Le risque d'humiliation diagnostique

Even before we begin any treatment whatsoever, diagnosis categories are theoretical-practical schemas that can have a curative action, but can also entail negative effects. The Somatoform pain disorder diagnosis can be harmful in that it suggests that what the patient is suffering from only has a somatic « shape », meaning that, that is how it appears to be, but that in its « substance », it is a psychological problem. As regards the Somatic symptom disorder proposed by the DSM-V, its definition is mainly based on the problematic notion of « excessive and disproportionate thoughts, feelings and behavior ». When they describe what they are experiencing, patients suffering the unexplained chronic pain are captured by a feeling of helplessness: in regards both to the pain and to the health care system that is unable to meet their demands for solace. From a phenomenological point of view, their experience is in many respects close to the experience of trauma (« injury »). It is the responsibility of the clinician to find ways to qualify these unspeakable pains so as not to add, through the diagnosis, to the shame carried by the patient already bearing insane pain.