Culture and Symptoms--An Analysis of Patient's Presenting Complaints

Physical disorder is often thought to be a fairly objective and relatively infrequent phenomenon. An examination of the literature reveals, however, that the empirical reality may be that illness, defined as the presence of clinically serious signs, is the statistical norm. Given that the prevalence of abnormalities is so high, the rate of acknowledgement so low, and the decision to seek aid unrelated to objective seriousness and discomfort, it is suggested that a socially conditioned selective process may be operating in what is brought in for medical treatment. Two such processes are delineated and the idea is postulated that it might be such selective processes and not etiological ones which account for many of the previously unexplained epidemiological differences between societies and even between subgroups within a society. A study is reported which illustrates the existence of such a selective process in the differing complaints of a group of Italian and Irish patients-a pattern of differences which is maintained even when the diagnosed disorder for which they sought aid is held constant.