Depressive illness is protean in its manifestations. The symptoms may be primarily psychological, such as misery, indecisiveness, irritability, inability to concentrate, or insomnia. They may be mainly physical, and the patient may present with one or more of a bewildering number of somatic complaints, often blaming those for his change in mood (Watts, 1957). Pain is a common and diagnostically puzzling presenting symptom of depression and other psychiatric disorders (Walters, 1961). It may take the form of generalized or poorly localized aches and pains, often associated with a feeling of tension, or it may be sharply delimited (Critchley, 1935). This form of localized pain may so dominate the symptomatology that the patient is referred by his general practitioner to a variety of specialists, who may perform a series of special investigations or even exploratory operations. Clearly, every effort must be made to exclude organic disease, even if positive signs of psychiatric illness are recognized, as an organic disease can obviously co-exist with a psychiatric one. In spite of thorough investigation, there will remain a proportion of patients in whom no lesion can be found to account for their symptoms.
J. J. Bradley
British Journal of Psychiatry