Medicine, Health Care and Philosophy

, Volume 17, Issue 1, pp 89–102 | Cite as

What is called symptom?

Scientific Contribution


There is one concept in medicine which is prominent, the symptom. The omnipresence of the symptom seems, however, not to be reflected by an equally prominent curiosity aimed at investigating this concept as a phenomenon. In classic, traditional or conventional medical diagnostics and treatment, the lack of distinction with respect to the symptom represents a minor problem. Faced with enigmatic conditions and their accompanying labels such as chronic fatigue syndrome, fibromyalgia, medically unexplained symptoms, and functional somatic syndromes, the contestation of the symptom and its origin is immediate and obvious and calls for further exploration. Based on a description of the diagnostic framework encompassing medically unexplained conditions and a brief introduction to how such symptoms are managed both within and outside of the medical clinic, we argue on one hand how unexplained conditions invite us to reconsider and re-think the concept we call a “symptom” and on the other hand how the concept “symptom” is no longer an adequate and necessary fulcrum and must be enriched by socio-cultural, phenomenological and existential dimensions. Consequently, our main aim is to expand both our interpretative horizon and the linguistic repertoire in the face of those appearances we label medically unexplained symptoms.


Symptom Medically unexplained symptoms (MUS) Basic human conditions Sensations 


  1. Alonzo, A.A. 1984. An illness behavior paradigm: A conceptual exploration of a situational-adaption perspective. Social Science and Medicine 19(5): 499–510.PubMedCrossRefGoogle Scholar
  2. Åsbring, P., and A.L. Närvänen. 2003. Ideal versus reality: Physicians perspectives on patients with chronic fatigue syndrome (CFS) and fibromyalgia. Social Science and Medicine 57(4): 711–720.PubMedCrossRefGoogle Scholar
  3. Baldwin, T. (ed.). 2004. Maurice Merleau Ponty: Basic writings. London: Routledge.Google Scholar
  4. Brand, P., and P. Yancey. 1993. The gift of pain. Grand Rapids, MI: Zondervan.Google Scholar
  5. Burnum, JohnF. 1993. Medical diagnosis through semiotics. Annals of Internal Medicine 119(9): 939-943.Google Scholar
  6. Burton, C. 2013. ABC of medically unexplained symptoms. West Sussex: BMJ Books, Wiley.Google Scholar
  7. Carel, Havi. 2011. Phenomenology and its application in medicine. Theoretical Medicine and Bioethics 32(1): 33–46.PubMedCrossRefGoogle Scholar
  8. Csordas, Thomas (ed.). 1994. Embodiment and experience: The existential ground of culture and self. Cambridge: Cambridge University Press.Google Scholar
  9. Damasio, Antonio. 2001. Descartes’ feiltakelse (eng. Title: Descartes’ Error). Oslo: Pax Forlag.Google Scholar
  10. Dickson, A., C. Knussen, and P. Flowers. 2007. Stigma and the deligitimation experience. An interpretative phenomenological analysis of people living with chronic fatigue syndrome. Psychology and Health 22: 851–867.CrossRefGoogle Scholar
  11. Eriksen T.E., A.L. Kirkengen, and A.J. Vetlesen. 2013. The medically unexplained revisited. Medicine Health Care and Philosophy 16(3): 587–600.Google Scholar
  12. Feld, AlinaN. 2011. Melancholy and the otherness of God. Maryland: Lexington Books.Google Scholar
  13. Fink, P., M. Rosendal, and T. Toft. 2002. Assessment and treatment of functional disorders in general practice: The extended reattribution and management model—An advanced educational program for nonpsychiatric doctors. Psychosomatics 43(2): 93–131.PubMedCrossRefGoogle Scholar
  14. Fink, P., T. Toft, M.S. Hansen, E. Ørnbøl, and F. Olesen. 2007. Symptoms and syndromes of bodily distress: An exploratory study of 978 internal medical, neurological, and primary care patients. Psychosomatic Medicine 69(1): 30–39.PubMedCrossRefGoogle Scholar
  15. Fink, P., and A. Schrøder. 2010. One single diagnosis, bodily distress syndrome, succeeded to capture ten diagnostic categories of functional somatic syndromes and somatoform disorders. Journal of Psychosomatic Research 68(2010): 415–426.PubMedCrossRefGoogle Scholar
  16. Hay, M.C. 2008. Reading sensations: Understanding the process of distinguishing ‘fine’ from ‘sick’. Transcult Psychiatry 45(2): 198–229.PubMedCrossRefGoogle Scholar
  17. Henningsen, P., S. Zipfel, and W. Herzog. 2007. Management of functional somatic syndromes. Lancet 369(9565): 946–955.PubMedCrossRefGoogle Scholar
  18. Heidegger, Martin. 1996. Being and time. Albany: State University of New York Press.Google Scholar
  19. Heidegger, Martin. 1966. Discourse on thinking. New York: Harper and Row Publishers.Google Scholar
  20. Heidegger, Martin. 2001. Zollikoner seminars. In ed. Medard Boss. Evanston, IL: Northwestern University Press.Google Scholar
  21. Hinton, D.E., D. Howes, and L.J. Kirmayer. 2008. Toward a medical anthropology of sensations: Definitions and research agenda. Transcultural Psychiatry 45(2): 142–162.PubMedCrossRefGoogle Scholar
  22. Hinton, D.E., and S.D. Hinton. 2002. Panic disorder, somatization, and the new cross-cultural psychiatry: The seven bodies of a medical anthropology of panic. Culture, Medicine and Psychiatry 26: 155–178.PubMedCrossRefGoogle Scholar
  23. Howes, D. 2003. Sensual relations: Engaging the senses in culture and social theory. Ann Arbor, MI: University of Michigan Press.Google Scholar
  24. Howes, D. (ed.). 2005. Empire of the senses: The sensual culture reader. Oxford: Berg.Google Scholar
  25. Husserl, Edmund. 1973. Zur Phänomenologie der Intersubjektivität I, Husserliana XIII. Den Haag: Martinus Nujhoff.CrossRefGoogle Scholar
  26. Janzen, J.M. 2009. Therapy management: concept, reality, process. Medical Anthropology Quarterly 1(1): 68–84.CrossRefGoogle Scholar
  27. Jenkins, J. 1991. The state construction of affect: Political ethos and mental health among Salvadoran refugees. Culture, Medicine and Psychiatry 15: 139–165.PubMedCrossRefGoogle Scholar
  28. Kanaan, R.A., J.P. Lepine, and S.C. Wessely. 2007. The association or otherwise of the functional somatic syndromes. Psychosomatic Medicine 69(9): 855–859.PubMedCentralPubMedCrossRefGoogle Scholar
  29. Kellerman, H. 2008. The psychoanalysis of symptoms. New York: Springer Science and Business Media.Google Scholar
  30. Kierkegaard, Søren. 2005. Begrepet angst. Oslo: Forlaget Oktober as.Google Scholar
  31. Kirmayer, L.J. et al. 2004. Explaining medically unexplained symptoms. The Canadian Journal of Psychiatry. 49(10): 663–672.Google Scholar
  32. Kirmayer, L.J. 1996. Confusion of the senses: Implications of ethnocultural variations in somatoform and associative disorders. In Ethnocultural aspects of post-traumatic stress disorder, ed. A. Marsella, M. Friedman, E. Gerrity, and R. Scurfield, 131–165. Washington, DC: American Psychological Association.Google Scholar
  33. Kirmayer, L.J. 2007. On the cultural mediation of pain. In Pain and its transformation: The interface of biology and culture, ed. K. Shelemay, and S. Coakley, 363–401. Cambridge, MA: Harvard University Press.Google Scholar
  34. Kleinman, A. 1980. Patients and healers in the context of culture. Berkeley, CA: University of California Press.Google Scholar
  35. Kleinman, A., and J. Kleinman. 1994. How bodies remember: Social memory and bodily experience of criticism, resistance, and delegitimation following China’s Cultural Revolution. New Literary History 25: 707–723.CrossRefGoogle Scholar
  36. Kristeva, Julia. 1994. Svart soldepresjon og melankoli. (fr. title Soleil Noir. Depression et melancolie). Oslo: Pax Forlag.Google Scholar
  37. Kugelman, R. 2003. Pain as symptom, pain as sign. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine 7(1): 29–50.Google Scholar
  38. Larsson, Katharine M. 2008. Understanding the lived experience of patients who suffer from medically unexplained physical symptoms using a Rogerian perspective. Dissertation for the degree of Doctor of Philosophy. Boston College. William F. Connell School of Nursing, USA.Google Scholar
  39. Leder, Drew. 1990. The absent body. Chicago: The University of Chicago Press.Google Scholar
  40. Lewis, C.S. 2002. The problem of pain. London: HarperCollins Publishers.Google Scholar
  41. Looper, KarlJ., and LaurenceJ. Kirmayer. 2004. Perceived stigma in functional somatic syndromes and comparable medical conditions. Journal of Psychosomatic Research 57(2004): 373–378.PubMedGoogle Scholar
  42. Marcel, G. 2001. The mystery of being. Volume I: Reflections and mystery. Indiana: St. Augustine’s Press.Google Scholar
  43. Maisel, Eric. 2002. The van Gogh blues. The creative Person’s path through depression. Novato, CA: New World Library.Google Scholar
  44. Malterud, Kirsti. 2000. Symptoms as a source of medical knowledge: Understanding medically unexplained disorders in women. Journal of Family Medicine 32(9): 603–611.Google Scholar
  45. Martìnez-Hernáez, A. 2000. What’s behind the symptom? On psychiatric observation and anthropological understanding. New York: Harwood academic publishers.Google Scholar
  46. Merskey, H. 2004. Somatization, hysteria, or incompletely explained symptoms. The Canadian Journal of Psychiatry 49(10): 649–651.Google Scholar
  47. Mugerauer, R. 2009. Call of the Earth: Endowment and (Delayed) Response. In Heidegger & the earth. Essays in environmental philosophy, eds. L. McWhorter and G. Stenstad. London: University of Toronto Press.Google Scholar
  48. Nessa, John. 1996. About signs and symptoms: Can semiotics expand the view of clinical medicine? Theoretical Medicine 17(363–377): 1996.Google Scholar
  49. Nichter, M. 1981. Idioms of distress, alternatives in the expression of psychosocial distress: A case study from South India. Culture, Medicine and Psychiatry 5: 379–408.PubMedCrossRefGoogle Scholar
  50. Nichter, M., and M. Nichter. 2003. Anthropology and international health. London: Routledge.Google Scholar
  51. Nimnuan, C., et al. 2001. How many functional somatic syndromes? Journal of Psychosomatic Research 51(4): 549–557.PubMedCrossRefGoogle Scholar
  52. Nyeng, Frode. 2003. Eksistensens filosofi. Oslo, Norge: Abstrakt Forlag as.Google Scholar
  53. Olde Hartman, T.C., L.J. Hassink-Franke, P.L. Lucassen, K.P. van Spaendonck, and C. van Weel. 2009. Explanation and relations. How do general practitioners deal with patients with persistent medically unexplained symptoms: A focus group study. BMC Family Practice 10: 68.PubMedCentralPubMedCrossRefGoogle Scholar
  54. Olde Hartman, T.C., van Rijswijk, E., van Dulmen, S., van Weel-Baumgarten, E., Lucassen, P.L., van Weel, C. 2013. How patients and family physicians communicate about persistent medically unexplained symptoms. A qualitative study of video-recorded consultations. Patient Education and Counseling 90(3): 354–360.Google Scholar
  55. Page, L.A., Wessely, S. 2003. Medically unexplained symptoms: Exacerbating factors in the doctor-patient encounter. Journal of the Royal Society of Medcine 96(5): 223–227.Google Scholar
  56. Peters, S., A. Rogers, P. Salmon, L. Gask, C. Dowrick, M. Towey, R. Clifford, and R. Morriss. 2009. What do patients choose to tell their doctors? Qualitative analysis of potential barriers to reattributing medically unexplained symptoms. Journal of General Internal Medicine 24(4): 443–449.PubMedCentralPubMedCrossRefGoogle Scholar
  57. Prasad, Vinay. 2009. Toward a meaningful alternative medicine. Hastings Center Report 39(5): 16–18.PubMedCrossRefGoogle Scholar
  58. Queiroz, J., and F. Merrell. 2006. Semiosis and pragmatism: Toward a dynamic concept of meaning. Sign Systems Studies 34(1): 2006.Google Scholar
  59. Ring, A., C.F. Dowrick, G.M. Humphris, J. Davies, and P. Salmon. 2005. The somatising effect of clinical consultation: What patients and doctors say and do not say when patients present medically unexplained physical symptoms. Social Science and Medicine 61(7): 1505–1515.PubMedCrossRefGoogle Scholar
  60. Risør, Mette Bech. 2009. Illness explanations among patients with medically unexplained symptoms – different idioms for different contexts. Health 13(5).Google Scholar
  61. Risør, Mette Bech. 2010. Healing and recovery as a social process among patients with medically unexplained symptoms (MUS). In The taste for knowledge: Medical anthropology facing medical realities, eds. Sylvie Fainzang, Hans Einar Hem and Mette Bech Risør, 131–149. Aarhus: Aarhus University Press.Google Scholar
  62. Salathe, C.R., M. Melloh, A.F. Mannion, Ö. Tamcan, U. Müller, N. Boos, and A. Elfering. 2012. Resources for preventing sickness absence due to low back pain. Occupational Medicine 62: 273–280.CrossRefGoogle Scholar
  63. Salmon, P., S. Peters, and I. Stanley. 1999. Patients’ perceptions of medical explanations for somatisation disorders: Qualitative analysis. BMJ 318(7180): 372–376.PubMedCrossRefGoogle Scholar
  64. Salmon, P., C.F. Dowrick, A. Ring, and G.M. Humphris. 2004. Voiced but unheard agendas: Qualitative analysis of the psychosocial cues that patients with unexplained symptoms present to general practitioners. The British Journal of General Practice 54(500): 171–176.PubMedCentralPubMedGoogle Scholar
  65. Salmon, P., Ring, A., Dowrick, C.F., Humphris, G.M. 2005. What do general practice patients want when they present medically unexplained symptoms, and why do their doctors feel pressurized? Journal of Psychosomatic Research 59(4): 255–260; discussion 261–262.Google Scholar
  66. Salmon, P., L. Wissow, J. Carroll, A. Ring, G.M. Humphris, J.C. Davies, and C.F. Dowrick. 2008. Doctors’ attachment style and their inclination to propose somatic interventions for medically unexplained symptoms. General Hospital Psychiatry 30(2): 104–111.PubMedCrossRefGoogle Scholar
  67. Scarry, Elaine. 1985. The body in pain. New York: Oxford University Press.Google Scholar
  68. Schur, E.A., N. Afari, H. Furberg, M. Olarte, J. Goldberg, P. Sullivan, and D. Buchwald. 2007. Feeling bad in more ways than one: Comorbidity patterns of medically unexplained and psychiatric conditions. Society of General Internal Medicine 2007(22): 818–821.CrossRefGoogle Scholar
  69. Soderlund, A., and K. Malterud. 2005. Why did I get chronic fatigue syndrome? A qualitative interview study of causal attributions in women patients. Scandinavian Journal of Primary Health Care 23(4): 242–247.PubMedCrossRefGoogle Scholar
  70. Strang, P., Strang, S., Hultborn, R., Arnér, S. 2004. Existential pain—An entity, a provocation, or a challenge? Journal of Pain and Symptom Management. 27(3): 241–50.Google Scholar
  71. Toombs, S. K. 1993. The meaning of illness. A phenomenological account of the different perspectives of physician and patient. The Netherlands: Kluwer Academic Publishers.Google Scholar
  72. Vetlesen, A.J. 2004. Smerte (eng title; Pain). Oslo: Dinamo Forlag as.Google Scholar
  73. Wall, Patrick. 2000. The science of suffering. New York: Columbia University Press.Google Scholar
  74. Ware, N.C., and A. Kleinman. 1992. Culture and somatic experience. The social course of illness in neurasthenia and chronic fatigue syndrome. Psychosomatic Medicine 54(5): 546–560.PubMedGoogle Scholar
  75. Ware, N.C. 1999. Toward a model of social course in chronic illness: The example of chronic fatigue syndrome. Culture, Medicine and Psychiatry 23: 303–331.PubMedCrossRefGoogle Scholar
  76. Woivalin, T., G. Krantz, T. Mantyranta, and K.C. Ringsberg. 2004. Medically unexplained symptoms: Perceptions of physicians in primary health care. Family Practice 21: 199–203.PubMedCrossRefGoogle Scholar
  77. Wolfe, F. 2009. Fibromyalgia wars. The Journal of Rheumatology 36(4): 671–678.PubMedCrossRefGoogle Scholar
  78. Zola, I.K. 1983. Socio-medical inquiries: Recollections, reflections and reconsiderations. Philadelphia: Temple University Press.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  1. 1.Department of Occupational and Environmental MedicineUniversity Hospital of North NorwayTromsøNorway
  2. 2.Department of Philosophy, Faculty of HumanitiesUniversity of TromsøTromsøNorway
  3. 3.Department of Community Medicine, General Practice Research UnitUniversity of TromsøTromsøNorway

Personalised recommendations