Abstract
The aim of this article is to present a conceptual review and analysis of symptom understanding. Subjective bodily sensations occur abundantly in the normal population and dialogues about symptoms take place in a broad range of contexts, not only in the doctor’s office. Our review of symptom understanding proceeds from an initial subliminal awareness by way of attribution of meaning and subsequent management, with and without professional involvement. We introduce theoretical perspectives from phenomenology, semiotics, social interactionism, and discourse analysis. Drew Leder’s phenomenological perspectives deal with how symptom perception occurs when any kind of altered balance brings forward a bodily attention. Corporeality is brought to explicit awareness and perceived as sensations. Jesper Hoffmeyer’s biosemiotic perspectives provide access to how signs are interpreted to attribute meaning to the bodily messages. Symptom management is then determined by the meaning of a symptom. Dorte E. Gannik’s concept “situational disease” explains how situations can be reviewed not just in terms of their potential to produce signs or symptoms, but also in terms of their capacity to contain symptoms. Disease is a social and relational phenomenon of containment, and regulating the situation where the symptoms originate implies adjusting containment. Discourse analysis, as presented by Jonathan Potter and Margaret Wetherell, provides a tool to notice the subtle ways in which language orders perceptions and how language constructs social interaction. Symptoms are situated in culture and context, and trends in modern everyday life modify symptom understanding continuously. Our analysis suggests that a symptom can only be understood by attention to the social context in which the symptom emerges and the dialogue through which it is negotiated.
Similar content being viewed by others
References
Merriam Webster Dictionary, s.v. "Symptom". http://www.merriamwebster.com Accessed November 20, 2015.
Bentzen, Niels. 1995. An international glossary for general/family practice. Family Practice 12(3): 341–369.
Ihlebaek, C., H.R. Eriksen, and H. Ursin. 2002. Prevalence of subjective health complaints (SHC) in Norway. Scandinavian Journal of Public Health 30(1): 20–29.
White, K.L., T.F. Williams, and B.G. Greenberg. 1961. The ecology of medical care. New England Journal of Medicine 265: 885–892.
olde Hartman, Tim C, Hiske van Ravesteijn, Peter Lucassen, Kees van Boven, Evelyn van Weel-Baumgarten, and Chris van Weel. 2011. Why the ‘reason for encounter’ should be incorporated in the analysis of outcome of care. The British Journal of General Practice 61(593): e839–e841.
van Weel, Chris. 2014. Primary health care and family medicine at the core of health care: Challenges and priorities in how to further strengthen their potential. Frontiers in Medicine 1: 37.
Malterud, K. 2001. The art and science of clinical knowledge: Evidence beyond measures and numbers. Lancet 358(9279): 397–400.
King, Lester Snow. 1982. Medical thinking: A historical preface. Princeton NJ: Princeton University Press.
Undeland, M., and K. Malterud. 2002. Diagnostic work in general practice: More than naming a disease. Scandinavian Journal of Primary Health Care 20(3): 145–150.
Malterud, Kirsti. 2013. Diagnosis—a tool for rational action? A critical view from family medicine. Atrium 11: 26–31. http://bioethics.northwestern.edu/atrium/articles/issue11/malterud.html. Accessed November 9, 2015.
Fortin, Martin, Lise Lapointe, Catherine Hudon, and Alain Vanasse. 2005. Multimorbidity is common to family practice: Is it commonly researched? Canadian Family Physician 51(2): 244–245.
Barnett, K., S.W. Mercer, M. Norbury, G. Watt, S. Wyke, and B. Guthrie. 2012. Epidemiology of multimorbidity and implications for health care, research, and medical education: A cross-sectional study. Lancet 380(9836): 37–43.
Peterson, M.C., J.H. Holbrook, D. Von Hales, N.L. Smith, and L.V. Staker. 1992. Contributions of the history, physical examination, and laboratory investigation in making medical diagnoses. Western Journal of Medicine 156(2): 163–165.
Leder, Drew. 1990. The absent body. Chicago IL: University of Chicago Press.
Sebeok, T., and J.U. Sebeok. 1981. “You know my method”: A juxtaposition of Charles S. Peirce and Sherlock Holmes. In The play of musement, ed. T. Sebeok, 17–52. Bloomington, IN: Gaslight Publications.
Skagestad, Peter. 1981. The road of inquiry. Charles Peirce’s pragmatic realism. New York, NY: Columbia University Press.
Hoffmeyer, Jesper. 2008. Biosemiotics: An examination into the signs of life and the life of signs. Scranton, PA: University of Scranton Press.
von Uexküll, Thure, and Wolfgang Wesiack. 1988. Theorie der Humanmedizin. Grundlagen ärtztlichen Denkens und Handeln. München: Urban & Schwarzenberg.
von der Fehr, Drude. 2008. Når kroppen tenker [The reflecting body]. Oslo: Universitetsforlaget.
Alonzo, A.A. 1979. Everyday illness behavior: A situational approach to health status deviations. Social Science and Medicine 13(4): 397–404.
Gannik, D.E. 1995. Situational disease. Family Practice 12(2): 202–206.
Gannik, D. 2002. Situational disease: Elements of a social theory of disease based on a study of back trouble. Scandinavian Journal of Primary Health Care. Supplement 20(1): 25–30.
Eriksen, T.E., and M.B. Risor. 2014. What is called symptom? Medicine, Health Care and Philosophy 17(1): 89–102.
Burton, Christopher. 2003. Beyond somatisation: A review of the understanding and treatment of medically unexplained physical symptoms (MUPS). British Journal of General Practice 53(488): 231–239.
Potter, J., and M. Wetherell. 1987. Discourse and social psychology: Beyond attitudes and behaviour. London: Sage.
Austin, J.L. 1962. How to do things with words: The William James lectures delivered at Harvard University in 1955. Cambridge MA: Harvard University Press.
Garfinkel, Harold. 1967. Studies in ethnomethodology. Englewood Cliffs, NJ: Prentice-Hall.
de Saussure, Ferdinand. 2006. Nature of the linguistic sign. London: Routledge.
Nessa, J., and K. Malterud. 1990. Discourse analysis in general practice: A sociolinguistic approach. Family Practice 7(2): 77–83.
Leder, D. 1990. Clinical interpretation: The hermeneutics of medicine. Theoretical Medicine 11(1): 9–24.
Merleau-Ponty, Maurice. 1962. Phenomenology of perception. London: Routledge.
Kleinman, Arthur. 1988. The illness narratives: Suffering, healing, and the human condition. New York, NY: Basic Books.
Hvas, L., H. Thorsen, and K. Sondergaard. 2003. Discussing menopause in general practice. Maturitas 46(2): 139–146.
Lock, M. 1986. Ambiguities of aging: Japanese experience and perceptions of menopause. Culture, Medicine and Psychiatry 10(1): 23–46.
Hay, M.C. 2008. Reading sensations: Understanding the process of distinguishing ‘fine’ from ‘sick’. Transcult Psychiatry 45(2): 198–229.
Stewart, W.F., M.E. Bigal, K. Kolodner, A. Dowson, J.N. Liberman, and R.B. Lipton. 2006. Familial risk of migraine: Variation by proband age at onset and headache severity. Neurology 66(3): 344–348.
Robinson, J.O., J.H. Alverez, and J.A. Dodge. 1990. Life events and family history in children with recurrent abdominal pain. Journal of Psychosomatic Research 34(2): 171–181.
Kozlowska, K. 2009. Attachment relationships shape pain-signaling behavior. Journal of Pain 10(10): 1020–1028.
Kamen, C., M.A. Tejani, K. Chandwani, M. Janelsins, A.R. Peoples, J.A. Roscoe, and G.R. Morrow. 2014. Anticipatory nausea and vomiting due to chemotherapy. European Journal of Pharmacology 722: 172–179.
Kirkengen, Anne Luise. 2001. Inscribed bodies: Health impact of childhood sexual abuse. Dordrecht: Kluwer.
Hiller, W., W. Rief, and E. Brahler. 2006. Somatization in the population: From mild bodily misperceptions to disabling symptoms. Social Psychiatry and Psychiatric Epidemiology 41(9): 704–712.
Elliott, A.M., A. McAteer, and P.C. Hannaford. 2011. Revisiting the symptom iceberg in today’s primary care: Results from a UK population survey. BMC Family Practice 12: 16.
Malterud, K., and H. Hollnagel. 2004. Positive self-assessed general health in patients with medical problems: A qualitative study from general practice. Scandinavian Journal of Primary Health Care 22(1): 11–15.
Ertmann, R.K., M. Soderstrom, and S. Reventlow. 2005. Parents’ motivation for seeing a physician. Scandinavian Journal of Primary Health Care 23(3): 154–158.
Giddens, Anthony. 1991. Modernity and self-identity: Self and society in the late modern age. Stanford CA: Stanford University Press.
Reventlow, S.D., L. Hvas, and K. Malterud. 2006. Making the invisible body visible: Bone scans, osteoporosis and women’s bodily experiences. Social Science and Medicine 62(11): 2720–2731.
Malterud, K., and A. Baerheim. 1999. Peeing barbed wire: Symptom experiences in women with lower urinary tract infection. Scandinavian Journal of Primary Health Care 17(1): 49–53.
Nessa, J., and K. Malterud. 1998. Tell me what’s wrong with me: A discourse analysis approach to the concept of patient autonomy. Journal of Medical Ethics 24(6): 394–400.
Maynard, D.W., and R.M. Frankel. 2006. On diagnostic rationality: Good news, bad news, and the symptom residue. In Communication in medical care: Interaction between primary care physicians and patients, ed. J. Heritage, and D.W. Maynard. Cambridge: Cambridge University Press.
Foucault, Michel. 2003. The birth of the clinic: An archaeology of medical perception. London: Routledge. Routledge classics.
olde Hartman, Tim C, Machteld S. Borghuis, Peter L.B.J. Lucassen, Floris A. van de Laar, Anne E. Speckens, and Chris van Weel. 2009. Medically unexplained symptoms, somatisation disorder and hypochondriasis: Course and prognosis. A systematic review. Journal of Psychosomatic Research 66(5): 363–377.
Malterud, K. 2000. Symptoms as a source of medical knowledge: Understanding medically unexplained disorders in women. Family Medicine 32(9): 603–611.
Malterud, K. 1995. The legitimacy of clinical knowledge: Towards a medical epistemology embracing the art of medicine. Theoretical Medicine 16(2): 183–198.
Werner, A., and K. Malterud. 2003. It is hard work behaving as a credible patient: Encounters between women with chronic pain and their doctors. Social Science and Medicine 57(8): 1409–1419.
Album, Dag, and Steinar Westin. 2008. Do diseases have a prestige hierarchy? A survey among physicians and medical students. Social Science and Medicine 66(1): 182–188.
Asbring, P., and A.L. Narvanen. 2004. Patient power and control: A study of women with uncertain illness trajectories. Qualitative Health Research 14(2): 226–240.
Nagel, Thomas. 1986. The view from nowhere. New York: Oxford University Press.
Malterud, Kirsti, Lucy Candib, and Lorraine Code. 2004. Responsible and responsive knowing in medical diagnosis: The medical gaze revisited. Nora 12(1): 8–19.
Montgomery, Kathryn. 2006. How doctors think: Clinical judgement and the practice of medicine. Oxford: Oxford University Press.
Code, Lorraine. 1995. Rhetorical spaces: Essays on gendered locations. New York, NY: Routledge.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Malterud, K., Guassora, A.D., Graungaard, A.H. et al. Understanding medical symptoms: a conceptual review and analysis. Theor Med Bioeth 36, 411–424 (2015). https://doi.org/10.1007/s11017-015-9347-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11017-015-9347-3