#68: Understanding Medically Unexplained Symptoms with Dr Hannah Sugarman

Have you ever experienced mysterious physical symptoms that doctors just can’t explain?

This week, I'm joined by Clinical Psychologist, Dr Hannah Sugarman. We unravel the complexities of medically unexplained symptoms (MUS). We demystify what these symptoms are, discuss the stigma and psychological impact around diagnoses like Functional Neurological Disorder and chronic pain, and explore how the mind and body are deeply connected, even when tests come back clear.

Highlights include:
8:46 Defining medically unexplained symptoms (MUS) and common presentations
15:09 The healthcare system's shortcomings
22:24 Trauma, stress and physical symptoms
28:42 Finding support and resources
33:25 Hope for managing symptoms

Want more?

Check out our exclusive mini interview with Hannah over on Substack

This week's guest:
Dr. Hannah Sugarman is a Clinical Psychologist with over 15 years of experience. From the beginning of her career, she’s been fascinated by how the brain influences our thoughts, emotions, and behaviours. Early on, much of her work focused on neuropsychology, supporting people with neurological conditions and brain injuries. Over time, her passion grew for understanding the complex and often misunderstood link between the mind and body, especially for those dealing with physical symptoms that don’t have clear medical explanations. In addition to her neuropsychology work with individuals, families, and professionals, Hannah works with individual adults experiencing mental health problems and medically unexplained symptoms in one to one therapy. 

Hannah is currently in independent practice, working with clients remotely, in the community and in person at Central Health London. Hannah is passionate about supporting individuals who are dealing with symptoms that medical tests can’t seem to explain. 

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Transcript

Introducing Medically Unexplained Symptoms

Dr Liz White 0:02

If you're looking to improve your mental health and well-being, then keep listening. I'm Dr Liz White, a consultant clinical psychologist with over 20 years of experience. Whether you're a frazzled parent, a stressed out professional or finding your way through the challenges of midlife, you're in the right place. Through a mix of solo episodes and insightful conversations with expert psychologists and therapists, I'm bringing you evidence-based tools and strategies to help you navigate life's ups and downs with confidence, clarity and compassion. With confidence, clarity and compassion this is your space to feel seen, supported and empowered.

Dr Liz White 0:53

Welcome to Hello Therapy. Has anyone ever said to you, it's all in your head. Well, this is what people who experience medically unexplained symptoms hear time and time again. Today, I'm chatting to clinical psychologist Dr Hannah Sugarman about physical symptoms like pain, fatigue, seizures and a whole host of other physical symptoms that doctors cannot explain. We get into why they can be so challenging to diagnose and treat and the ways our healthcare system can sometimes fall short in supporting people. So, whether you've experienced persistent physical issues yourself or you want to better understand someone who has, this episode is packed with insights and practical suggestions to help you cope. So let's dive in. So, Hannah, thank you so much for joining me on the Hello Therapy podcast today.

Dr Hannah Sugarman 1:51

Oh, you're so welcome. It's a pleasure to be here.

Dr Liz White 1:54

We are talking about we were just saying before a bit of a complex topic medically unexplained symptoms. We're going to get into all of that and you're going to help us understand what that means and maybe some tips later on. But before we do that, can you tell our listeners who you are and what you do? I can.

Dr Hannah Sugarman 2:15

So I'm a clinical psychologist and I work with adults experiencing mental health problems and people who have neurological illnesses and injuries, but my special interest is the way that our minds and bodies interact, and so that has led me to work with lots of people who are experiencing these physical symptoms that are medically unexplained.

Dr Liz White 2:37

Brilliant, so medically unexplained symptoms. So I think a lot of people don't really know or struggle to understand what that actually means. So can you just define it in really simple terms?

Dr Hannah Sugarman 2:50

for us Absolutely. It is confusing because there's been so many different terms used for medically unexplained symptoms over the years. It's been called things like conversion disorder, psychogenic symptoms, somatization, psychosomatic. The preferred terms now are like persistent physical symptoms, functional symptoms, medically unexplained symptoms. They're all under the same umbrella. I think the catch all like simple definition is physical symptoms that cannot be easily or fully explained by medical tests.

Dr Liz White 3:26

Okay, so someone would presumably go through a process of having various tests and assessments, scans, maybe, and at the end of all that the doctor might say, right well, there's no known cause and therefore we're going to diagnose you with medically unexplained symptoms. Is that what happens?

Dr Hannah Sugarman 3:50

That tends to be the way and unfortunately, unfortunately, that can be quite a painful process. But yeah, that usually someone only ends up with this diagnosis when they have had a lot of tests and the doctors have ended up saying, well, none of these have shown up anything, so this is what we're giving you okay, so can you give us a picture of how this might present in someone's life, like with some examples, just to give us a bit of context.

Dr Hannah Sugarman 4:11

Sure, yeah. So there's a huge range of different presenting problems that might come under this umbrella, affecting different parts of the body, different severity, different associated levels of disability. The body different severity, different associated levels of disability. I'll just talk through some of the common ones. So some of them.

Dr Hannah Sugarman 4:28

Some people might experience groups of symptoms that are considered syndromes, so things like irritable bowel syndrome. There's also individual symptoms that people get, like pain, neurological symptoms, like weakness, headaches, that can be considered medically unexplained. There's also syndromes that you may have heard of that can come under this wider umbrella of medically unexplained symptoms, but they're quite somewhat controversial. So things like chronic pain, chronic fatigue syndrome, and an increasingly common diagnosis now is functional neurological disorder. So that refers to when people do have these neurological symptoms. It might be pain, it might be seizures, but there's no evidence of the disease on the scans or on the tests.

Dr Hannah Sugarman 5:14

But one thing to say is really important to say that putting any of these conditions under this umbrella doesn't mean the symptoms aren't real. Although there aren't biological processes underpinning them, they are real, very distressing physical experiences that affect someone. But we understand that psychological, emotional and social factors like stress or trauma, or how we interpret and respond to symptoms can play a role in how these symptoms develop or persist, but it absolutely doesn't mean that they are only psychological. It's just understanding that the mind and the body are deeply connected, and that's very relevant to people who are experiencing these symptoms.

Dr Liz White 5:54

Okay, and functional neurological disorder. You mentioned a couple of things there. What's the most common presentation in terms of symptoms? If somebody had that diagnosis?

Dr Hannah Sugarman 6:08

it can really vary. Um, I think the most well known would be what we call non-epileptic seizures, so it's where someone's having seizures, so they might have sort of full blown tonic clonic seizures, um, or they might be partial seizures, but but having had the investigations, there's no evidence of epilepsy. So it's a confusing diagnosis for lots of people. It might not be something people are aware of unless they work in the field or they've had personal experience of it. But that's quite a common one. But otherwise it's just a really varied expression of functional neurological disorder. For some people it will be pain. For some people, people that will be pain. For some people it'll be weakness. There can just be all sorts of things going on where we might expect to see something going, something visible on a scan that's happened in the brain.

Dr Liz White 6:56

But that's not the case for these people okay, and presumably just taking the example of FND or functional neurological disorder does that mean that if a doctor is saying right, we can't see any evidence on any scans or any tests, does that mean that they then that person doesn't then get treatment?

Dr Hannah Sugarman 7:16

It can mean that and it's important to say that the two it's not exclusively FND. A lot of the time you can have people with neurological symptoms with an organic basis that are accompanied by FND. But if it is someone's experience that they get a diagnosis of FND, that can be the end of the road in terms of the support offered. So it might be that they're told there's nothing more we can do for you because there's nothing physically wrong with you, which can be absolutely devastating to hear for someone who's experiencing these symptoms because there is something physical wrong.

Dr Liz White 7:54

and the other option that might be available, depending on where you live, is that there are some specialist FND services but the wait lists are really really long and so in my experience, most people are told yes, we'll put you on the wait list for this, but don't expect anything anytime soon so my experience of of this area is very, very small, but what I do know about it is that it is one of the more stigmatized areas of health care, isn't it as you say? I think people can have that experience of well, it's all in your head, but as you say that, I mean that in itself can be incredibly traumatizing, can't it?

Defining MUS and Common Presentations

Dr Hannah Sugarman 8:31

for someone, definitely, and I think the tricky thing is that when we think about the ways that our medical system is designed, we have physical health services and we have mental health services, which doesn't make sense, I know, to us psychologists. We know that the mind and the body aren't separate, but it's an idea as old as time. Really, it's this Cartesian dualism that is based on this idea that a philosopher one day said here's the mind and here's the body, and they're separate, and our services reflect that. So when someone's experiencing a problem that clearly has something to do with both, the system doesn't really know how to handle it, and what people end up with is this label of well, it's just psychological, which is hugely invalidating because the symptoms are real and they're disabling, in the same way that a diagnosis of medically explained symptoms is. And it is strained, really, because we don't in general, have an issue with the idea that our bodies affect our minds. So you know, when you're upset, tears come out of your eyes. When you're nervous, your legs feel wobbly, but we then seem to struggle with this idea that psychological stress could be related to these more persistent and disabling symptoms. And so I think, because of those the symptoms being psychological.

Dr Hannah Sugarman 9:54

There's a lens of this, this stigma, these really outdated ideas about what it means if your symptoms are psychological and I find it helpful to think with people about this in terms of like, imagine that you had to have some time off work for a physical health problem and if, if you could go to your boss and say here's a letter from my doctor and this is the scan and this is the diagnosis, you know, I've proven that there's a physical problem, most people wouldn't find that too difficult.

Dr Hannah Sugarman 10:19

But what if there was no blood test or no scan that you could show them? Then most people would find that much more difficult because you might worry about being taken seriously. You might think are people going to think I'm making this up or is it going to say something about my personality? So this stigma is so widespread, much a product of, unfortunately, that persistent stigma around mental health problems bumping up against the way our services are designed. That can mean that the prognosis for these people can actually be worse than the prognosis for people who are experiencing organic, medically explained symptoms.

Dr Liz White 10:56

Yeah, and you. You've alluded to this, but that there can be a very long journey for someone, sort of from the onset of symptoms to being told it's medically unexplained years, I'm guessing sometimes. But in that time, what's happening to that person? Are they struggling on, or maybe working, not working? What's your experience in terms of that, that kind of journey for someone?

Dr Hannah Sugarman 11:29

it can be a really difficult time and, yeah, you're right that it's. For lots of people it's not a short amount of time. It can be years, it can be decades, and throughout that time they're having to advocate for themselves. And it's a really uphill struggle to represent the symptoms accurately, like these are physical symptoms that are really bothering me, all the while being told well, we'll try this test, oh, that showed up nothing, the tests are clear, there's nothing wrong with you. So you constantly you know clients have told me that sometimes you doubt yourself and you'll start to think well, what, what am I complaining about?

Dr Hannah Sugarman 12:06

But actually, for lots of people, these symptoms are in no way less disabling than the symptoms that can be seen on a scan. Um, it's just that, like, for people who get a diagnosis that's physical, organic, there's a more straightforward route to getting help. Yeah, um, whereas for, like, most of the people who don't or who are in this, um, this situation, they wind up basically constantly being told what they don't have but not being told what can help them. Um, and it's just, it's a shame, um, that that journey has to be so long and so painful for most people what would be the ideal, then, in terms of like?

Dr Liz White 12:47

obviously, I know maybe this is a bit pie in the sky, but I guess I was thinking they're like so how can services help people who are experiencing this? I mean, it would it be like to you know if we're really in fantasy land. We would. We would sort of just do all of the tests known to man in one go and really try and help diagnose or you know what what would help.

The Healthcare System's Shortcomings

Dr Hannah Sugarman 13:50

I mean, it's a really tricky one because there's a temptation to think that doing all the tests in one go might be helpful. But actually tests can do harm and we need to think about that as well. There's a book that came out recently about diagnosis by Susanna Sullivan, who's a neurologist who works a lot with these symptoms, and she writes very, very powerfully about these, I think in a very compassionate way about these symptoms, and she talks about this that we don't think about the fact that if someone is having seizures and we put them on a wait list to have a scan, all that time you know they're concentrated on well, I'm waiting to find out what's physically wrong with me, yeah, and then they have that scan and actually scans and tests aren't as good as we think they are at determining whether something is medically unexplained or not, and she talks a lot about that. So that's a whole other issue. But basically you, you end up with a very strong idea about what's causing your symptoms and so you end up kind of seeking out those more physical solutions. So if you do then end up with a diagnosis of medically unexplained symptoms, it's very confusing, it can feel very invalidating because it's like well, what then? And so I think we need to be a bit careful around, assuming that doing all the tests would be a better approach to this.

Dr Hannah Sugarman 15:22

In an ideal world and I think this is very pie in the sky we'd have practitioners who are better informed on this. I mean, these symptoms are so common. We're all experiencing medically unexplained symptoms all the time, I should say, but the ones that present themselves to healthcare, I mean, the estimates are like you know a quarter to half of all consultations with primary care involve some kind of medically unexplained symptom, and yet practitioners aren't thinking about it that way. You know they're very much trained in that. Well, it's either physical or it's caused by stress, it's psychological and therefore there's nothing we can do.

Dr Hannah Sugarman 16:01

So I would really love to see a medical system that just thinks more holistically and sees less of a divide between the mind and the body, because then we start to think about well, if it's psychological, then what are the next steps for this person? And now I say it's certainly pie in the sky, because we know that even the most specialist doctors in this area struggle to tease apart the contribution of mind and body. It's not an easy thing to do the thing that I. That speaks to me most. Um, this was from Susanna Sullivan. One of the things that she said in an interview that I listened to recently was that, actually, whether the symptoms are physically based and can be seen on a scan is actually the wrong question to be asking people and it's not actually that helpful.

Dr Hannah Sugarman 16:50

So I would love to see a healthcare system that's less focused on we must find out the physical cause and spend years trying to rule out physical causes and just more on understanding the person's experience and trying to get to what would help them more quickly.

Dr Hannah Sugarman 17:06

And I want to say I don't want to be totally doom and gloom about the health service because they they deal with health problems, um, in the way they're supposed to, which is like looking for the cause and, of course, if there is something on a scan or a blood test that can be treated, that's by far the most efficient way to go about this.

Dr Hannah Sugarman 17:24

But then it has this byproduct where people are made to feel as though their symptoms aren't real because they are psychological. But it's interesting, you know, if you were alone in your house at night and you heard a noise unexpectedly, and then you know your heart would start pounding, is that in your head? It's not like. And so this stuff is happening all the time and we don't doubt it. We don't doubt it as a concept. It's just when it becomes a, I suppose, a clinical issue, when it starts to be disabling in the way that medically unexplained symptoms or persistent physical symptoms, are we start to see people falling through the gaps or, even worse, or repeatedly attending a medical system that isn't set up to help them?

Dr Liz White 18:11

yeah. So someone who is experiencing that uncertainty, that self-doubt, yeah, how would you help someone that's in that kind of headspace, especially if they've been told there's nothing wrong with you physically. It's?

Dr Hannah Sugarman 18:30

tricky, because we need to be realistic about what is available, getting to that point of recognising recognizing, okay, that, so understanding the full picture of what's going on for someone and you're having these symptoms, and so this, we think, is influenced by psychological factors, and this one we can see a reason for on a scan. Most people don't ever get the opportunity to clarify that, and so I think the hardest part for most people is just getting to the point where they recognize that, okay, some of the symptoms are psychological, but it doesn't end there. You know, this is a thing, this is a phenomenon that we understand. It's real, it's not imagined, it's not like a feature of a weak personality or you some of the other really terrible ideas that people can hold about themselves if they have symptoms that are psychological. So, first and foremost, I really want people to have access to the ideas that are more helpful about these symptoms, which is that you're not making them up, and I think that's that's. Often.

Dr Hannah Sugarman 19:34

People's biggest fear is that they're maybe being seen to be exaggerating to get attention or like consciously faking symptoms. But there are very, very rare cases where that happens and it's not this. It's nothing to do with medically unexplained symptoms. So I would want people to understand that the kinds of symptoms that we're talking about they're not consciously produced, that the kinds of symptoms that we're talking about they're not consciously produced. You're not doing this on purpose, despite the unfortunate experiences you might have had of being I am sure they're not being told that, but I certainly know that it can feel like that when you're repeatedly being told there's nothing wrong with you, it's all in your head and so like. First and foremost, I would want people to have access to information that's validating and understanding of what they're going through, as a bridge to where might there be some help for this then? This is not like a cul-de-sac. You don't have to stop looking for help because you've received this information. It's more about finding the right information.

Dr Liz White 20:33

And we've touched on the idea of trauma and stress, and we've touched on the idea of trauma and stress. Can you give us a flavour of how stress, trauma, maybe anxiety as well or the psychological factors, how they influence those physical symptoms and medically unexplained symptoms?

Dr Hannah Sugarman 20:52

They definitely play a role, but it's not a straightforward one. You will have people who are experiencing these symptoms, where there's a clear trauma or a series of traumatic experiences, and for some people they'll say, no, I don't have that experience at all. Nothing bad's happened, and it's quite puzzling that people would be bringing up this idea of trauma. I know in our field and more widely, we're thinking about trauma quite differently now than we used to, both in terms of what constitutes trauma and also just the impact of trauma.

Trauma, Stress and Physical Symptoms

Dr Hannah Sugarman 21:23

And so there has been a lot of work and you know a lot of books published, a lot of papers around this idea that stress and trauma, in whatever form, don't just affect us mentally, they also shape our bodies. Affect us mentally, they also shape our bodies and we know that traumatic experiences can actually change how our nervous system works and make it more sensitive to stress. So it's not just an emotional thing, like there are real physical effects that we can see as the outcome of trauma. There is a theory that I find very helpful called polyvagal theory, this idea that there's this big nerve we've got running from our brain all the way down to our organs, our heart, our lungs, our gut, this vagus nerve, and it controls lots of our physical processes heart rate, breathing, digestion and it's a key part of how we manage stress. So when we're faced with stress, we know that this nerve helps to trigger our fight or flight response, so preparing us to deal with a threat.

Dr Hannah Sugarman 22:22

But if we face ongoing stress, we sort of stay stuck in survival mode.

Dr Hannah Sugarman 22:28

We can get physical symptoms like pain, fatigue or even digestive problems, and if we can't fight the stress or run away, then we can be pushed into this state of freeze, so it can make us feel disconnected or numb, and so over time, if our nervous system keeps being triggered, we know it can become more reactive and that can lead to more frequent or more intense symptoms.

Dr Hannah Sugarman 22:52

So this is thought to be a factor for some people with these symptoms. They're real physical symptoms, but they are massively influenced by the body's nervous system being in this constant state of stress. And it's important to say that it's not just like a one-off traumatic event that can cause this. It's also things like long-term emotional stress so childhood neglect, emotional abuse. Term emotional stress so childhood neglect, emotional abuse, physical abuse, all that more subtle unmet needs so a parenting style that means that someone's needs for safety and attunement and connection are consistently unmet, that they all influence the development of our nervous system and that has physical effects. They're not necessarily going to show up on scans, but they have a huge impact on how our bodies work and the physical symptoms that we experience.

Dr Liz White 23:42

So if someone listening is kind of recognizing yeah, I'm stuck in fight or flight and I have had a lot of stress over a long period of time and maybe I did have a difficult childhood and I'm experiencing pain or migraines or or whatever it is what might be like a first step for someone like that to sort of start helping themselves there are loads and loads of things that can be helpful.

Dr Hannah Sugarman 24:07

I would always go to find good information first of all, and it depends how you like to digest information. There are amazing books out there if you, if you like to, you know, really get stuck in and read a book. The, you know the body keeps the score is a very famous book that touches on these topics. There's also some really good books, um, by like gabor mate that he has a book called when the body says no, and monty lyman writes really, really nicely about this. He's a psychiatrist. He writes about pain. He also writes about how the immune system and the mind are connected. So there's some really, really good books.

Dr Hannah Sugarman 24:44

Social media is brilliant and also worrying in ways, because you can't always be sure of how, how evidence-based the information is on there. So I would you know, if people are savvy about what kind of information they seek out, then there's some fantastic information out there too, and there's also some really, really great charities, so, say, fnd Hope. There's fantastic information on a website called neurosymptomsorg, which was started by aI believe, a neurologist who was seeing these symptoms a lot and recognized the same thing that we're talking about, where there's there's just not much helpful information out there. So that's really helpfully worded information about these symptoms. And then, of course, there's like there's finding the right help from health professionals, and also when you're more well informed, when you have a better understanding of your symptoms, it can help you to appreciate which self-help lifestyle things might be helpful for you. So of course it's not there's no lifestyle intervention that's going to be a silver bullet for these symptoms, but it's definitely helpful to be thinking about well-being more generally and how that impacts our bodies and our minds.

Dr Hannah Sugarman 26:00

So you're talking there the kind of basics around sleep, nutrition hydration movement, that kind of stuff, exactly, exactly, um, I think, um, and for what clients have told me? You know they've, they have been told by lots of people when they've been experiencing these symptoms oh, have you thought about using Headspace or, you know, just get better sleep?

Dr Hannah Sugarman 26:21

And that again, well-meaning advice can feel quite invalidating for such a complex presentation, not saying that this stuff is going to solve the problem, but let's face it. We can all benefit from getting good sleep. Thinking about what we put in our bodies, keeping our bodies moving, again like that's a really important one. Especially when it comes to symptoms like pain and fatigue. We need to think very, very carefully about activity and sort of doing the right amount and making sure that we don't feed into unhelpful cycles.

Dr Liz White 26:55

It's one piece of the puzzle, but it's a very, very important one, because we all know how much that has an impact on our physical and mental health as well but even something so seemingly simple right like the sleep and and the food like the kind of I always talk about those things as like the basics of good mental health care, because it obviously, yeah, physical health, but for someone who is, say, in pain every day and is feeling overwhelmed and is stuck in fight or flight, you know, it's that's overwhelming to think about. Oh, my goodness, now I've got to sort out my sleep and sort this out, sort that out and, as you say, there is so much out there, isn't there? Or, you know, just chuck on a meditation app um, it's like another thing that you need to to do and when someone's really, really struggling, that's really tough it is, and it might feel like, sorry, you want me to, you know, do some mindfulness and try and like get better sleep.

Finding Support and Resources

Dr Hannah Sugarman 27:54

When I'm completely crippled by this problem. It might feel kind of irrelevant, and so we just want to make sure it's not the only thing they're being told. Unfortunately, if a health practitioner isn't well equipped to understand these symptoms, if that advice isn't going hand in hand with some more helpful, more tailored advice around how to support medically unexplained symptoms, it's just going to feel like such a miss, and well, it's completely missing the point of what this person needs, and so I would suggest people take it as one piece of the puzzle, like a thing that can be helpful as long as you can find a route to it that works for you and the symptoms that you're experiencing yeah.

Dr Liz White 28:38

So what would you suggest in terms of some like practical strategies, um for managing medically unexplained symptoms, particularly, you know, things like pain in in daily life, like, do you have any snappy strategies? I think you're going to say no, I think you're going to say more complicated than that, but anything that someone listening could sort of take away, oh yeah, let me try that. Oh.

Dr Hannah Sugarman 29:07

I don't want to be too doom and gloom about this uh, but I wouldn't want to suggest that there's anything snappy that could be done that's going to meet the needs of someone who is experiencing these symptoms. It's not to say that the the practical things that we all know are good for us can't help. I guess when someone isn't sure you know they've got these symptoms, they're told they're probably stress related. There's always going to be that idea of well, I'm not sure whether I should sort of accept that, leave it there. Okay, I'll go and try some stress reduction stuff and see if that helps.

Dr Hannah Sugarman 29:44

So it's important to do your due diligence around symptoms and make sure that you do have the investigations. We do want to rule out medical causes because of course, you know most people with this diagnosis would rather have a symptom that could be treated with a medical test. You know it's people might think it's reassuring to say, oh, there's nothing wrong with you, but it's like but there is and I and I can't do anything about it. So once you're in that place of what, I know that this is what I'm dealing with. For me the practical stuff would be around like learning about your symptoms, learning what help is out there, because it's not the end of the road.

Dr Hannah Sugarman 30:24

There are specialists in this area who really have quite a different understanding of it than that. That traditional. It's either in your mind or it's in your body. It's, and so that lends itself to some really promising treatments. And we're usually talking about like a multi-disciplinary approach. It would never be I would like to think it's never just I'll go and see a psychologist, because that can also feel quite stigmatizing and invalidating, but it's sort of thinking about the mental health piece and the physical piece and stress and trauma and all of the different pieces that are relevant to people experiencing these symptoms and having these really thoughtful interventions that address each of those so that they've got the best chance of finding their way back to a life that works for them and that might be working around some of the symptoms.

Dr Liz White 31:15

Symptoms might not be eliminated, but they can certainly do things that improve quality of life a lot and in your experience, do people get better from the physical symptoms, or most of the time it's, yeah, it's like a. You know it's a condition that needs to be managed it depends, yeah, sometimes.

Dr Hannah Sugarman 31:38

Yes, I think what we're always wanting is to instill a message of hope, like the in a way, the fact that there isn't visible damage or disease is a good thing, because, like that, if we can find the right treatment, like if we can try and understand this condition better, then there is real hope here.

Hope for Managing Symptoms

Dr Hannah Sugarman 31:59

But the flip side of that is, well, it would be much more straightforward if there was something to treat, because it's a lot harder to find the route to a solution, if you like, when there isn't. Find the route to a solution if you like when there isn't, but absolutely there are possibilities for reducing symptoms and sometimes eliminating them. It just totally depends on the person and their situation. But there are certainly lots of success stories and it's not impossible to eliminate these symptoms. I see it as, unfortunately, a lot of damage can be done along the way, you know, while someone's pursuing a medical explanation which I would do the same if I was experiencing debilitating medical symptoms but it's sort of taking them further away from the stuff that might help. And they often don't know that until down the line when they do receive this diagnosis, and then it's. It's only with hindsight they can recognize that some of this stuff might have been helpful a few years ago or a few months ago, but it's much harder to implement now.

Dr Liz White 32:59

So someone who's listening, who is really struggling with medically unexplained symptoms and feeling really lost with it all. What's a message that you would want to leave that you know that person?

Dr Hannah Sugarman 33:15

I would want them to know that they're not on their own. It's not something that they have to face forever, in terms of the way that they've been experiencing it and the the disheartening experiences they can have in trying to find help. That can feel so frustrating, um, so overwhelming, but there is hope. So I would want to tell them that there are treatments, there are ways of understanding and managing symptoms that aren't how we might conventionally think about physical symptoms, but they can be really transformational. You know, they can make a huge difference both to the symptoms and to the person's quality of life, and to the person's quality of life. Yeah, um, and I would want to say to them that in no way does adopting this lens on your symptoms make them less real.

Dr Hannah Sugarman 34:02

You're never suggesting that we're just treating a purely psychological problem here, but it's about finding the tools to help your mind and your body work together in a healthier way. So I would say don't give up on finding support, because there is support well, thank you so much for coming today.

Dr Liz White 34:19

As I said, it's an area that I don't know much about and I think there's so many different bits and pieces in our conversation that I think will help someone who is who is struggling with this. So thank you so much for your time oh, I really, really hope.

Dr Hannah Sugarman 34:35

If this can be of help to someone, then that would mean the world to me so thank you so much thank you for having me.

Dr Liz White 34:42

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