Exploring "medically unexplained symptoms" with GPs and counselling psychologists : a Foucauldian Discourse Analysis
"Medically unexplained symptoms" or "MUS" has been constructed as a term to describe persistent physical symptoms for which no medical aetiology can be found. "MUS" account for at least 20 per cent of UK medical consultations, yet fit uneasily within a biomedical discourse where illness is legitimised by medical diagnosis. "MUS" supposedly operates as a neutral category, yet critical review of the literature problematises this so-called neutrality: it fails to be neutral whilst avoiding depicting the situation as it is. There is widespread conflict about terminology and aetiology, which results in the subjective creation of legitimacy criteria; disavowal of a psychological dimension; and patients receiving costly and ineffective treatment. This research, motivated by the need within this conflict to better understand the implications of how we talk about “MUS”, explores how practitioners are constructing “MUS”. Four semi-structured interviews with GPs and counselling psychologists were undertaken and analysed using Foucauldian Discourse Analysis. Alongside underlying biomedical discourses, discourses of separation, mindbody dualism, psychology and holism were identified. These contributed to various constructions of "MUS", including "MUS-as-choice", "MUS-as-challenge", "MUS-as-unreal", "MUS-as-placeless" and "MUS-as-untold-story". This research problematises the separation of illness into categories, the psychologisation of "MUS" and the lack of availability of an acceptable holistic discourse with which to construct illness. It emphasises the performative nature of our talk about "MUS" and the importance of discourse awareness for deepening our understanding of social and cultural influences on how we see the world and act within it. Exclusive biomedical and psychological constructions of illness displace "MUS" as legitimate illness and limit opportunities for constructive dialogue. As practitioners, we need to resist getting caught up in these frameworks. Suggestions are made for how practical disturbances of current working practices might be achieved.
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