LETTERS TO THE EDITOR: IT IS ALL RIGHT TO CRY AND SIGH ANS SQUALL AND MOAN AND WHINE AND COMPLAIN.

Dear Editor,

This is in response to the article, "Hypochondria: Imaginary or not, it still costs" that appeared in your esteemed daily April 30. As a practicing psychiatrist who deals with thousands of people who have physical symptoms but no identifiable cause, I would like to draw the readers' attention to some inaccuracies that have crept in the article.

First of all, it is not correct to say that 50 percent of patients seen by physicians have "primary hypochondriacal symptoms." Primary hypochondriasis is a condition in which the patient obsesses with body symptoms and believes that there is something wrong with him. This is a relatively rare condition. Doctos are not easily fooled by hypochondriacs, and so, not much is misspent on testing them.

It is, however, correct to say that more than 50 percent of patients seen by physicians have symptoms for which the doctors can not find a physical basis. This does not automatically make these patients "hypochondriacal." The symptoms most of these patients experience are real, not imaginary. They are not magnified or distorted by the patients to get attention and sympathy. The fact that the doctors can not find an identifiable physical cause does not make symptoms imaginary. By far the vast majority of these symptoms are caused by stress, and the symptoms are real, and often very frightening.

Because patients misread these symptoms as evidence of a serious physical illness, they go on a medical Wild Goose Chase which results in huge health care bills. In the end many of these patients end up having Medical Trauma, a complex syndrome in which the patient suffers physical and emotional damage as a result of the medical Wild Goose Chase. The medical profession is yet to acknowledge this serious problem.

Billions of dollars are wasted away in this country due to medical Wild Goose Chase.

Why do people have frightening physical symptoms and yet doctors can't find any cause to explain them? The mechanism of this is as follows: When people are upset (stressed) over some bad events and problems, they experience painful emotions in their mind. These, in turn, cause uncomfortable physical, emotional, mental and behavioral symptoms which are often very distressing (E.g: Sleeplessness, nervousness, pain, etc.). Some people bury their stress-related painful emotions (fear, anger, hurt, guilt, etc.) in the hidden part of their mind believing that they are "handling" their stress well. They are good at projecting a "strong" front to others and themselves. Burying painful emotions in the hidden mind, instead of talking them out, makes stress symptoms disappear temporarily. However, there comes a time when they can not bury their emotions any more. This results in emotions steadily accumulating in their mind. Stress symptoms then begin to reappear. Sometimes stress symptoms reappear as a result of buried emotions resurfacing while reliving another similar trauma.

This "delayed" appearance of stress symptoms comes to most as a surprise. They had believed so far that they have been "handling" their stress well. Unable to connect the symptoms to various stresses that preceded the symptoms, they run to doctors to find out what is causing their now persistent symptoms. When asked if they have had any stress in their lives, their standard reply is, "I have handled everything well! This can not be stress. I am not imagining these symptoms!" What they are saying is that they are good at burying emotions, not expressing them. If only they had fallen apart when they were upset about something, they would have been all right.

What then is the simple cure to this problem? It is time everyone realizes that it is all right for us to cry and sob and sigh and bawl and squall and moan and groan and complain and whine. It is all right for us to just fall apart and look a little weak and vulnerable. It is stupid to bottle up emotions and pretend one is strong when, in fact, all he is doing is hiding them.

K.P.S. Kamath, M.D.

Cape Girardeau