Symposium Themes
Theme 1: What is a symptom?
In 2013, a debate paper described symptom interpretation from three distinct perspectives: biomedical, psychological, and cultural. The paper explored how these differing approaches influence research findings and interpretations, particularly in understanding sensations and symptoms as potential signs of disease. The discussion revealed that no single discipline can fully encapsulate the nature of a "symptom." Instead, symptoms must be understood as the result of a complex interplay of multiple factors.
Over the past decade, our understanding of symptoms has widened. Evidence from placebo and nocebo research has grown substantially and contributes to our understanding of symptoms at an individual level and highlights the effects of social contagion. Furthermore, emerging hypotheses about the brain as a “prediction machine” that produces symptom perceptions sometimes even without sensory input has provided a new understanding of persistent symptoms and functional disorders. These new findings challenge our traditional views and previous understanding of symptoms as experiences that depend primarily on sensory input. Instead, they stress the importance of mediating factors ranging from individual cognitive styles to socio-cultural meanings and practices, as well as features of the wider sensory, spatial, and aesthetic environment that patients engage or are placed in.
In modern biomedicine, symptoms have been and still often are regarded as secondary manifestations of a more fundamental reality – the reality of ‘disease’. Admission into the sick role is typically predicated on (objective, verifiable) evidence of disease rather than on the presence of symptoms alone. However, the new science of symptoms is improving our capacity to explain how symptoms arise and persist. Arguably, this new form of understanding does more than simply add to what we already know. By enabling us to understand symptoms as entities ‘in their own right’, it transforms the epistemological significance of symptoms – that is, their function in a system of knowledge.
We ask:
- what factors are involved in mediating the experience and presentation of symptoms – at an individual, socio-cultural, and environmental level?
- how do sensory mediations (e.g. soundscapes, touch in clinical interaction, technological mediations) affect ways of understanding and perceiving one’s body?
- how do we understand the relationship between these different perspectives on symptoms? What are the challenges involved in combining them?
We invite presentations that explore the full scope of what is relevant to our present understanding of symptoms as a phenomenon in its own right.
Subsequent parallel session is chaired by:
Marianne Rosendal, DK
Monica Greco, UK
Theme 2: Symptoms in society
This theme explores how symptoms are shaped by societal dynamics, how stigma affects those experiencing symptoms, and how digital platforms mediate the experience of illness. We aim to explore the broader implications of symptoms in society, drawing on interdisciplinary insights from sociology, anthropology, philosophy, and digital media studies.
The experience of symptoms is not an isolated event but a complex dynamic interaction between individuals and their social environments which can create tension and struggle. How do individuals decide when to seek medical help, and what role do social influences (family, friends, online communities) play in this process? How do clinicians respond to symptoms for which no clear medical explanation exists, and how do patients and their social environment interpret these responses?
Symptoms do not exist in a vacuum; they are embedded in social structures that shape how they are perceived and responded to. Stigma is a pervasive issue for individuals experiencing symptoms without a clear medical diagnosis. They meet scepticism, both in medical settings and in broader society. Moreover, social inequalities influence access to healthcare, diagnostic processes, and treatment options, further exacerbating disparities in symptom management and patient outcomes.
Digital platforms such as YouTube, Instagram, and online patient forums have played a crucial role in shaping how symptoms are understood and shared. For example, the recognition of the condition known as Long Covid provides a contemporary example for the study of symptoms in society, while also demanding attention as a severe disruptor of many people’s lives. User involvement was key to identifying the condition and supporting and informing the research agenda ever since. Patient-driven online communities have been instrumental in gaining recognition for widespread issues around symptoms, expectations and explanations in contemporary societies.
Understanding symptoms in society requires an interdisciplinary approach that considers social interactions, digital mediation, stigma, and historical perspectives. We invite researchers and clinicians to explore how symptoms are shaped, contested, and legitimized in different contexts. By engaging with diverse perspectives including patient perspectives, we aim to contribute to a more comprehensive and inclusive insight into symptom research and healthcare practice.
Subsequent parallel session is chaired by:
Tim olde Hartman, NL
Sue Ziebland, UK
Theme 3: Understanding 'risk factors' and 'causes' in the development of symptom persistence
An increasing number of epidemiological studies now reveal factors of importance for the development of persistent symptoms and functional disorders. These may be biological such as genetic inheritance as a risk factor or changes arising later in life for example in the autonomic nervous system, the immune system, or the microbiome. Also, psychological factors established in childhood and reinforced later or activated by external triggers play an important role. These biological and psychological factors interact with a number of social factors including social contagion, all contributing to the persistence of symptoms in a complex interaction. Fortunately, our knowledge is increasing in this field, but there is still plenty to explore and a need to combine different scientific approaches.In epidemiology, causality is inferred by observing correlations between phenomena, a process that depends on the possibility of making generalisations based on observing large numbers of similar cases. Persistent symptoms and functional disorders present a particular challenge to this approach due to their complex pathogenesis, which makes it difficult to produce useful generalisations. As a complement to the epidemiological approach, researchers have recently proposed ‘causal dispositionalism’ as a way of addressing causality ‘in the unique patient’, and specifically in relation to conditions characterized by irreducible complexity.
We ask:
- What factors are involved in the development of symptom persistence?
- How do different types of factors relate to each other or combine in the development of symptom persistence? Are they moderators, mediators, or direct risk factors?
- What methodological approaches are relevant to understanding the development of symptom persistence?
- How can knowledge about risk factors contribute to the prevention or mitigation of symptom persistence?
For this theme, we invite contributions that address factors of importance for the development of persistent symptoms from a range of methodological perspectives (e.g. empirical, theoretical, and methodological contributions), as well as contributions that address how we understand and research causality in relation to symptom persistence.
Subsequent parallel session is chaired by:
Tina Wisbech Carstensen, DK
Monica Greco, UK
Theme 4: Management and alleviation of symptoms
This session builds on the previous themes (thinking about what symptoms are and how they develop) to focus on “what to do” about symptoms. It will include patient, systemic and professional perspectives. While the keynote will focus on what patients and professionals can do about persistent symptoms in diagnosed and treated medical conditions, the scope of the session is much wider.
We are interested in “what to do” at different levels: micro (the individual person or clinician-patient dyad), meso (the social network or the clinic), and macro (wider social systems and structures). We are particularly interested in how approaches to symptom management engage with or resist societal and professional discourses: how are diseases and diagnoses rejected, embraced, or ignored? And how do people relate to discourses on living with chronic conditions, aging, disease prevention, and other forms of medical advice. We also want to explore the process of determining the seriousness of symptoms, for instance in terms of acuteness, level of care needed, and care-seeking trajectories.
We invite presentations that focus on decisions to seek diagnosis, self-management, treatment or care, and the nature and outcomes of interactions with professionals. We welcome perspectives from all disciplines that engage in cross-disciplinary discussions about how patients and professionals engage in formal and informal management and alleviation of symptoms, in different social and cultural contexts.
Subsequent parallel session is chaired by:
Chris Burton, UK
Camilla Hoffmann Merrild, DK