The large and heterogeneous group of patients with "unexplained somatic sym
ptoms," with or without coexisting psychiatric, "functional," or "organic"
illnesses, provides continuing difficulty for clinicians. The construct of
somatization artificially separates bodily and psychological symptoms that
patients experience as a unified whole. Concurrent chronic illnesses make i
t difficult to exclude "general medical conditions." The diagnosis requires
that the patient seek medical care. Conflict between patients' experiences
of illness and physicians' diagnostic categories, and fear of blaming the
patient, complicate naming and characterizing the illness. We recommend an
approach to clinical care that involves exploring the patient's life contex
t, finding mutually meaningful language to arrive at a name for the illness
, normalizing the patient's bodily experience of distress, using a chronic
disease model that attends to functioning, and addressing the physician's n
eed for certainty and efficacy. Health systems can help coordinate care and
avoid iatrogenic harm by appropriately controlling access to medical servi
ces.