‘It’s the unknown’ – understanding anxiety: from the perspective of people with multiple sclerosis (2018) Chalder et al

[Diluted-biscuit]

So you believe that a biopsychosocial model, involving physical and psychological factors, likely underlies mental health conditions such as anxiety and depression that appear in neurological diseases such as MS? Judging by the Likes your post received, so do others here.

But I expect at the same time, the same people would fiercely deny that the core mental symptoms of ME/CFS are biopsychosocial. ME/CFS mental symptoms listed in the CCC include these emotional symptoms:

• Emotional lability (pseudobulbar affect) = unstable or exaggerated emotion
• Emotional unpredictability, emotional disability, emotional disturbances
• Hypersensitivity to emotional overload
• Emotional flattening

Cognitive dysfunction (brain fog) is also classified as a mental symptom in the DSM, but again most ME/CFS patients I expect would strongly deny that their brain fog is psychologically-caused, or involves a BPS model.


So I find it paradoxical that on the one hand, ME/CFS patients often support the biopsychosocial for some mental symptoms like anxiety, but on the other, the same patients will vehemently deny the BPS model for the core ME/CFS mental symptoms such as the emotional and cognitive symptoms.

Perhaps you could explain the reasoning on this paradox. Why ME/CFS patients are fiercely against BPS for the core ME/CFS symptoms, but support BPS for some of the comorbid mental health symptoms like anxiety and depression that can appear alongside ME/CFS and other neurological diseases.

This is important, because the whole ME/CFS community has fought a long hard battle against BPS views of ME/CFS. We need to make sure we are conceptually clear on this.



My view is that psychologists and psychiatrists have been far too quick to propose psychogenic causes (life event factors) for mental health conditions, and far to slow to consider organic biological causes of mental symptoms.

Sure, there are some mental health conditions such as depression that can be caused by both psychogenic factors and/or organic biological factors. But where organic neurological disease is present which affects the brain, in my view depression is far more likely to be caused by organic brain disease.

And even in general, even in the absence of overt neurological disease, my view is that major depression is far more likely to be caused by organic brain disease. I know several people who developed major depression after catching my ME/CFS-triggering virus, coxsackievirus B4. Depression has been linked to brain inflammation, which chronic viral infection may cause.

I don't believe that psychogenic factors (life event factors) are much involved in mental health conditions such the various anxiety disorders (like GAD, panic disorder, OCD, social anxiety), bipolar disorder, SAD, schizophrenia, psychosis, autism (which is believed in France to be psychogenic), anorexia nervosa, dissociative disorders (like depersonalization), etc.

Adverse life event factors can certainly be harder to bear or cope with once you have a mental health condition. For example, once you have generalized anxiety disorder (GAD), your ability to cope with life's stressors is greatly reduced. But that is not the same as saying that GAD is caused by life's stressors.



I think the study of mental illnesses in general is in the same dire state as ME/CFS, with far too many researchers believing that mental illness primarily arises from psychogenic factors, rather than arising from a physical pathophysiology of the brain.

CBT does nothing for my brain fog but helps my anxiety and OCD immensely, that’s my reasoning.

I find it far weirder that you are so militantly against anything being psychological than people thinking different symptoms can be from different causes.

 

[large donner]

Yes, it's more the more the views of the ME/CFS community in general that I am referring to, rather than focusing on anyone in particular.

Very scientific.

 

[Hip]

CBT does nothing for my brain fog but helps my anxiety and OCD immensely, that’s my reasoning.

Yes, I appreciate that CBT can be useful for some things such as OCD. But I think we would agree that the fundamental cause of OCD is not a deficit of cognitive-behavioral therapy.

So there is a difference between the cause of an illness, and the treatments that help. As mentioned, I am not against psychological therapies if they show some useful benefits.

What I am talking about is the fundamental nature and causes of mental illness. That's ultimately what medical science needs to get to grips with.

I find it far weirder that you are so militantly against anything being psychological than people thinking different symptoms can be from different causes.

Militant? No. Enthusiastic perhaps.

I think it's an important issue: mental ill health can cause horrible long-term suffering. It's a terrible blight on humanity. We need to solve this problem.

Yet we see psychiatric research heavily biased towards psychobabble psychogenic/psychosocial causes, faffing around with silly psychogenic notions of mental disease — primarily I expect because many psychiatrists and psychologists simply don't have the right sort of intelligence to understand the mechanics of the brain.

Not everyone is cut out to understand the hard sciences of biochemistry, immunology, virology, etc, and I expect lots of psyche professionals may be more oriented towards softer sciences, so that's why they choose soft science professions like psychology or sociology. Thus they may trade in psychogenic theories because many lack the skill set to delve into the biological underpinnings of mental ill health.


It's worth showing table 3 of a 2011 survey study of psychiatrists' attitudes toward mental disorders: this table shows the dire state of psychiatry.

As you can see, even for the most severe mental illnesses such as schizophrenia, only 15.6% of psychiatrists view it as biological. The rest assume schizophrenia arises from psychogenic or psychosocial-type causes. I think this profession needs to pull its socks up, and learn some real science.

Table 3: Psychiatrists' attitudes toward mental disorder classification

 

[Mithriel]

Thanks for your sympathies, Trish; though the reason I mentioned my experience (which I should have been clearer about) was really to point out that unless you have personally had clinical anxiety or major depression in their full power, you may merely assume that these illnesses are nothing much more than the regular anxieties or glumness healthy people have in ordinary life.

When a study talks about clinical anxiety in MS, I would think that these are levels of anxiety beyond extrapolation from the regular anxieties of ordinary life.

It would be good to think they actually looked at clinical, pathological anxiety but given the evidence I think it is unlikely. So many of our symptoms (and that of other diseases) are "explained" as mental illness (and claimed by psychologists!) The often repeated statement that ME is often associated with depression is based on this sort of dubious thinking and I have seen no convincing evidence that it is true. I have known people with clinical depression and bipolar disorder and it is a dreadful thing which ruins their lives in the same way ME does to us, however I have not seen much of that sort of thing on the forums and groups I have been in. There have been people who are frightened and anxious because of social circumstances though and a lot of people who have had their physical symptoms dismissed as anxiety by medics.

As you say, any neurological disease can affect the brain in such a way as to cause pathological mental disease. In the 25 years I have been attending an MS therapy centre I have met one (young) man with MS induced dementia. Sadly the neurons damaged were not the usual ones affecting the legs or arms. However at one point most of the people there were taking amytriptaline for "depression" when they were obviously worrying about the disease and not like my friends with true clinical depression.

I think we are all talking at cross purposes, caused by the duplicity of BPSers and to accuse the ME community of hypocrisy is unfair.

 

[Hip]

The often repeated statement that ME is often associated with depression is based on this sort of dubious thinking and I have seen no convincing evidence that it is true.

One area where I do have considerable trust in the judgement psychologists and psychiatrists is in their ability to diagnose of mental symptoms and mental illnesses (as opposed to their views on what causes those illnesses).

Psychiatric and psychological professionals tend to have empathetic skills well beyond the abilities of the average person. Empathy can be thought of as the uncanny ability to "X-ray" another person's mind; to understand what goes on in that mind. All of us have some degree of empathy, but some people are exceptionally gifted in this area.

So these professionals are going pretty skilled at sensing the mental states of the subjects they are studying. Indeed, if you don't have this empathetic ability, then you are not going to make a good psychologist and psychiatrist (just like if you don't have an X-ray machine, you won't be much good as a radiologist).

So in general I trust the judgement of psychiatric and psychological professionals in their perception and diagnosis of mental symptoms and mental states.



The opposite end of the empathy spectrum is often the techie or engineering types — the Bill Gates of this world — who are typically (but not always) lower in empathy. Techies have high logico-mathematical intelligence, but usually do not excel in empathy. So it seems it's hard to find both empathy and logico-mathematical skills in the same person.

And this actually is the crux of the issue of why psyches are not very good at understanding the nuts-and-bolts biological underpinnings of mental health — because it requires empathy to perceive mental symptoms, but logico-mathematical skills to understand the underlying biochemistry, immunology, etc of the brain that might lead to these mental symptoms.

So what we need is a new breed of psychiatrist, who has both empathy and logico-mathematical skills. I think you need to be gifted at both ends of this spectrum to get to the biological causes of mental illness.

I have known people with clinical depression and bipolar disorder and it is a dreadful thing which ruins their lives in the same way ME does to us, however I have not seen much of that sort of thing on the forums and groups I have been in.

Well what about just asking ME/CFS patients themselves if they are depressed, which this PR forum poll did, and so did this MEA survey. On the poll, 1 in 3 ME/CFS patients themselves said they were depressed.

I am one of these ME/CFS patients who does suffer with depression, although it comes and goes from month to month, or week to week.

But agree with you that the depression in ME/CFS is probably relatively mild in comparison to the depths of depression that can occur in clinical major depression.

 

[Cheshire]

Psychiatric and psychological professionals tend to have empathetic skills well beyond the abilities of the average person. Empathy can be thought of as the uncanny ability to "X-ray" another person's mind; to understand what goes on in that mind. All of us have some degree of empathy, but some people are exceptionally gifted in this area.

Psychiatric and psychological professionals, the best psychics...

 

[Diluted-biscuit]

Yes, I appreciate that CBT can be useful for some things such as OCD. But I think we would agree that the fundamental cause of OCD is not a deficit of cognitive-behavioral therapy.

So there is a difference between the cause of an illness, and the treatments that help. As mentioned, I am not against psychological therapies if they show some useful benefits.

What I am talking about is the fundamental nature and causes of mental illness. That's ultimately what medical science needs to get to grips with.





Militant? No. Enthusiastic perhaps.

I think it's an important issue: mental ill health can cause horrible long-term suffering. It's a terrible blight on humanity. We need to solve this problem.

Yet we see psychiatric research heavily biased towards psychobabble psychogenic/psychosocial causes, faffing around with silly psychogenic notions of mental disease — primarily I expect because many psychiatrists and psychologists simply don't have the right sort of intelligence to understand the mechanics of the brain.

Not everyone is cut out to understand the hard sciences of biochemistry, immunology, virology, etc, and I expect lots of psyche professionals may be more oriented towards softer sciences, so that's why they choose soft science professions like psychology or sociology. Thus they may trade in psychogenic theories because many lack the skill set to delve into the biological underpinnings of mental ill health.


It's worth showing table 3 of a 2011 survey study of psychiatrists' attitudes toward mental disorders: this table shows the dire state of psychiatry.

As you can see, even for the most severe mental illnesses such as schizophrenia, only 15.6% of psychiatrists view it as biological. The rest assume schizophrenia arises from psychogenic or psychosocial-type causes. I think this profession needs to pull its socks up, and learn some real science.

Table 3: Psychiatrists' attitudes toward mental disorder classification
View attachment 5421

My position is that we don’t have enough evidence either way to say mental illness is always psychological or always biological and to say one way or the other is an expression of your own biases.

I suspect some mental health conditions will be caused by purely biological factors and some will be purely psychological. Others a mix of both. I will keep an open mind and follow the research.

Psychiatry is the weakest link in medicine and does cause lots of problems but psychological therapies and medication have stopped me from killing myself so I will always ‘enthusiastically’ fight back against people such as yourself.

Last reply on this subject.

 

[Hip]

My position is that we don’t have enough evidence either way to say mental illness is always psychological or always biological and to say one way or the other is an expression of your own biases.

There is increasing evidence that mental illnesses are biologically based; but even if we accept your position, and we want to give potential psychological and biological causes equal weight, we would then need to get around 50% of psychiatrists interested in biological causes. Whereas at the moment, only around 15% or less are interested in biological causes, according to the above table 3.

So there is a heavy and unhealthy bias is in the psychiatric profession itself, where the vast majority see the causes of mental illnesses as psychological.

 

[large donner]

So there is a heavy and unhealthy bias is in the psychiatric profession itself, where the vast majority see the causes of mental illnesses as psychological.

Well they would if people enable them by using the term mental illness as it suits them for any arbitrary symptom collection.

 

[BruceInOz]

Psychiatric and psychological professionals tend to have empathetic skills well beyond the abilities of the average person. Empathy can be thought of as the uncanny ability to "X-ray" another person's mind; to understand what goes on in that mind. All of us have some degree of empathy, but some people are exceptionally gifted in this area.

I think that's a dangerous way to think and has something of the 'appeal to authority' logical fallacy about it.

Many years ago when I had only been sick for a couple of years, I had to see a psychiatrist who was a professor in a top Australian university in order to get a temporary disability insurance payment. I was absolutely truthful and open with him for nearly an hour at which point he declared that I had depression. I was absolutely floored because the reasons he gave showed he had twisted things I said and completely ignored things that didn't fit his preconceived hypothesis. I know my own mind and I knew I was not depressed.

I still got the disability payment (but possibly for the wrong diagnosis) and the first thing I did was consult another psychiatrist who did listen and wrote a report that was the complete opposite. So in my sample of two psychiatrists, one had very poor empathetic skills.

So in general I trust the judgement of psychiatric and psychological professionals in their perception and diagnosis of mental symptoms and mental states.

My exprience means that I am very cautious about trusting the judgement of psych professionals regarding diagnosis.

 

[Hip]

I think that's a dangerous way to think and has something of the 'appeal to authority' logical fallacy about it.

Saying that psychiatrists and psychologists (should) have good empathetic skills is a "dangerous" way to think?

Not really seeing the dangers that you perceive there. If I said that pilots have good eyesight, would that be dangerous too?

I was absolutely truthful and open with him for nearly an hour at which point he declared that I had depression. I was absolutely floored because the reasons he gave showed he had twisted things I said and completely ignored things that didn't fit his preconceived hypothesis. I know my own mind and I knew I was not depressed.

Well, I guess it is possible your psychiatrist may not have been the best in his profession, but I am not sure why you were "absolutely floored" just because you got a misdiagnosis. Misdiagnosis happens all the time.

Disease diagnosis is a difficult thing, in the case of both mental and physical illnesses. It's common for GPs to initially misdiagnose their patients' physical illnesses. And sometimes psychiatrists may initially diagnose one condition, but as they get to know you more, they may change their diagnosis in the light of further evidence.


But I am not sure what relevance this has in relation to the general discussion, which is about whether mental illness is psychologically or biologically caused.

 

[large donner]

Well, I guess it is possible your psychiatrist may not have been the best in his profession, but I am not sure why you were "absolutely floored" just because you got a misdiagnosis. Misdiagnosis happens all the time.

You are sure why he was absolutely floored hip because he told you plain and simple in black and white.

It wasn't, "just because he got a misdiagnoses", it was because in his own words.....

BruceInOz said: ↑
I was absolutely truthful and open with him for nearly an hour at which point he declared that I had depression. I was absolutely floored because the reasons he gave showed he had twisted things I said and completely ignored things that didn't fit his preconceived hypothesis. I know my own mind and I knew I was not depressed.

Are you just pretending not to understand that?

 

[Invisible Woman]

Psychiatric and psychological professionals tend to have empathetic skills well beyond the abilities of the average person. Empathy can be thought of as the uncanny ability to "X-ray" another person's mind; to understand what goes on in that mind. All of us have some degree of empathy, but some people are exceptionally gifted in this area.

So these professionals are going pretty skilled at sensing the mental states of the subjects they are studying. Indeed, if you don't have this empathetic ability, then you are not going to make a good psychologist and psychiatrist (just like if you don't have an X-ray machine, you won't be much good as a radiologist).

So in general I trust the judgement of psychiatric and psychological professionals in their perception and diagnosis of mental symptoms and mental states.

So, by this logic, do you agree with Wessely, Sharpe and White that ME/CFS is a psychological condition?

I'm afraid I find your summation of the qualities of various professionals and the reasons they might be drawn to their chosen fields very oversimplified, @Hip.

Some people, such as teachers, doctors, nurses may well be drawn to their chosen profession because of their natural skill set and a desire to help people. Those are likely to be the good ones. Unfortunately, others are just as likely to be drawn to those professions because they like to be in charge and have some control over those perceived to be more vulnerable than themselves.

I know of others still who were pushed along a certain professional path by their parents and end up spending their whole career doing jobs they hate.

 

[Trish]

Moderator note:
This thread has been reviewed by moderators.
Please remember that the thread topic is a study of anxiety in MS, and be mindful of the forum rules, particularly Rules 1 and 4.

(edited)

 

[Mithriel]

Too many mental illnesses, especially in research, are diagnosed by questionnaires. Add up the scores, job done. Can't sleep, one point for depression (no questions about intense pain keeping you awake.)

 

[Hip]

Are you just pretending not to understand that?

I have to admit that my reply to @BruceInOz was not very sympathetic, so I apologize for being a bit brusque. I was quite tired and PEM'ed when I wrote my reply, so responded without really thinking.

Yes, some psychiatrists may clumsily try to impose their theoretical model of mind over a patient's symptoms, rather than using the more fluid and flexible tools of intuition and empathy. But even a psychiatrist with lots of intuition and empathy can still get it wrong; all humans are fallible.

Though it should be pointed out that there is a type of depression called dysthymia which sufferers often do not know they have. They don't understand that they are actually depressed. So sometimes you do get a situation where the patient does not know they are depressed, but the psychiatrist identifies it.

So, by this logic, do you agree with Wessely, Sharpe and White that ME/CFS is a psychological condition?

No, this is precisely what I was trying to say, and precisely why I think Wessely and Co arrived at their erroneous theory that ME/CFS is psychologically-caused.

The hackneyed phrase goes: if you only have a hammer, everything looks like a nail. Since the skillset of Wessely and Co only gives them the tools to work at the level of mind (at the psychological level), then every symptom they see — even physical symptoms — they try to explain in psychological terms.

Whereas if they had a skillset that also allowed them to work at level of body and brain, such as an in-depth understanding of immunology or neurochemistry, then they might have looked at ME/CFS very differently.



But I have to bow out of this conversation, so I will not say anymore.

 

[large donner]

Though it should be pointed out that there is a type of depression called dysthymia which sufferers often do not know they have. They don't understand that they are actually depressed. So sometimes you do get a situation where the patient does not know they are depressed, but the psychiatrist identifies it.

Ah well that sounds rock solid objectivity then.

How do you square such subjective psychiatric pontification with your other statement here ...

Hip said: ↑
Well, I guess it is possible your psychiatrist may not have been the best in his profession........ Misdiagnosis happens all the time.

.....when "dysthymia" requires by its own definition that the patient must not be experiencing the symptoms in order to receive the "diagnosis".

If the patient is experiencing the symptoms and the psychiatrist claims he is not experiencing them but still diagnosis dysthymia would that be a misdiagnosis or would it be a correct diagnosis because the psychiatrist said so?

Or could it be possible that psychiatry needs to take a good look at itself and challenge its own claims instead of just inventing terms and drawing up catch all subjective criteria based on a show of hands and zero objectivity.

 

[Invisible Woman]

I'm sorry @Hip, but reading through it does rather seem as if you're trying to play both ends against the middle. It seems very unclear to me.

But I have to bow out of this conversation, so I will not say anymore.

In that case I will leave it there. I'm not going to spend further energy on it if the conversation is closed.