Morality in clinical space: treatment of youngsters with functional somatic symptoms in a Western clinical context

ABSTRACT

This paper explores the moral implications of treatment of young people with functional somatic symptoms. Based on an ethnographic field study at a Danish pain clinic for youngsters (age 8 to 18), the paper seeks to unearth the cultural, moral values that clinical practice steers by and upholds, and the implications this has for the assessment and management of ill body-selves. Through an exposition of the general practice of the clinic and an investigation of two specific cases of youngsters, it is found that the assessment of symptoms and selves and the goals of treatment are informed by cultural ideals of ‘the good self’ and ‘the good life’ in which agency and work ethic – both pertaining to the notion of individual responsibility – figure as prevalent virtues. The study underpins the findings of other researchers who have found that ideals of individual autonomy and responsibility for own life and health permeate the Western health care system and the discourses of ill individuals. The contribution of this article is to portray in ethnographic detail how such a cultural ethics manifests in practice and what implications this have for the treatment of young people with functional symptoms at a specific location and in specific cases. The two cases illustrate that the underlying norms and values can give rise to very different moral assessments of symptoms and selves within the same diagnostic category.

KEYWORDS:

• Functional somatic symptoms
• youngsters
• morality
• biopsychosocial treatment

Ethical approval

Informed consent was obtained from the participants in the study. The study was reported to the National Committee on Health Research Ethics and approval was obtained from The Danish Data Protection Agency [J.nr. 2013-41-1820].

Acknowledgments

The authors would like to thank all participants in the study – youngsters, parents, therapists and others – who made the study possible. Furthermore, the authors would like to thank three anonymous reviewers, whose helpful comments improved the paper. The authors regret that a few suggestions for further analysis have not been included due to lack of space.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. The Danish concept ‘at udrede’ means both ‘to diagnose’, in a clinic sense of the term, as well as ‘to disentangle’/‘to straighten out’/‘to unravel’.

2. This and the following excerpts are reconstructed and translated from detailed field notes taken during non-audio recorded meetings or therapeutic sessions.

3. A colloquial expression for antidepressant medicine.

Additional information

Funding

Faculty of Health Sciences, University of Southern Denmark; Region of Southern Denmark Research Funding [grant number J.nr. 11/28625]; Hospital of Southern Denmark; Knud & Edith Eriksens Mindefond.