1. Melanie D’Ornellas ANTC24 1 of 7
Going Mad in North America: Somatic Symptom Disorder
“Does your body hurt? Is the pain localized? General? Is it debilitating? Are you overly
tired? Do you worry excessively about your health? If you answered yes to these questions, then
you may be suffering from Somatic Symptom Disorder. Consult not a physician, but your local
mental health care specialist to see what treatment options are best for you.”
In North America today, we are constantly bombarded with medical advertisements,
awareness campaigns and other medical media. Whether it be through our T.V commercials or
radio ads, these self medicating awareness models are everywhere. Although they are brought to
our attention using twenty-first century methods, the same eighteenth century ideologies
criticized by Michel Foucault during the liberation of madness are easily read. In 1791, when
madness was liberated from its archaic forms of treatment, into newly philanthropic forms of
treatment, specifically related to the notions of self watching and self awareness through moral
treatment and moral therapy, new ways of understanding the self and ones mental state were
developed (Foucault 1988: 241). These same ideologies, that the individual themselves is
responsible for understanding and seeking treatment for their issues, has sunken its roots even
deeper in our constantly evolving neoliberal society. Individuals not only conceptualize their
own well-being, sense of self, and even the mind body dualism differently, but these same self
truths have now been cemented into a society that has turned to the process of medicalization to
explain away everything. These processes of medicalization have especially grown in the area of
mental health. It is as if everyday a new mental illness is being developed alongside a big
Pharma treatment solution. Essentially, because of our neoliberal, self truth seeking and
obsessively medicalizing society, the development of mental illnesses like somatic symptom
disorder have manifested. This paper seeks to not only provide a clear definition of somatic
symptom disorder as well as its history in the DSM, but also to critically analyze the

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development of the disorder in its ecological niche in the most understanding and sympathetic
way possible.
Somatic symptom disorder is one of many disorders in a new category in the DSM-V
called Somatic Symptoms and Related Disorders. The key component to the disorder is the
prominence of somatic symptoms associated with significant distress and impairment (APA
2013: 308). Somatic symptom disorder is a mental illness characterized by physical symptoms,
which usually suggested a link to a physical illness or injury — but not anymore. Usually
encountered in primary care settings, somatic symptom disorder is not highly recognized, in its
initial stages, in psychiatric or mental health care settings (APA 2013: 308). This is again
because of the strong physical pain patients feel, unlike major depressive disorder for example,
an illness almost exclusively isolated to the mind. At times patients may experience multiple
reoccurring somatic symptoms that effect their daily lives, either as a specific solitary pain like a
leg pain, or a general form of pain or discomfort, for example chronic fatigue (APA 2013: 308).
These forms of pain are considered as completely authentic, regardless of the fact that they
cannot be traced or explained. Some factors that contribute to the development of the disorder,
according to the DSM-V include individuals that have either: (1) Genetic and biological
vulnerability (e.g. increased sensitivity to pain); (2) Early traumatic experiences (e.g. abuse);
and lastly (3) Cultural and social norms that devalue and stigmatize psychological suffering over
physical suffering (APA 2013: 310). In regards to treatment, an article written by Mahendra
Sharma and M. Manjula (2013) discusses the multiple methods of treatment developed for
patients with somatic symptom disorder. These include behavioural and psychological strategies
like cognitive behavioural therapy and psychodynamic psychotherapy (Sharma 2013:120).
Overall, there are varying levels of somatic symptom disorder. In extreme cases, patients have

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unusually high levels of worry about illness and consider their health concerns as central in their
lives. Essentially, their ailment becomes a central feature of their identity and in their
interpersonal relationships (APA 2013: 312).
The DSM made many changes when the inclusion of somatic symptom disorder
occurred. Somatic symptom disorder is a multifaceted combination of disorders most notably
including somatization disorder, undifferentiated disorder and hypochondriasis (Dimsdale 2013:
1393). It first appeared in the DSM-III and was symptomatically organized based on gender. It
required that from a list of thirty-seven, men identify with twelve symptoms, while women
identify with fourteen (Dimsdale 2013: 1393). Later, in the DSM-IV, there were revised
symptomatic requirements. Patients now had to mention, of four types of pain symptoms; two
gastrointestinal symptoms, one sexual symptom, and lastly one neurological symptom (Dimsdale
2013: 1393). In the DSM-IV, there was a significant amount of overlap across the somatoform
disorders. It lacked a clear sense of diagnostic boundaries (APA 2013: 308). Considering
individuals presenting the disorder were primarily seen in primary care rather than mental health
settings, many non-psychiatric physicians found the DSM-IV diagnosis, “…Extremely difficult
to understand and use,” (APA 2013: 308). Now however, the DSM-V classification system
defines the major diagnosis of somatic symptom disorder on the basis of positive symptoms all
the while hold the medically unexplained symptoms at the same standard (APA 2013: 310).
As mentioned in the previous sections, somatic symptom disorder, in laymen terms, is a
mental illness attributed to debilitating, sometimes isolated physical pain that cannot be traced
back to any form of physical illness or injury as the cause. How does this constitute going mad in
North America? Usually, when an individual complains that they are experiencing a physical
form of pain, a pain that has the ability to restrict their daily lives, it is almost always attributed

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to a physical cause. For example, a strong pain in an individuals elbow can range from a muscle
problem, a bone problem, or inflammation— the options are endless. However, someone with
somatic symptom disorder that experiences the same excruciating elbow pain, does not have a
physical cause like the ones listed previously. All that matters is that the pain is very real,
relentless, and it consumes said individuals daily life. So what does this say about our society?
Are we a society that has a heavy attachment — a reliance — on the biomedical model to
explain away everything? I say that yes we are a biomedical obsessed society that runs to
biomedical explanatory models for everything, but we also run to medicalize everything. The
2004 journal article Medicalization, Markets and Consumers by Peter Conrad and Valerie Leiter
explains this idea further.
In their 2004 article, Conrad and Leiter define medicalization as the labelling of things as
illnesses or disorders that were not illnesses or disorders before (Conrad 2004: 158). It is the use
of a medical lens to analyze social and structural issues which in turn causes society to loose
sight of real issue like unequal access to resources for example. Crucial in the process of
medicalization is the push for treatment by way of either therapies or drugs (Conrad 2004: 158).
It is a wide ranging process composed of multiple players; medical professionals, pharmaceutical
companies, and the general population. Thus the process of medicalization is bi-directional,
essentially a relationship between producers (the medical professions and pharmaceutical
companies) and consumers (the masses) (Conrad 2004: 159). Medicalization is about creating
new medical norms. Therefore, when there is an abnormality, like untraceable somatic pain, a
new label and new treatment method is required to correct said abnormality and form of
madness.

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The second factor that contributes to somatic symptom disorder as a new way of going
mad in North America, is our society’s hyper-neoliberal attitudes and beliefs. North American
society is a constantly evolving neoliberal mecca. The new ways of knowing the self and
conceptualizing the mind and body dualism have been twisted and turned in ways that are almost
exclusively specific to each and every individual in their own specific way. Generalizations are a
thing of the past — to conform to societal norms is deemed today as being a sheep, and no one
likes a sheep. Thus, we have the creation of peoples own self truths and it is these self truths, like
an untraceable pain, that constitutes going mad. Carla Freeman’s 2011 article Neoliberalism:
Embodying and Affecting Neoliberalism elaborates further on how neoliberalism has created new
ideals on the conception of the self.
Freeman writes,
“The embodiment of neoliberalism unfolds in other realms of life as increasing numbers of people
seek medical and therapeutic interventions as part of a transnational circuit of healthcare and other
bodily practices, (Freeman 2011: 356)”
She states that the neoliberal self is encouraged to seek self mastery, and consider the self as a
producer, consumer, citizen and a social being that cares for the self’s health, body, mind and
soul (Freeman 2011: 356). In my opinion, individuals with somatic symptom disorder take this
idea to an entirely new level. For example, consider the mind body dualism. This theory assumes
that mental phenomena are in most cases, non-physical; that the mind and body are not identical.
However, in our self truth seeking, medicalizing, neoliberal society, the two have essentially
become one by way of illnesses like somatic symptom disorder. The supposed physical pain, that
no one can claim as originating from anywhere, causes mental strife. Basically, this logic ignores
completely the mind body dualism and instead creates a new medicalized truth: That people can

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feel pain, without a cause and this in turn causes a mental disorder. What is the point in bringing
up the mind body dualism if medicine is forcing the two to become one?
Overall, medicalization and neoliberalism have fostered an environment in which somatic
symptom disorder can flourish. What is this environment called? According to Ian Hacking, it is
called an ecological niche. In his book Mad Travellers: Reflections on the Reality of Transient
Mental Illnesses (1998), Hacking describes the ecological niche as the large scale diverse
elements, outside of social and medical factors, that momentarily provide, “… A stable home for
certain types of manifestations of illness, (Hacking 1998: 2)”. So what large scale elements are
contributing to somatic symptom disorder? In my opinion it is our overly medicalizing, hyper
sensitive, politically correct neoliberal society in general. In conclusion, somatic symptom
disorder is a mental illness that I would be extremely interested in following. North America
today is all about neoliberal self truth seeking ideologies, all the while medicalizing every feeling
or action people have. Our world is made up of both wholehearted and advantageous individuals.
How will a doctor know a person has not done extensive research on somatic symptom disorder
and is just faking pain in order to claim a disability cheque?
Word Count: 1732
Bibliography
American Psychiatric Association
2013 Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC:
American Psychiatric Association.
Conrad, Peter, and Valerie Leiter

7. Melanie D’Ornellas ANTC24 7 of 7
2004 Medicalization, Markets and Consumers. Journal of Health and Social Behaviour
45: 158-176.
Dimsdale, Joel E. and James Levenson
2013 What’s Next for Somatic Symptom Disorder. American Journal of Psychiatry 170
(12): 1393-1395.
Foucault, Michel
1988 Madness and Civilization: A History of Insanity in the Age of Reason. New York
City, New York: Random House Inc.
Freeman, Carla
2011 Neoliberalism: Embodying and Affecting Neoliberalism. In Companion to the
Anthropology of the Body and Embodiment. Blackwell Publishing
Hacking, Ian
1998 Mad Travellers: Reflections on the Reality of Transient Mental Illnesses.
Charlottesville, Virginia. University Press of Virginia.
Sharma, Mahendra P. and M. Manjula
2013 Behavioural and Psychological Management of Somatic Symptom Disorders: An
overview. International Review of Psychiatry 25(1): 116-124.