The biomedical approach to health and illness, not only puts lesions, or pathological changes in the body’s tissues or symptoms, at the heart of diagnosis and treatment. The idea is that disease is a physical phenomenon, with changes which can observed and/or measured. However, what drives patients to consult doctors is frequently not the sudden appearance of a lesion which can be seen. Rather, it’s often the experience of a symptom. Some of the commonest symptoms include pain, weakness and dizziness.
Researchers who have studied patients with common symptoms have found that in a large proportion of cases, there are no objective findings which might explain the presence of the symptoms. This may be dismissed as “in yer heid”, or “nothing wrong” but both of these judgements are unfair and inaccurate. The occurrence of symptoms in the absence of detectable tissue changes has been labelled “Medically Unexplained Symptoms” (MUS) This is a very, very common situation. Different studies have shown that a lack of a medical explanation may occur in 30% of all consultations at a Primary Care level, and in up to 85% of those with particular, common symptoms.
This is really a big problem.
- Firstly, all treatments, surgical or pharmacological, are directed against lesions – measurable, pathological changes in tissues or systems. So, in the absence of such pathology, modern medicine’s tools are hopelessly inadequate.
- Secondly, non-surgical and non-pharmacological treatments are not well developed, tested or proven, so patients in this situation often end up with operations or drugs because no other solutions are known, and these interventions all carry risks of harm, so patients find that not only are they not helped, but they end up worse off because of side-effects and other iatrogenic harms.
- Thirdly, patients in such a predicament often find their suffering dismissed as either psychological and sent for psychiatric treatment, or, worse, find that they nobody actually believes that they are experiencing the suffering they are complaining of.
- Fourthly, (and this one is hardly ever mentioned), the existence of “MUS” suggests that symptoms are not the reliable indicators of disease which doctors assume them to be. This leads to the problem of patients whose symptoms are ascribed wrongly to the discovery of pathology. Just because some inflammation is found, or a growth is found, it does not mean that this pathology is the whole cause of the symptoms which the patient is experiencing. In fact, it does not even mean that the pathology is the partial cause of the symptoms. This can lead to the prescription of drugs or the carrying out of surgical procedures which make absolutely no impact on the patient’s suffering.
The concept of “Complex Adaptive Systems” gives us another whole way of understanding such diverse and difficult symptoms – the problem need not lie in a body tissue or in the mind – the problem can lie in maladaptation or malfunctioning of the system as a whole. Such a concept leads to a demand for holistic interventions, because no simple, single-explanation, solutions can work.