Change and uncertainty.

We can never know for certain if the science of medicine applies to us

In reality, all of medicine involves uncertainty. Tests give false positives and false negatives, and there are always a significant number of people for whom standard treatments are not the right fit.

Even as treatments become more personalised, each body and situation remains unique, and complete certainty about what is happening now—or what will happen in the future—is rarely possible.

While this is true across medicine, functional symptoms have a particular uncertainty profile. In functional disorders, the tools and knowledge structures of medical science often fall profoundly short. There may be no blood test, scan, or biomarker that definitively explains what is happening in the body.

Sharing Uncertainty

Clear diagnoses and definitive test results function not only as medical tools but also as social ones, allowing everyone—patients, professionals, families—to agree on what is happening. This shared understanding itself can bring relief.

With functional somatic symptoms, reaching this shared understanding can be difficult.

Different professionals may offer different explanations or advice. Without clear test results, it can be hard to align understanding not only within healthcare settings but also with family, friends, and employers. The uncertainty can feel like a burden you are carrying alone.

Uncertainty within established knowledge frameworks

When trying to understand any illness, we need to engage in a process of gathering the best available information and trying out approaches that seem most likely to help.

This process always involves uncertainty, regardless of diagnosis.

However functional symptoms may feel particularly difficult to pin down, perhaps in part because they challenge our usual ways of understanding illness.

One of these frameworks that shapes medical thinking is the mind–body divide. For example, we tend to understand depression as a mental illness. If someone becomes depressed after major life stress, we readily accept this explanation. We don’t need a scan or blood test to validate their suffering. We see the evidence of depression in their suffering and behaviour, and we respond with compassion and support.

Our frameworks for understanding physical illness bring a different set of assumptions. We expect to find a localised problem in the body that explains the symptom. These assumptions are often based on model conditions such as infections or cancer, where a clear biological cause can be identified.

Functional symptoms do not fit comfortably into either category. They are neither clearly “mental” nor fit with the assumptions we make about “physical” illnesses. In falling between these frameworks, functional symptoms challenge the language we have available to talk and think about ourselves.

Related to this, functional symptoms are often invisible in how healthcare is organised, and how research is designed and funded.

A rational, pragmatic approach to understanding symptoms

Despite the absence of clear biomarkers, we are not without ways of understanding functional symptoms.

When we look beyond narrow frameworks and draw on a wider range of evidence and experience, we see that there is helpful knowledge to draw on.

At the same time, it is important to remember that knowledge gained in one context—whether through experimental research or the experiences of others—may not map neatly onto our own situation. We always need to be prepared to test our theories out through practice, and be prepared to keep an open mind.

For example, it is common to be told told that symptoms themselves might be unreliable signals about what is actually going on it the body. When you are told this, it can be hard to know which signals to trust, and when to ignore the complaints and demands of the body.

This dilemma means that everyday decisions can become surprisingly complex. Here is just one example: Should you rest when you feel fatigued, or gently push yourself to do a little more?

This way of relating to the body is a skill to learn. It requires we stay curious, letting bodily experiences unfold without labelling or catagorising sensations too early. It requires we get out of our head sometimes, and into our bodies.

It can be helpful to approach the physical experience as symptoms flare up, like a surfer. A surfer doesn’t try to control the waves—they can’t. Instead, they learn to move with them. The waves keep coming, but the surfer finds their balance by adjusting their movements, staying present, and working with the rhythm of the water, not against it. Over time, they build the skill to ride out the waves, confident that they can keep some distance between themselves and the turbulence beneath.

Like the ocean, your body, its sensations and symnptoms, is in a constant state of change. Similarly, your relationship with your symptoms isn’t static—it can evolve. With patience and care, you can find ways to engage with your health that feel steadier, more compassionate, and less overwhelming.

One day, you might notice that the way you experience your body has profoundly shifted—not because a quick fix or cure has appeared, but because you’ve learned to navigate the waves with more ease.

Until you practice it, this might seem highly abstract, counter-productive or frightening. It should be noted that everyone will relate to these questions and challenges differently. There is no single approach that is right for everyone, and some, especially those with a tendancy to dissociation, may need additional support to relax the body sufficiently to be able to ‘surf’ symptoms.

However, it seems that psychological flexibility is an important factor in recovery. The aim is not to eliminate change and uncertainty but to develop a accepting, open and curious relationship with it—this attitude is the foundation that allows both your responses to symptoms, and the symptoms themselves, to change and evolve over time.