Personal Constructs of Body-Mind Identity With Persons Who Experience Medically Unexplained Symptoms (MUS)
Medically Unexplained Symptoms (MUS) are bodily symptoms for which no organic cause has been identified, and which result in significant levels of psychological distress and functional impairment. MUS are thought to be highly prevalent in primary care settings, and have considerable costs to society. Despite evidence of overlapping psychological and physical presentations, MUS are not well understood or treated in culture that predominantly views the body through the lenses of dualism and mechanistic reductionism. An alternative ‘interactive’ view of the body as playing a more dynamic role is elaborated through George Kelly’s (1955) Personal Construct Psychology. The author draws upon Lin & Payne’s (2014) ‘frozen construing’ theory, and empirical literature on relationships between identity and MUS, to suggest that for people with MUS, the symptomatic body is distressing because the person is struggling to integrate its meaning with their identity. It is hypothesized that embodied processes, that may actually protect the self (and others who share a construct system with that person) from events which threaten to dramatically alter how the self is construed, are difficult to understand because of their preverbal nature. Hence symptoms, and the body itself, are dissociated from the person’s more elaborated verbal self-constructions. Several hypotheses relating to this suggestion were tested using a modified form of the repertory grid technique that was designed to explore construct systems of both mind and body, for self and others. Twenty participants with MUS, recruited from the community, completed the repertory grid interviews and measures of depression, anxiety and symptom severity, which were correlated with relevant repertory grid indices to test hypotheses. Findings indicated that symptom constructs, contrary to expectations, were well integrated into participants’ construct systems. The alleviation of psychological distress was significantly associated with increased perceived distance between the self in general and the self when symptoms are worst (a relationship which appeared to be independent of severity of symptoms), providing evidence of a process of dissociation that protected the current self from assimilating the undesirable characteristics that were associated with the symptom. The way in which the self when symptoms are worst is construed appeared to influence levels of distress, with more predictive power than several other indices. The study also found evidence for some participants of hypothesized relationships between desired aspects of the current self and symptoms, that would imply that symptom disappearance would actually threaten a desirable aspect of how the self is construed. Content analysis of these constructs revealed (as predicted) that such desirable aspects of self tended to relate to being responsible and sensitive to the needs of others, and were elaborated through bodily constructs in a way that suggested that they were not well integrated with the primary ways that these participants made sense of their identity. For these particular participants, discrepancies between the ideals that they had for themselves, and how they would like to be seen by others, were associated with increased depression. Several participants were identified whose constructions of self and others were dominated by constructs relating to both mental and physical strength and weakness. These participants appeared to be struggling to find coherent meaning for themselves as the result of symptoms, which were regarded as invalidating a pre-symptom construal of themselves as being ‘strong’. There seemed to be a continuum of being a ‘body for others’ on the one hand, a previously ‘strong person’ on the other, and a person who is ‘strong for others’ in the middle. Implications for clinical practice are discussed. Although the findings of the current study are limited by a small sample size, it appears that exploring the meaning of the body in the construction of self helps to elaborate the meaning of the body and symptoms in a verbal, expressible form. This process is likely to be helpful to those who struggle to find meanings for their symptoms both in their own construct systems and in a society that objectifies the body.