Sergio Angeletti

If you are ill but all your tests are all right, then you are mad.

“Psychosomatic” is a term that has been rightly banned, given that “psyche” and “soma”, mind and body, are all one.

All that to say that the fact of not recognizing and not being able to properly diagnose and treat an evident case of glossodinia may cost:

a) an exhausting routine of suffering, anxiety, fears, illness and unpleasant side effects for the patient due to wrong treatments;

b) dozen million lire to the health service for useless, and even detrimental, treatments;
c) a poor figure for the category of doctors

On the occasion of the Course of the Italian Society for Psychosomatic Dermatology I collected from doctor Anna Graziella Burroni, a specialist dermatologist working at the Genoa hospital, the following testimony for the session devoted to the “Presentation of clinical cases”.

“At the end of August 1999, I meet a nice 74-year-old lady in the outpatients' department of the hospital where I work. Her problem is a case of glossodinia: from the moment when her dentist obliged her to use a complete prosthesis, her life has become a living hell.

'It seems as I had fire in my mouth - she says. My saliva is more and more abundant and stringy, resembling a chewing-gum and, despite this, my mouth is dry. I have lost all my friends because I cannot eat or drink with the other people: I am afraid of losing my saliva, like froth, making my horrified table companions run away'.
I examine the patient closely: as I expected, the oral cavity mucosa is intact. Then I decide to see her in day hospital, so I will have more time to devote to her and to examine her with a psychiatrist. Yet, due to a misunderstanding, the woman is examined by one of my colleagues, according to whom she has no psychological problems. Starting from this judgement expressed by my colleague, the patient is subjected to the following set of treatments:

1) A series of hematochemical tests in the event of lichen ruber planus. Negative.
2) A series of tests in the event of a connectivopathy. A negative result.

3) A series of test for a probable allergopathy. Negative.

4) A series of tests in the event of an infection to the mucosa.

Three different types of antibiotics are then prescribed with no result. At this point it is decided to consult the ORL specialist at the hospital. This shows some doubts about the infective origin of the problem. Last but not least, a private ORL specialist is consulted. This confirms the infective origin and thus a fourth therapy with antibiotics is prescribed. The result: gastralgia, diarrhea, nausea, inappetence, aggravation of the oral symptomatology. Meanwhile November has arrived, and all the
diagnoses made have turned out to be wrong...then why not consulting a famous immunologist from the Cancer Institute? This finds nothing strange but cannot resist the temptation to prescribe an ETC of salivary glands from which nothing emerges. On 6th November 1999, my colleague asks me to examine one of her patients “one of those mad people you like”, so she can finally close the DH record. The “madwoman” is our nice old lady. She is even more downcast and depressed. At that point, when looking at her folder filled with tests, an idea flashes through my mind: how much did all that cost to our community? Well, about 16,000,000 lire! Then the conclusion is that doctors with psychosomatic training should maybe be considered not as unproductive people who waste their time, but as figures who can give a practical contribution, saving patients painful treatments and, last but not least, also saving money”.

We would like to add this consideration to those made by doctor Burroni: it is a good thing to recognize and appreciate doctors with psychosomatic training.
But one should not remember that the mind is corporeal and biochemical only when narcotic biochemical agents modify and deteriorate its physical structures, as aging also does.Yet, everybody keeps on talking of “mind and body”, thus creating discordances in the mind of doctors and patients, as well as between diagnoses and treatments, and also discordances in our life, which leave a nasty taste in our mouth. The fact of ignoring the difference between soul and psyche cost us 8,256 Euro; if one could only be sure that through the suffering of the last, the other goes to heaven...