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J R Soc Med. 2004 July; 97(7): 360–361.
PMCID: PMC1079548

Medically unexplained symptoms

Professor Butler and colleagues propose an approach whereby both patients and clinicians can regard ‘medically unexplained symptoms’ as unambiguously medical (May 2004 JRSM1).

As a clinician I found myself wondering how this new formulation of medically unexplained symptoms would actually help in my clinical work where I see a significant number of such patients. In contrast to the authors' assertion that clinicians are required ‘to do an awkward dance of collusion with the patient’ I find that a rational understandable discussion of the ways in which normal sensations are modified on a continuous basis by the brain (e.g. the perception of touch that changes when the ring is moved from its usual finger to a different finger) or the effects of the brain on somatic symptoms (e.g. stage fright causing vomiting and diarrhoea) a remarkably powerful and intuitively useful explanation to the patient. I then go on to explain that this process occurs in the subconscious mind which is not amenable to reason or voluntary control. The only way to deal with these symptoms is to train, rather than persuade, the subconscious mind to behave differently.

I am at a loss to see how bringing in another dimension—i.e. that their symptom is somehow due to their ‘reaction to the world’—helps, or how this assists patients to see their problems as unambiguously medical. Nevertheless an enjoyable and challenging article.


1. Butler CC, Evans M, Greaves D, Simpson S. Medically unexplained symptoms: the biopsychosocial model found wanting. J R Soc Med 2004;97: 219-22 [PMC free article] [PubMed]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press