Why Bioethics Should Be Concerned With Medically Unexplained Symptoms

Biomedical diagnostic science is a great deal less successful than we've been willing to acknowledge in bioethics, and this fact has far-reaching ethical implications. In this article I consider the surprising prevalence of medically unexplained symptoms, and the term's ambiguous meaning. Then I frame central questions that remain answered in this context with respect to informed consent, autonomy, and truth-telling. Finally, I show that while considerable attention in this area is given to making sure not to provide biological care to patients without a need, comparatively little is given to the competing, ethically central task of making sure never to obstruct access to biological care for those with diagnostically confusing biological conditions. I suggest this problem arises from confusion about the philosophical value of vagueness when it comes to the line between biological and psychosocial needs.     

Personal Constructs of Mind-Body Identity in People Who Experience Medically Unexplained Symptoms

“Medically unexplained symptoms” (MUS) refers to chronic physical symptoms without a clear medical cause, which produce significant levels of distress and functional impairment. This project modified the repertory grid technique to explore how twenty participants experiencing MUS construed self and others in bodily and psychological ways. Findings suggested that symptoms are well integrated within participants' wider mind–body construct systems. Increased distance between how self in general is construed compared to self when symptoms are worst was associated with reduced anxiety. Measuring intrapersonal and interpersonal implicative dilemmas suggested that moral and relational construing of identity is affected by MUS.     

Children and Adolescents with Medically Unexplained Symptoms: A Systematic Review of the Literature

Abstract

Medically unexplained symptoms (MUS) in children and adolescents are confounding and concerning for patients, parents, and health care practitioners. Our goal was to review and summarize the literature for family therapists working with a diverse, challenging patient population coping with MUS. A search of multiple databases from 1994 to 2018 was conducted using MUS and related terms. The literature was then organized into subcategories based on its relevance to family therapists, particularly medical family therapists collaborating with primary care physicians. We conclude with a discussion about gaps in the literature and suggestions for clinical management.     

Potentially Harmful Side-Effects: Medically Unexplained Symptoms, Somatization, and the Insufficient Illness Narrative for Viewers of Mystery Diagnosis

Illness narrative has often been found to play a positive role in both patients’ and providers’ efforts to find meaning in the illness experience. However, illness narrative can sometimes become counterproductive, even pathological, particularly in cases of medical mystery—cases wherein biopsychosocial factors blur the distinction between bodily dysfunction and somatizing behavior. In this article, the author draws attention to two examples of medical mystery, the clinical presentation of medically unexplained symptoms, and the popular reality television program Mystery Diagnosis, to demonstrate the potentially harmful effects of illness narrative. The medical mystery’s complex narrative structure reflects and tends to reinforce providers’ and patients’ mistaken assumptions, anxieties, and conflicts in ways which obstruct, rather than facilitate, healing.     

无法解释的躯体症状患者的医患关系研究

无法解释的躯体症状（MUS）这个术语来源于西方,目前也成为我国临床各科门诊常见就诊原因。 MUS 患者的躯体症状体验真实,但是找不到任何器质性异常,导致患者反复就医。其与接诊医生的医患关系成为研究的热点。本研究分别从医患两个视角出发,通过横断面研究发现门诊 MUS 患者医患双方对医患关系的评价较低,MUS 成为一个重要的变量影响了门诊医生对医患关系的评价。借鉴中医理论和方法避免身心分离对治疗 M US 患者有重要意义。     

Multimodal Rehabilitation: A Mind-Body Family-Based Intervention for Children and Adolescents Impaired by Medically Unexplained Symptoms. Part 2: Case Studies and Outcomes

In Part 2, we describe three cases implementing our mind-body, family-based, multimodal rehabilitation approach for treating children and adolescents presenting with medically unexplained symptoms. For each child and family, treatment interventions were selected and implemented, simultaneously or sequentially. In a cohort of 100 consecutively referred children, 56 suffered from, and were treated for, significant physical or chronic school absenteeism. Thirty-five of these children (63%) recovered fully, 10 (18%) had a relapsing course, 7 (12.5%) had chronic symptoms, and 4 (7%) were lost to follow-up. These outcomes suggest that mind-body multimodal rehabilitation is a successful, cost-effective model of treatment.     

An Innovative Treatment Approach for Children With Anxiety Disorders and Medically Unexplained Somatic Complaints

Anxiety disorders in children and adolescents are largely undetected and the majority of youth do not receive services. Given the deleterious consequences of anxiety disorders, early identification and intervention have public health implications. In order to increase identification and treatment of anxious youth, expansion to nonpsychiatric settings (i.e., pediatric medical settings, schools) is necessary. Pediatric medical offices represent ideal settings for detection and intervention for several reasons: (1) access to large numbers of children, (2) high prevalence of unrecognized anxiety disorders in medical settings, and (3) an association between anxiety disorders and medically unexplained somatic symptoms. This paper describes a cognitive-behavioral intervention for youth who present to pediatric medical settings with nonmedical somatic symptoms and undiagnosed anxiety disorders. We explain the rationale for and focus of our treatment approach, present two case studies illustrating the treatment process, and conclude with a discussion of implementation considerations.     

Judgments About Sexism: A Policy Capturing Approach

Different definitions of sexism have been usedby different experimenters and little attention has beengiven to the possibility that participants' definitionsof sexism might vary across individuals and across situations, just as the definitions ofinvestigators vary. Judgments about sexism areinextricably based on individual perceptions, values,and beliefs. It would seem reasonable, therefore toexamine individual conceptions of what constitutessexism. A total of 95 primarily middle-class Caucasianparticipants (68 females, 27 males) participated inthree studies investigating what information people use in deciding whether or not a male actor issexist. Six specific categories of information (or cues)were examined: (1) comments (or lack thereof) by theactor on a female target's physical appearance, (2) unwanted or inappropriate physical contact(or lack thereof), (3) assumptions (or lack thereof)about the target's work, personality, etc., based on hergender, (4) the target being interrupted (or not) by the actor, (5) an apparent powerdifferential (or lack thereof) between the actor and thetarget, and (6) assumptions by the actor aboutappropriate gender role behaviors. A policy capturingmethodology was employed in which three different sets ofscenarios, each describing a number of interactions(called profiles) between a target and an actor, werepresented to male and female participants who rated the degree of sexism exhibited by the actor ineach scenario. Policy capturing represents anideographic approach to research in which the primaryfocus is on establishing statistical parameter estimates that describe each individual's behavior in avariety of environmental situations. Only when that isaccomplished does the researcher examine the possiblenomothetic aggregations across participants. Thus many fewer participants are required than intraditional nomothetic approaches. Each profile set useda different subset of the cues which contained eithersubtle (Study 1), overt (Study 2), or very overt (Study 3)levels of the cues. Multipleregression analysis revealed that when relatively overtacts of sexism were described, most participants hadreliable policies; that is, their judgments werepredictable from the cues. However, when relatively subtleacts of sexism were described, most participants did nothave reliable policies; that is, their judgments werenot very predictable from the cues. There were large individual differences in howparticipants weighted the importance of various cues,especially with subtle cue levels, and in participants'mean sexism ratings.     

Racial Categorization and Stereotype-Based Judgments About Homeless People1

The present study uses a social-cognitive paradigm to examine the association between racial categorization and stereotype-based judgments about homeless people. The study uses data from a national White subsample (N= 1,221) surveyed about attitudes toward homeless/homeless mentally ill people. It was hypothesized that individual differences in perceptions of the representativeness of Blacks in the homeless population, as measured by subjective estimates of the percentage of Blacks, would be associated with the enhancement of racially relevant negative stereotypes about homeless people. A secondary hypothesis was that perceptions of the representativeness of Blacks would be more strongly associated with the stereotype of homeless people as dangerous than with the view of them as lazy. The results support these hypotheses.     

Epistemological Development and Judgments and Reasoning About Teaching Methods

Children's, adolescents’, and adults’ (N = 96 7–8, 10–11, and 13–14-year-olds and university students) epistemological development and its relation to judgments and reasoning about teaching methods was examined. The domain (scientific or moral), nature of the topic (controversial or noncontroversial), and teaching method (direct instruction by lectures versus class discussions) were systematically varied. Epistemological development was assessed in the aesthetics, values, and physical truth domains. All participants took the domain, nature of the topic, and teaching method into consideration in ways that showed age-related variations. Epistemological development in the value domain alone was predictive of preferences for class discussions and a critical perspective on teacher-centered direct instruction, even when age was controlled in the analysis.     

Age/Cohort Differences in Judgments About Criminal Transgressions

To examine possible age/cohort differences in social judgment processes, young and older adults were asked to evaluate criminal offenders described in case files that manipulated both race of offender and the extenuating circumstances preceding the crime. Direct mail was used to reach a wider sample; 218 young (M = 30.21 years) and 167 older (M = 68.57 years) adults provided usable responses. Older adults more strongly recommended parole and estimated less future crime than young adults. There were no age differences in attributions to the criminal's basic nature, but respondents from older age groups and earlier born cohorts more frequently attributed crimes to circumstances. Respondents' judgments of White and Black criminals were generally equitable. Findings suggest that older adults may attach greater importance to contextual factors in their judgments of criminals' actions and make more circumstantial attributions than young adults when there is sufficient context to offer a nondispositional account for behavior.     

Physiological Desensitization and Judgments About Female Victims of Violence

Earlier published studies have indicated that exposure to filmed violence against women leads to decreased perceptions of violence, systematic reductions in emotional reactions, reduction in self-reported physiological arousal to the violence in the films, and a tendency for subjects exposed to the violence to judge a victim of a sexual assault presented in a more realistic context more harshly. The present study was designed to measure physiological desensitizatian (heart rate) and to investigate the relationships between this measure and other cognitive, affective, and attitudinal components of the desensitization process. Subjects were either exposed to a two-hour videotape portraying violence against women or to exciting, nonviolent material (i.e., auto races, nonviolent sex). Following this, all subjects were exposed to two brief clips of violence perpetrated by a man against a women. During these clips, all subjects’ heart rates were monitored. Afterwards mood reactions and perceptions of the perpetrators and victims depicted in the dependent measure clips were measured. The results indicated that heart rates for subjects exposed to the violent videotape were lower during the final 90 seconds of each violent dependent measure film clip than controls. Although the violence-viewing subjects experienced no change in moods, control subjects experienced significant increases in hostility, anxiety, and depression during the dependent measure clips. Subjects in the violence-viewing condition attributed less injury to the victims but greater responsibility to the perpetrators in the dependent measure clips, compared to control subjects. There was no apparent relationship between physiological desensitization and later victim/perpetrator judgments.     

Impairment and Distress Judgments of Symptoms Composing Childhood Externalizing and Internalizing Syndromes

The pattern of perceived dysfunction associated with symptoms composing the externalizing childhood disorder syndrome was compared to the pattern characterizing the internalizing syndrome. In Study 1, undergraduate students (N = 205) judged the social impairment, academic/occupational impairment and personal distress associated with symptoms from the child and adolescent psychopathology scale (Lahey et al. 2004) related to externalizing and internalizing syndromes. As predicted, symptoms composing the externalizing syndrome were judged as involving less personal distress and more impairment than those composing the internalizing syndrome. Converging findings emerged in Study 2 when undergraduates (N = 183) judged DSM-IV symptoms composing externalizing and internalizing disorders. This research reveals systematic differences in perceptions of impairment and distress related to the symptoms that compose the externalizing and internalizing syndromes.     

Intuitive Political Theory: People's Judgments About How Groups Should Decide

Societies must make collective decisions even when citizens disagree, and they use many different political processes to do so. But how do people choose one way to make a group decision over another? We propose that the human mind contains an intuitive political theory about how to make collective decisions, analogous to people's intuitive theories about language, physics, number, minds, and morality. We outline a simple method for studying people's intuitive political theory using scenarios about group decisions, and we begin to apply this approach in three experiments. Participants read scenarios in which individuals in a group have conflicting information (Experiment 1), conflicting interests (Experiment 2), and conflicting interests between a majority and a vulnerable minority who have more at stake (Experiment 3). Participants judged whether the group should decide by voting, consensus, leadership, or chance. Overall, we find that participants prefer majority‐rule voting over consensus, leadership, and chance when a group has conflicting interests or information. However, participants' support for voting is considerably diminished when the group includes a vulnerable minority. Hence, participants showed an intuitive understanding of Madison's concerns about tyranny of the majority.     

Attributions About Morally Unreliable Characters: Relationship Closeness Affects Moral Judgments

Across 6 studies, relationship closeness strongly influenced moral attribution. First, we found that moral attributions were stronger when one interacted with an intimate compared to less intimate other. Second, we examined attributions about those who treat some people well and others badly. Moral character attributions were worse when an actor harmed an intimate relationship partner compared to a less close relationship partner. Further, the effect of relationship partner on moral attributions was influenced by perceivers’ beliefs about one’s true character. Perceivers were apt to believe that one’s true character is revealed when interacting with close others.