Somatisation in primary care

Editor—On the surface, Schilte et al in their study suggest that disclosure of emotional events has no effect on markers of physical health or health related behaviours—a finding at odds with studies published over the past few years.^1–3 A critical difference between the study by Schilte et al and most other disclosure studies is that Schilte et al required participants to talk about a traumatic experience to another person. Most successful disclosure studies, on the other hand, have had participants write anonymously about a trauma for several days in a laboratory, in a neutral setting, or at home.

The study may help show when disclosure can be helpful versus harmful. It may also address recent controversies surrounding critical incident stress debriefing, where people who have experienced recent trauma are pressed to talk about their emotions to people in the context of a group. An increasing number of controlled tests of techniques wherein people have been asked to talk about emotional upheavals to others have found this form of debriefing either to be unhealthy or to have no effect.⁴ Having to deal with deeply emotional topics in a social setting forces the listener to help regulate what is and is not said. The social pressure of talking to an “expert” may invite embarrassment or humiliation on the part of the patient. When people are writing or talking into a tape recorder by themselves, they are able to determine how much they are willing to disclose. In short, solitary disclosure allows people to determine their own dose.

Schilte et al suggest that it is not in the physician's or patient's best interest to encourage the deep disclosure of highly traumatic experiences. Separate, equally controlled projects should address whether disclosure in alternative ways (for example, disclosive writing) may bring about the beneficial effects that Schilte et al were originally predicting.