To the Editor.
—The article by Drs Barsky and Borus1 on somatization was timely, but certain issues need discussion. First, the authors overrate the role of psychiatrists in treating somatization. They cite Smith et al,2,3 who show that a psychiatric consult intervention of a specific type is helpful in reducing health care costs among patients with somatization syndrome or somatization disorder, but then Barsky and Borus recommend a psychiatric management approach opposite to that of Smith et al in asserting that patients should be "taught about the process of somatization" and that cognitive and behavioral therapy should be used. Although the recommendations of Barsky and Borus are based in part on speculation that "medicalization fosters somatization," there is no evidence that medicalization causes or reinforces somatization or contributes significantly to health care costs. The cause of somatization is, in fact, not known. In the studies by Smith et
Fabian RH, Langsjoen HA, Kent TA. Somatization and Medicalization. JAMA. 1996;275(18):1398. doi:10.1001/jama.1996.03530420026018