In this chapter, we traverse and integrate perspectives on psychosomatic illness from primary care and critical social theory. At the core of our chapter is a question that patients with medically unexplained or mixed physical and emotional symptoms often ask or are asked: is this all in your head? The chapter reviews how the ontology of psychosomatic illness is understood under different diagnostic labels, and discusses how the act of diagnosis gets entangled with offering ethical and supportive care for patients, most of whom may be equally well understood as living with precarity, trauma and social inequality.