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Paper short abstract:

This paper explores patient and clinician orientations to medical uncertainty in somatoform disorders (a contemporary term for hysteria). Interested in the therapeutics of uncertainty, I ask how insistence on medical certainty shapes the conditions of possibility for suffering, care, and recovery.

Paper long abstract:

Medical knowledge is often colloquially synonymous with certainty and truth; however, where do we find ourselves when medicine is uncertain about a diagnosis, prognosis, or treatment? Somatoform disorders are the phenomenon in which someone is seriously ill – e.g. seizures, complex pain, paralysis – but no pathophysiological cause can be found. A multitude of competing explanations for this phenomenon exist – emotional distress somatically manifested, disturbances in nervous system connectivity, etc. – and yet profound uncertainties in care and illness experience remain. Research has historically focused on the therapeutic benefits of certainty, however, this paper follows recent calls to embrace medical uncertainty (Greco 2017) and approaches uncertainty not as a cipher for ignorance, but as a flicker, a simultaneous polyphony; how do patient and clinician orientations to uncertainty shape the conditions of possibility in the clinic?

Based on two months of ethnographic fieldwork with clinicians and somatoform patients in a Canadian neuropsychiatric hospital, I found that while patients and clinicians were avowedly conscious of medicine’s uncertainties in this context, in practice, both enacted medicine as a regime of certainty – a term I offer to describe a cultural tradition that imagines medicine as able to provide access to objective truth, making uncertainty an unacceptable mode to inhabit. This paper argues that while this will to certainty may be therapeutic in the moment, in the long-term, it fails to hold the strange, dynamic, experiences of somatoform symptoms and participates in the marginalization of suffering that does not neatly correspond to pathology.