I need a good summary of the problems with mind-body theory

Saz94

Saz94

Senior Member (Voting Rights)
What's your top article or paper (or even a short book) that you'd send to somebody from a scientific background who is semi-convinced by mind-body theory and you want to explain to them, scientifically, the problems with it? Without sounding like you're being skeptical of the importance of mental health.

So ideally it would summarise:
- no papers have proved the mind body theory
- correlation does not equal causation
- anecdotal experiences are not scientific proof
- and anything else that's important!

This shouldn't be ME-specific. Just to the general concept of chronic illnesses being caused by the mind-body connection.

He doesn't believe they are completely caused by the mind. He just believes that the mind can sometimes be part of it. So, he's not too far gone to convince!

No rush with this but ideally I need it in the next few weeks.
 
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The blogs by @Michiel Tack on illnesses that used to be assumed to be psychosomatic until their biology was understood might be helpful.
Not exactly what you are looking for, but they strongly show that the default position in medicine seems to be "if we haven't worked out what causes this, then it must be psychological".
 
I don't have any recommendations but it really bothers me how many people seem to believe things like this without really questioning it.

People seem particularly ready to simply believe claims about trauma, stress, and anxiety causing illness and needing "CBT". I was just listening to a podcast the other day when a musician I like was talking about this in the context of a vestibular migraine diagnosis. It was from the US (for a change) and I was appalled to hear them talking about how they believed themselves to have been mostly cured with an app that effectively did CBT.

I think the person had a lot of experience with having mental health issues before, so it all sounds somehow plausible and makes the adverse experiences they have experienced in life somehow carry more weight. I got the sense that this is something people are often told by therapists, or by someone similar. It's an orthodoxy. I could not believe what I was hearing about the app. It made me feel even more isolated. Where to begin? It's hard to know where to jump in with "actually there is no evidence that trauma causes neurological issues"; it would seem cruel to even say it to a person who believes themselves to have been affected in such a way by trauma and stress. I feel like people have zero understanding of how harmful all of this has been to so many patients. There is just no awareness at all that people like us exist.
 
I cannot think of any specific documents. It is such a huge question.
But the simple answer is that it is just a theory - based on popular myths given scientific sounding names. We have no means of testing the idea that the mind influences the body beyond what is obvious - we walk to the fridge when we want some milk.
 
I don't know there's such a thing as 'mind-body theory' but I know what you mean. I also struggle to articulate an argument in response to these ideas, I think it's a struggle precisely because the ideas are so vague and generalised. I think it's a philosophical argument more than anything and one that we just don't have the scientific knowledge to fully answer yet (there is no agreement philosophically about what 'the mind' is). I tend not to disagree just to question them further about precisely what claims they are making and how they see these ideas being of practical use. Get them to be specific. If he believes that 'the mind can sometimes be part of it', fine, it's a possibility (as it is a possibility with all illnesses - until we understand the mind more we can't know) but how does he think this is useful? Does he think ME can be cured by behavioural/social/psychological interventions? If yes, what is his evidence? There is no good evidence as far as I'm aware. Tell him that MANY ppl with ME have tried behavioural/psych interventions and not recovered (I think so many people assume that we just haven't tried these approaches). And ask him if he thinks it's okay to give treatments for which there's no evidence. If yes, would he say the same for people with cancer for example? I don't know if that's helpful, there are no easy answers because it's a muddled argument they are putting forth imo!
 
Even if it were the case that physical problems were somehow caused by "the mind", on some reading of what that would mean, it does not follow that this could be healed or treated with psychological etc approaches. This latter step is never even addressed.
 
The mind/ body theories are very hard to refute because they are not specified anywhere I have been able to find. They are just assumed as a given and everything else is theorised on top of this void.

Even trying to write this I keep getting stuck on exactly why they think CBT can help patients.

The papers refuting the PACE trial may be your best bet and the writings of Brian Hughes and David Tuller as they show that the research which is used to exploit the mind body connection a useful concept in medicine actually shows that it is not, unless the research technique is abysmal and null results spun to look positive.

If the mind did have a part to play in illness it is most likely to show up in those diseases with very little easily demonstrated pathology and these are the ones most researched by Biopsychosocial psychologists who believe most strongly in the mind/ body connection. If such a connection existed, the sheer amount of money funding all the papers for the past thirty years should have had at least one showing an unassailable result.

The only connection is the trivial; we can take the tablets, have the operation, keep to the diet.
 
It's more a vague belief than a theory that is specified somewhere.

All the details are vague. If you ask someone to explain how somatization works, you get no good answers. Even the building blocks of a theory are absent.
 
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Here is a paper which examines mind-body theory in relation to medicine. I can't actually recommend it as I have not yet read it - it is on my to-do list.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3115289/
Mind-body Dualism: A critique from a Health Perspective**
Neeta Mehta, PhD.*
Philosophical theory about the nature of human beings has far reaching consequences on our understanding of various issues faced by them. Once taken as self-evident, it becomes the foundation on which knowledge gets built. The cause of concern is that this theoretical framework rarely gets questioned despite its inherent limitations and self-defeating consequences, leading to crisis in the concerned field. The field, which is facing crisis today, is that of medicine, and the paradigmatic stance that is responsible for the crisis is Cartesian dualism—a view that mind and body are essentially separate entities. This paper discusses Cartesian dualism in the context of the practice of medicine. Focusing more closely on how disease, health and treatment are defined through this position, the paper builds up its critique by throwing light on its accomplishments, limitations and self-defeating consequences. The paper also seeks to understand why this dualism is still alive despite its disavowal from philosophers, health practitioners and lay people.
 
Yvonne said:
Here is a paper which examines mind-body theory in relation to medicine. I can't actually recommend it as I have not yet read it - it is on my to-do list.
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I think that article may confuse. It claims that Cartesian Dualism is a terrible misunderstanding and that the mind and body interact. But Cartesian Dualism is the theory that mind and body interact. The psychologists have got this in a complete muddle.
 
I have not read this article.

O’Leary, D. Medicine’s metaphysical morass: how confusion about dualism threatens public health. Synthese (2020). https://doi.org/10.1007/s11229-020-02869-9

Abstract (spacing mine)

What position on dualism does medicine require?

Our understanding of that question has been dictated by holism, as defined by the biopsychosocial model, since the late twentieth century. Unfortunately, holism was characterized at the start with confused definitions of ‘dualism’ and ‘reductionism’, and that problem has led to a deep, unrecognized conceptual split in the medical professions.

Some insist that holism is a nonreductionist approach that aligns with some form of dualism, while others insist it’s a reductionist view that sets out to eradicate dualism. It’s important to consider each version. Nonreductive holism is philosophically consistent and clinically unproblematic. Reductive holism, however, is conceptually incoherent—yet it is the basis for the common idea that the boundary between medical and mental health disorders must be vague.

When we trace that idea through to its implementation in medical practice, we find evidence that it compromises the safety of patient care in the large portion of cases where clinicians grapple with diagnosis at the boundary between psychiatry and medicine.

Having established that medicine must embrace some form of nonreductionism, I argue that Chalmers’ naturalistic dualism is a stronger prima facie candidate than the nonreductive alternatives. Regardless of which form of nonreductionism we prefer, some philosophical corrections are needed to give medicine a safe and coherent foundation.
 
Yvonne said:
Here is a paper which examines mind-body theory in relation to medicine. I can't actually recommend it as I have not yet read it - it is on my to-do list.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3115289/
Mind-body Dualism: A critique from a Health Perspective**
Click to expand...
I'd avoid this one. Here's an quote to show why (my bolding):

As a reaction to the inadequacies of mind and body dualism, several nondualistic philosophical frameworks have been proposed. Still, mind and body dualism persists in the field of medicine. The reasons are multiple: The medical knowledge of the last 300 years is built on the biomedical model. Lot of money, energy, dedication have been invested in this field, which has paid back hugely in terms of technological success. This success has made medicine a very powerful and all encompassing health care field and has reinforced the philosophy that formed the basis of biomedical paradigm (Kriel, 2003). The pharmaceutical companies with their focus on commercial interests have great stakes in the existing medical system. They fund research in a big way but opt for status quo by selectively publishing their findings (Singh and Singh, 2005b) which does not allow new knowledge to surface. Established importance of drugs in the treatment of diseases, drug taking as a norm for any health concern and cultural tendency to expect quick remedies do not allow paradigmatic change to take place in favour of alternative and complementary medicine based on holistic view of human beings. Physicians are neither aware of the philosophical framework within which they operate, nor do they realise the power such model exerts on their thinking and behaviour. It is so because the dominant model is not necessarily made explicit, though the entire sociocultural and educational context of medical education/training reflects the prevailing conceptual model of nature of human beings, health and disease (Kriel, 2003). So strong is the influence of these philosophical frameworks that they act as blinders and human beings who are known as cognitive misers (Taylor, 1981) tend to treat them as facts and whatever does not fit into the paradigm as trivial or even nonsense. Therefore, even when unity of mind and body presents a more realistic picture of the human functioning, physicians rather stick to the familiar dualistic thinking to match that of their mentors and colleagues. Like medical practitioners, patients also perpetuate the mind and body dualism. Being a product of modern dualistic culture, they tend to feel sceptical about nonbiological explanations for their illnesses, as they appear unreal, illegitimate and unscientific in nature (Duncun, 2000).
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It seems to be arguing that we should be more open to non biological explanations for illness, by which I assume they mean things that can't be shown scientifically to be true. That sounds to me like they want people to be open to psychosomatics and quackery.

I'll leave it to someone else to read the O'Leary paper. I don't find the writings of a philospher on medicine particularly useful, and some of her writing on ME has been completely wrong in my view.
 
I think the 'mind-body theory', or psychosomatic medicine is a result of a number of problems including:
  • a natural human inclination to fill gaps in knowledge with whatever comes readily to hand e.g. superstition, and
  • the attractiveness of ideas that make the believer feel that illness is something that either won't happen to them because of their moral superiority; or is something that can be cured, by just thinking right; or that illness can be blamed on someone you don't like (the refrigerator mother, the demanding boss, yourself).
  • poor science that has not refuted the ideas, but instead has often appeared to support them
Brian Hughes' book, Psychology in Crisis is useful on the last issue. The fact that the PACE trial is specifically discussed as an example of the problems is a bonus.

There's a book called the 'The Cure Within: A History of Mind-Body Medicine' by Harrington, discussed here
https://news.harvard.edu/gazette/story/2008/03/sobering-look-at-mind-body-connection/. that looks interesting, and might help to lead someone to being open to the idea that the application of mind-body medicine should be a lot more limited than they thought. Has anyone read it?

Harrington review said:
The story isn’t over, says Harrington. Historically, some of the ideas of mind-body medicine that were once taken for granted have fallen in and out of favor with mainstream medicine. Harrington points out that it was widely accepted by most physicians until at least the 1970s that diseases such as asthma, ulcers, and even cancer could be caused by repressed emotions and/or stress. Today, few people adhere to that idea in its classical form, and yet variants of these ideas persist on the margins of mainstream medicine. If history is any predictor, it is possible that some of these ideas could re-emerge in some new form in the mainstream.

Even within the medical community, Harrington says, people sometimes respond with regret when an idea from mind-body medicine appears to be scientifically disproved. A recent (December 2007) study looking at the effects of positive attitude on the progress of cancer found that it made no difference. The study resulted in expressions of disappointment by some members of the medical community, and the author of the paper expressed that he was sorry to have to report the results.

We want to believe, says Harrington, in the effectiveness of many of these practices, and we’re attracted to their moral and existential power, even when faced with scientific evidence that should perhaps make us more skeptical.
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