It’s All in the Mind (and Body): An Interpretative Phenomenological Analysis of the Lived Experience of Psychotherapists Treating Patients With Medically Unexplained Symptoms (MUS)

MUS are a heterogeneous group of conditions characterised by persistent physical symptoms that cannot be explained by illness or injury. The symptoms can be as painful as any organic disease. Due to their physical nature, they are typically managed within medical settings. The doctor attempts to find a structural abnormality or pathology. They may refer the patient to a gastroenterologist, cardiologist, rheumatologist or immunologist for investigative tests. Oftentimes surgeries are carried out with no relief and the problem persists. As a result, MUS accrue significant financial costs to healthcare systems on a worldwide scale. Symptoms can be transient or chronic and debilitating. Patients can become disabled, withdrawn and unable to work. They may suffer in silence as a result of not being believed or become despondent when tests show that there is nothing physically wrong with them. The prevalence of MUS and chronic pain is an ever-increasing health problem. It can have an impact on a personal and societal level due to accompanying co-morbid conditions, such as depression and anxiety. The aim of this thesis is to explore how psychotherapists understand MUS and to establish if patients with MUS can be effectively treated in psychotherapy, rather than a medical setting. A literature review was carried out as an empirical part of the project. Evidence from clinical, epidemiological, and experimental observations show that psychological factors are regarded as central to the problem of MUS. However, extant research has neglected to account for the treatment of MUS in psychotherapy. Having determined a real-world need to find new ways to treat the problem of MUS, a qualitative study was undertaken with 14 psychotherapists experienced in working with the phenomenon in clinical practice. Semi-structured interviews were conducted and analysed using Interpretative Phenomenological Analysis (IPA). The study revealed that unresolved feelings and disavowed emotions are at the root of MUS. Participants emphasised the role of traumatic events in the pathogenesis of symptomatology. The participants view the mind and body as one and that MUS is a complex interaction of the mechanisms of both. A bidirectional network of information is relayed throughout the entire organism involving many cells and bodily tissues. The systems of the body are in a constant cycle of communication, linking mental processes to the immune system and nervous system. The problem is that conditions such as rheumatoid arthritis, asthma or autoimmune disorders can develop but the underlying cause might remain undiagnosed, and the problem persists. Supporting patients with MUS is an area in need of therapeutic innovation. Even though there is a surplus of data on the phenomenon, there has been minimal research specific to the field of psychotherapy. This thesis endeavours to provide psychotherapists with a theoretical understanding of the aetiology of MUS and offers trusted interventions that have informed the participants clinical practice. It provides an understanding of how the body responds to adverse childhood experiences (ACEs) and how MUS can occur when difficult emotions are not processed or expressed. It confirms the link between the mind and body and its influence on health and disease. The thesis adds to the body of knowledge on MUS specific to the field of mental health, as opposed to medicine. It makes an original contribution by synthesising scientific literature with practical data derived from participants’ experiences as practitioners. It seems that MUS may be an inaccurate term since all symptoms can be explained. The term MUS does not acknowledge the diverse biological processes often associated with common physical symptoms. A more appropriate definition may be ‘inflammatory disorder’ or ‘neuro-immune disorder’ which could be more helpful when applied to people with chronic pain.