"Unexplained" somatic symptoms, functional syndromes, and somatization: do we need a paradigm shift?

Area of Science:

• Neuroscience
• Psychiatry
• Medical Humanities

Background:

• Historically, medically unexplained symptoms (MUS) have been attributed to various causes, with a recent emphasis on psychological explanations.
• The predominant "mental" explanation over the past century has led to effective treatments like antidepressants and cognitive-behavioral therapies (CBT).
• However, this approach has resulted in limited integration into medical practice and patient resistance.

Observation:

• Pre-Freudian medical understanding of MUS offers valuable insights.
• Etiologic theories from this era are increasingly supported by contemporary scientific evidence.
• Clinical practices from this period demonstrated methods for enhancing patient acceptance of psychological interventions.

Findings:

• A paradigm shift is proposed, reframing MUS as functional disturbances of the nervous system.
• Integrating "psychiatric" treatments into general medical care is suggested.
• Learning from historical medical approaches can improve current management strategies.

Implications:

• Remedicalizing MUS around nervous system function can reduce stigma.
• Enhanced integration of psychological therapies into primary care is feasible.
• Improved patient acceptance and treatment adherence are anticipated outcomes.