Nervous Routes: Tracing Explicability Between Medical Knowledge and Bodily Experience

This project focuses on the problematic encounter between the lived/felt/experienced physical symptom in relation to their unexplained status in medical science. I trace different routes, which I identify as nervous routes, to examine how and where experiences of medically unexplained illness are mediated. My analysis operates along three different axes that run through this project: the science and profession of medicine, cultural theory, and lived experience. Along these, I analyze different cultural objects, such as medical texts, internet memes, personal memoirs and documentary film, from which I identify different routes along which both knowledge and affective experience travel, coalesce, and collide, resulting in a conflictual conceptual space in which to relate to the ill body.

Within medical practice, the term ‘medically unexplained physical symptom’ is used to describe symptoms for which there is no structural physiology or underlying physical disease that can be identified in relation to the symptom. Among the group of symptoms commonly classified as medically unexplained are back pains, chronic fatigue and severe pains in muscles and joints. In practice, this means that these symptoms are ‘explained’ (away) as somatizations: physical manifestations of psychological distress. Thus, medical discourse itself establishes the rift between mind and body, locating the problem exactly in between: the problem experienced in the body is at the same time a problem of the mind. The conditions for the patients’ experience of the disease as physical entity are thereby considerably reduced, but the painful experience itself is enlarged by offloading the responsibility for the lack of explanation onto the patient. Here, mind/body dualism presents itself as a painful impasse.

Divided into three parts, the first part of this dissertation delineates the interdisciplinary field in which I engage with unexplained illness. This interdisciplinarity is not only found in the methods with which I approach various accounts of medical inexplicability, but also in the medical fields itself, where medical inexplicability is defined and treated. The second part deals with two conceptual problems encountered in different medical syndromes which count as unexplained. The first, in chapter four, being the notion of transference, and the notion of psychosomatic contagion in the case of fibromyalgia, and the second, discussed in chapter five, being the notion of illness localization in the body, discussed in relation to illnesses of the gut. The third part of this dissertation closes these discussions with theoretical reflections which arose out of the close analyses conducted in the first parts. Problems discussed here relate to the self in relation to narration in chapter six, the possibility of a non-dualistic relation to the body in a discussion of affect theory in chapter seven, or the notion of accountability, which is discussed in relation to long COVID and ME/Chronic Fatigue Syndrome in chapter eight.