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At the borders of medical reasoning: aetiological and ontological challenges of medically unexplained symptoms

Thor Eirik Eriksen, Roger Kerry, Stephen D. Mumford, Svein Anders Noer Lie, Rani Lill Anjum · 2013 · 65 citationsRead the paper

Medically unexplained symptoms (MUS) remain recalcitrant to the medical profession, proving less suitable for homogenic treatment with respect to their aetiology, taxonomy and diagnosis. While the majority of existing medical research methods are designed for large scale population data and sufficiently homogenous groups, MUS are characterised by their heterogenic and complex nature. As a result, MUS seem to resist medical scrutiny in a way that other conditions do not. This paper approaches the problem of MUS from a philosophical point of view. The aim is to first consider the epistemological problem of MUS in a wider ontological and phenomenological context, particularly in relation to causation. Second, the paper links current medical practice to certain ontological assumptions. Finally, the outlines of an alternative ontology of causation are offered which place characteristic features of MUS, such as genuine complexity, context-sensitivity, holism and medical uniqueness at the centre of any causal set-up, and not only for MUS. This alternative ontology provides a framework in which to better understand complex medical conditions in relation to both their nature and their associated research activity.

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Theory or simulation

Epidemiological studies on non-specific low back pain (NSLBP) fail to establish strong causal links between pain and mechanical stresses (lifting, posture, etc.) or biological factors (Interleukin-1 gene cluster polymorphisms, nerve growth factor). (Non-specific low back pain (NSLBP) population studies)
Lifetime prevalence of non-specific low back pain (NSLBP) is reported as high, contributing to significant societal costs. — up to 84% (General population)
The paper proposes a 'dispositionalist' ontology of causation as a framework to handle the heterogeneity, context-sensitivity, and medical uniqueness of MUS, moving away from reductionist and categorical diagnostic models. (Theoretical framework for Medically Unexplained Symptoms (MUS))

Setup: Literature review and theoretical analysis of conditions including CFS, LBP, FM, IBS, and GAD.
How: The authors perform a philosophical and epistemological analysis of existing medical literature and epidemiological data on MUS. They critique the biomedical and bio-psychosocial models and propose an alternative ontological framework based on dispositionalism.
Limitations: The paper is a philosophical exploration rather than an empirical clinical trial. · The proposed dispositionalist framework is a theoretical model and not a validated clinical tool.

Summarized by Gemma 4 from the open-access full text · 7 Oct 2026. Read it