Awakening the sense of the possible: the Symptoms Clinic as liminal affective technology

Persistent ('medically unexplained') physical symptoms (PPS) that are disproportionate to detectable disease are common in all clinical settings, with significant impacts in terms of quality of life and cost to health services and society. In the absence of an orthodox biomedical explanation, PPS are often attributed to psychological causes and associated with significant stigma. Emerging neuroscientific approaches to symptom explanation imply causal complexity - involving factors across biological, psychological, and social systems - which exceeds what a conventional diagnostic consultation is designed to address. A successful clinical model needs to be able to open, but also contain, a discursive space for the type of complexity that is relevant to PPS. In this paper we present the Symptoms Clinic Intervention (SCI) as a new model of consultation for patients with PPS. While the SCI was developed in the context of a system broadly organised by the norms of biomedicine we argue that, in its operation, it deviates from such norms in significant and instructive ways. Drawing on causal dispositionalism and on liminality theory, we offer an account of the efficacy of the SCI focused on its ability to shift problematic dispositions. We propose that a carefully crafted experience of liminality can catalyse change by shifting hardened dispositions even in the context of a relatively brief and time-limited intervention such as the SCI. Importantly, this shift refers not only to dispositions in and of the patient, but also to the dispositions of the medical system and of the clinician as its operator and representative.