Pragmatism in the Fray: Constructing Futures for ‘Medically Unexplained Symptoms’

The expression ‘medically unexplained symptoms’ is still widely used to indicate physical symptoms that are not attributable to any known conventionally defined disease. It is discursively related to several other concepts including somatisation, somatic symptom disorder (DSM 5), and functional somatic syndromes, which include the diagnoses of fibromyalgia, chronic fatigue syndrome, multiple chemical sensitivity, and irritable bowel syndrome, among others. Some of these conditions are currently the object of controversies and political battles. This chapter examines what it can mean to approach this group of conditions ‘pragmatically’ by contrasting two different versions of pragmatism. One version, exemplified in social research that aligns itself with arguments proposed by some patient movements, is consistent with Rorty’s ‘epistemological behaviourism’. Another version, exemplified by a novel clinical intervention (the Symptoms Clinic) is consistent with William James’ ‘radical empiricism’. It is argued that these different approaches yield significantly different consequences. The first affords legitimacy to patients on an immediate and piecemeal basis at the expense of reinforcing a bifurcated mode of thought. This, it is argued, is a factor in (re)producing the experience of ‘medically unexplained symptoms’. The second is premised on the assumption of a relational continuity between social structure, embodied experience, and physiology.