to fruitless debate as to whether the depression is psychiatric in origin or an effect of the cancer, when what is really required is not discussion, but a cooperative practical effort of physician and psychiatrist to assist the patient.

In this chapter, I therefore attempt to describe the different ways physical symptoms may present in psychiatric practice, with some suggestions as to management. The chapter should be read in conjunction with Chapter 11 on liaison psychiatry, which covers related matters, including service provision.

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