Explaining the unexplained? Overcoming the distortions of a dualist understanding of medically unexplained illness

Abstract

Our understanding of medically unexplained illnesses (MUI) is distorted by a culturally prevalent dualism where symptoms are either “real” or “psychological”. This paper aims to outline the philosophic and scientific evolution of this dualism and from this to develop an alternative ontology more appropriate for understanding MUI. It begins by considering the work of Descartes, the “father” of the mind body split, then traces this split through the scepticism of Hume, through the idealism of Kant and finally to the work of modern cognitive science. The latter is also seen to have been foreshadowed by the philosopher Jeremy Bentham, who outlined the important notion of societal “fictions”. The historical development of Cartesian dualism is seen to be towards an increasing interaction and co-dependency of mind and world. Using the interactionist paradigm whose evolution has been traced, the materialism and epiphenomenalism of the “old” paradigm is highlighted and an attempt is made to apply a new ontological model to MUI. It is argued that in so doing these become far less inexplicable. Similarities between this ontology and the cognitive behavioural world view are indicated. Finally it is suggested that the main barriers to our understanding of MUI may be ideological.