Abstract
Medicine is facing wide-ranging challenges concerning the so-called medically unexplained disorders. The epidemiology is confusing, different medical specialties claim ownership of their unexplained territory and the unexplained conditions are themselves promoted through a highly complicated and sophisticated use of language. Confronting the outcome, i.e. numerous medical acronyms, we reflect upon principles of systematizing, contextual and social considerations and ways of thinking about these phenomena. Finally we address what we consider to be crucial dimensions concerning the landscape of unexplained “matters”; fatigued being, pain-full being and dys-ordered being, all expressive momentums of an aesthetic of resistance.
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Notes
What is important here is not the lack of explanations, but the absence of meaningful and adequate understandings.
In the specialty of Occupational and Environmental Medicine one refers to labels such as: Multiple Chemical Sensitivity (MCS), Idiopathic Environmental Intolerance (IEI), Sick Building Syndrome (SBS), Electromagnetic Hypersensitive Persons (EHS).
A special issue of the Journal of Psychosomatic Research from 2010 (vol. 68, nr. 5) is entirely dedicated to this subject. Furthermore, the Journal of the Norwegian Medical Association (Tidsskrift for Den norske legeforening) in 2002 published a series of 17 articles on the topic “functional disorders”. In 2010, the same journal published 11 articles about the “musculoskeletal disorders” that include a majority of the “functional disorders”, usually in the form of chronic pain.
The current terminology presented is obtained by a non-systematic research in PubMed using key words such as unexplained, medically unexplained symptoms, somatoform disorders, functional somatic syndromes, central sensitivity syndromes, multisymptomatic disorders, psychosomatics.
In a more extensive examination one should first give an account of the numerous and various interpretations concerning the different concepts that are presented (cf. Table 1). Next, a more thorough investigation should also include the full range of all (diagnostic) terms that could possibly belong to this landscape of unexplained health issues. Finally, it would be necessary to explore the distinctions concerning different grades of medically unexplained symptoms (MUS) such as (a) normal to mild, (b) moderate, and (c) severe.
An exploration of Habermas’ colonialization theses is, inter alia, found in Fredriksen (2003). He states that “Medical technologies colonise our lifeworld. They change the way we think and act. They make us all accept that we can become patients almost any minute, even if we feel perfectly healthy. Sense transcending technologies turn us all into proto-patients” (p. 287).
Thus, we suggest that persons and patients participate in a medicalized discourse. These individuals also put further pressure on the medical professional precisely on the basis of such a discourse. Consequently, the doctor faces a major challenge (major or minor depending on his experience and knowledge) in trying to support the patient in a necessary process of reconceptualization (or reattribution). It is however not only the patient who opposes such creative efforts. The authorities and the health bureaucracy are uncompromising in terms of approving diagnoses and evidence-based treatments. Nevertheless, such processing does not deviate from our main message: although the patient holds a prominent role in the clinical encounter, we call attention to one of the assumed primary sources of the patients conceptual bewilderment—the incessant supply of new diagnostic classifications in the medical field of unexplained conditions.
In connection with the presentation of different acronyms (Table 1), we clarified that we have no intention of introducing or reviewing the full range of contributions from medicine, psychiatry or psychology. Correspondingly, and related to the subsequent introduction of an alternative perspective (the aesthetics of resistance), we have no intention of introducing or reviewing the extensive amount of contributions from non-medical disciplines. Nevertheless, we find it necessary to mention a few of those voices (in addition to those mentioned in the reference list) that have attempted to challenge the dominant bio-medical approach to these conditions and that represent fragments of the disciplinary background underlying our approach; Sociology; Greco (1998), Nettleton (2005). Anthropology; Martínez-Hernàez (2000), Cameron Hay (2008).
The expression “aesthetics of resistance”, involving such phenomena as fatigued-Being, pain-ful-Being and dysordered-Being, resides within human experience. The living body, Leib, constitutes the worldly arena wherein such experiential “events” are taking place and wherein meaning holds a crucial position. (Meaning should therefore not be seen primarily as a by-product of mental processes, (as in many interpretations of Descartes), but more fundamental as something arising from our embodied being-in-the-world). Throughout these meaning-ful events, human beings find themselves in the midst of an aesthetic realm. Every meaning-creating, meaning-receiving or meaning-relating involves qualitative and sensuous richness that belongs to aesthetics. (See e.g. Johnsons 2007). The experience of being fatigued, being painful, being disordered could be said to be accompanied with an (the) experience of resistance. Accordingly, within human experience, the experience of resistance is. How it is, or shows itself, is by no means self-evident. From the outset of Irving Zola’s medicalization concept, Jürgen Habermas’ colonization hypothesis and Foucauldian power analysis we can assume a kind of embodied reactive-ness, as “standing up against”, “fighting back” or being “in opposition to” external and hostile forces. Furthermore, and from a psychological angle, the Swedish stress scientist Lennart Hallsten has launched the concept performance-based self-esteem (your value depends on your performance) and reminds us of the burned-out and fatigued body which rails/rampages against (in)human constraints. Even in the branch of occupational medicine one has found that a challenge like sickness absence could be seen as the concrete manifestation of resistance (Lipsedge and Calnan 2010). Although we both appreciate and acknowledge the importance of those perspectives mentioned, we will especially emphasize a dimension or an aspect of resistance which could be seen as the “aesthetic moment”—within experience. This approach is, among other sources, grounded in philosophical hermeneutics. We consider every genuine experience to represent some kind of “rupture”. Through Leib, and inextricably connected to meaning, such a “rupture” always involves friction or resistance. In resonance with Gadamer’s thoughts (2004. Truth and method. Continuum Publishing Group) experiences therefore could be seen as series of disappointments, i.e. every experiencing process is essentially negative. However, one should not misinterpret this negativity. “That experience refers chiefly to painful and disagreeable experiences does not mean that we are being especially pessimistic, but can be seen directly from its nature. Only through negative instances do we acquire new experiences, as Bacon perceived. Every experience worthy of the name thwarts an expectation. Thus the historical nature of man essentially implies a fundamental negativity that emerges in the relation between experience and insight (p.350)”. Through this interpretation, one leaves behind a one-dimensional and common understanding of resistance, i.e. we must also acknowledge the pain-ful-Being and the fatigued-Being as being life-affirming resistance. What these events essentially offer are new experiences. The Gadamerian reader, Monica Vilhauer, adds the following; “Though our experience of negativity involves a kind of pain, and is something we undergo and suffer, it is the kind of growing pain proper to development, and from it we emerge with new insight” (p.64) (Vilhauer 2010).
Light intermittent fever of unknown cause.
Pathological condition with fatigue as the core symptom.
“Psychasthenia is more distinctly a mental disease than neurasthenia, since its main symptoms are morbid fears, imperative ideas, doubting mania and morbid impulses” (p. 53) in Myerson 1976/1925.
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Eriksen, T.E., Kirkengen, A.L. & Vetlesen, A.J. The medically unexplained revisited. Med Health Care and Philos 16, 587–600 (2013). https://doi.org/10.1007/s11019-012-9436-2
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DOI: https://doi.org/10.1007/s11019-012-9436-2