Symptoms should be explained in the broader perspective of the patient's cognition and mood

Doctors often turn to psychology when trying to understand patients and their problems, especially when no underlying physical pathology can be found. They focus on depression and anxiety as causes of symptoms and propose therapies such as counselling and cognitive behaviour therapy as possible solutions. The symptom itself is rarely questioned. But is the symptom so unproblematic? Why does one person experience headaches and sore throats whereas another has migraines and tonsillitis? Why does retirement exacerbate symptoms but a busy job make them disappear? And why do some patients bring their headaches to the doctor whereas others manage their migraines at home? An understanding of how symptoms arise and how only some are given the status of a problem can create a broader psychological perspective in which to understand patients' health and illness.

In this issue Mercer et al and Nazareth et al describe “lacking interest in sex” as the problem reported most often.1 2 In their anxiety not to feed into the medicalisation …