Symbolic diseases and "mindbody" co-emergence. A challenge for psychoneuroimmunology.

Physical diseases that appear to be symbolic somatic representations of patients' personal meanings or individual 'stories' continue to be reported in the medical literature. The identification of a symbolic disease requires a clinical focus upon a patient's highly individual and nuanced meanings largely rendered invisible by the usual methodologies of clinical and research medicine, which has no coherent model for understanding symbolic disease. Therefore, a model is proposed of co-emergence of physicality and subjectivity, body and mind, disease and meaning, disease and symbol, which does provide a coherent basis for understanding symbolic disease. The 'mindbody' co-emergence model avoids mind and body dualism, assumes unbroken continuity between internal body processes and external interpersonal meanings and influences, and asserts that disease-related 'internal' bodily changes and collateral external interpersonal and environmental fluxes are mutually contingent and crucial to the development of the disease. The co-emergence model is discussed specifically in relation to psychoneuroimmunology, but it has exciting clinical and research implications for the whole of medicine.