Invalidating symptom definition

It is often the source of disagreement between patients, their carers or families, and health professionals.

This is a delicate balance; they have to provide compelling evidence of their incapacity so they can legitimately seek support, while not being seen as passive and incompetent so they can retain their dignity and self-worth.

Sufferers strive to become ‘good’ patients: strong, in spite of illness and disability and not ‘crazy, lazy, illness-fixed or weak'.

The doctor–patient relationship has undergone significant changes in recent decades.

Without a diagnosis, they often feel they have to fight for the right to access care and they lack a narrative or vocabulary to make sense of their own suffering.

In this review, the focus is on the experience of the doctor and patient, the challenges inherent in the therapeutic relationship, and the construction of meaning through explanations and narrative.

Sensitive appreciation of the parent-abused child interpersonal dynamics can help avoid an unintentional repetition of this pattern.

Because some symptoms cannot be observed, but are inferred from conversation, there is potential for substantial disagreement between the doctor, the patient and other health professionals around the aetiology of the illness and the nature of the distress.As his general practitioner (GP), Matalon struggled with feelings of worthlessness, frustration, anger and guilt.It is easy to identify with Matalon’s difficulties in being a ‘good’ doctor when he wrote ‘How could I be angry with a person who suffered disease and depression that prevented him from any rational discourse on life, impaired his ability to enjoy himself and destroyed my positive feelings? We recognise their suffering, but at the same time struggle with the feelings they engender in us. We recognise their suffering, but at the same time struggle with the feelings they trigger in us. Without a diagnosis they lack a narrative or vocabulary to make sense of their own suffering.This article explores some of the challenges faced and strategies utilised when managing patients with medically unexplained symptoms.

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