Cartesian dualism in the service of ill health - new step called for
We need to be better at communicating about body and "soul"
Key messages
Although everything that happens in the body is biological, we express ourselves as if bodily and mental processes are separate.
Such dualistic language seems to have implications for how we think about health and the care we provide.
We need a medical language that does not suggest outdated models of the human being. [...]
In some cases, a dualistic approach seems to have had particularly unfortunate consequences. In the 1980s it was claimed that ME (myalgic encephalomyelitis, later ME/chronic fatigue syndrome or ME/CFS) was psychological in nature. This led to strong reactions from some sufferers. In other words, the problem was psychosomatic, functional, somatoform and psychogenic and was therefore only in the head and was one's own fault?
We all recognise these unfortunate notions that separate physical from mental processes. Surely problems with the former should be dealt with by a doctor and the latter by oneself? Understandably, sufferers protested against this devaluation, which perhaps also reduced the chances of funding research into the 'true cause' of the condition.
In the field of ME/CFS, a trench warfare began between individuals who wanted to see an explanation at a primarily biomedical level and others who wanted to involve the brain and behaviour to a greater extent. These conflicts have contributed to the harassment of researchers who ask the question of whether physical exercise or psychological treatment can be useful as an additional treatment [3].
A recent interdisciplinary meeting one of us attended was kept secret for security reasons and had to be guarded by guards. One of the researchers declined an interview because of all the concerns that were expected to follow publication; another attended because the damage activists can inflict "can't get any worse".
The point here is not to take a position on the cause of the condition or how best to treat it, but to point out the negative consequences of maintaining an artificial distinction between models and treatments that are entirely biomedical and those that involve behaviour.
With regard to conditions where severe fatigue is a key symptom, the situation varies markedly between countries, and this affects what is focused on as disease mechanisms. In the UK and Norway, the infection hypothesis (ME/CFS) gets a lot of attention; in Finland, there is a lot of debate about 'sick houses' (chemical sensitivity); in Sweden, the negative consequences of stress, often prolonged work stress (exhaustion disorder), are discussed.
The problems of multifactorial conditions that overlap at the level of symptoms seem to highlight the importance of explanatory models and the consequences for treatment, sick leave and societal interventions - and the individual's hope for recovery [4] - these have. [...]
References
3. Hawkes N. Dangers of research into chronic fatigue syndrome. BMJ. 2011;342:d3780
4. Oslo Chronic Fatigue Consortium; Alme TN, Andreasson A, Asprusten TT, et al. Chronic fatigue syndromes: real illnesses that people can recover from. Scand J Prim Health Care. 2023;41(4):372-6.
