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

Spot on.

[Apologies in advance if this doesn't make sense. I have terrible cognitive issues which affect my ability to think, read and argue coherently. I'm sure someone smarter than me can correct me if I've made any mistakes.]


My view is that the onus isn't on you to disprove the mind-body (ie, psychosomatic causation) hypothesis of chronic illness. It's up to him (and its proponents) to prove it in the first place. The burden of proof should be on those putting forward the hypothesis.

Where is the definitive scientific proof for the hypothesis of psychosomatic causation of illness? There certainly wasn't any scientific evidence offered by those espousing mind-body causes of asthma, autism, epilepsy, ulcers, AIDS etc. Apparently you can make such claims without the need for scientific evidence in many parts of medicine.

There's no evidence to support the hypothesis of psychosomatic illness because it is an untestable and unfalsifiable hypothesis. For this reason, I would argue that psychosomatic medicine is pseudoscience.

 

It's because doctors are taught that ME is a delusion.

 

Exactly. I get particularly hopeless when people start bringing up Descartes, which is irrelevant and used as a frankly asinine but admittedly clever obfuscation by certain sections of practitioners, academics, and commentators. It has nothing to do with medicine, and certainly not with medicine in 2021. It should be an embarrassment.

 

The basis is more general. Doctors are taught there is a type of disease which is not caused by physical damage to the body but by a problem with psychological processes. There are symptoms but thinking is causing them. Change the thinking then the body will be perfectly healthy.

A lot of the antipathy to people with ME is that medics are so convinced this is right but we won't listen. During the FINE trial the nurses spoke about their frustration and anger towards the patients they were trying to help who would not listen and argued all the time.

It is not that they think we are delusional that is the problem, that would be treated compassionately, it is that they have a cure but we won't take our medicine.

The BPS people have gone to great effort to paint people who won't accept their theories as a small group of fanatics, think antimaskers and antivaxxers.

 

Fair enough that many people have been taught wrong information, but it sounds like they were the ones who weren't listening. How far gone to you have to be?

 

This is so important! There are many illnesses in psychiatry where it's a given that the mind is heavily involved and is probably part of what caused the problems in the first place. That doesn't necessarily mean that they respond to psychotherapy. So it's quite the leap the CBT-proponents are making.

 

I understand the point but technically its important to use psychogenic when talking about illness causation. This is only so those who will argue against you have one less ground to do so ... and yes, I realize I do the same thing sometimes, but have not corrected some comments because I have used them for a long time and they have value in keeping the history.

Technically psychosomatic refers to of the mind and body interacting, sometimes referring to aspects of illness. Psychogenic means a psychological cause of symptoms or illness.

A good book on psychogenic illness, though heavy reading in parts, is Angela Kennedy's "Authors of our Own Misfortune". She was an academic sociologist who went into it quite deeply, and we had many long discussions. In discussing Freudian psych issues I recommend "Why Freud was Wrong" (I mainly just read the interesting bits) but there are many other books. Psychosomatic versus psychogenic may alter what is found in searches.

Now this is not mathematically valid but it gives the flavour of the issue. The number of times psychogenic causation has been proven wrong is huge, probably hundreds of diseases, including many cancers and heart disease. The number of times proven right, not just suggested or claimed, is ZERO. Any number divided by zero gives infinity as a result. So its suggested, not proven, that its infinitely more likely that any specific claim to psychogenic disease is wrong. Of course they will argue they were wrong all these many times but this next one might be right. Its not proven wrong. (Yet.) So they are right the next one might be proven right, or some speciific one. It just looks super unlikely.

Unfalsifiable unproven hypotheses are speculation not science. Should we be treating patients based on speculation?

 

Apologies for posting something I'd not yet read - I won't do that again.

 

Thanks for starting this thread @Sarah94, it’s really helpful.

I’m curious to know what people think of this comment a friend made to me in an email exchange:

“So many illnesses have such unknown/complex/multiple physical and mental causes, it’s impossible to unpick them.”

I’m not sure how to respond. Any thoughts?

Also, just to add that I share the concerns about the use of the word ‘complex’ to describe our illness, for reasons that have been discussed elsewhere on the forum, such as here.

 

When I hear this from people I don't personally know I tend to think that they are either trying to be 'nice and neutral' or 'clever and informed'.

When this was said to me directly the relationship did not usually end well in the long run. It was just a sign that people were not prepared to listen or do minimal research. Providing medical info fell on deaf ears mostly, aside very few exceptions.

When you think about it it's a mantra, a clever form of blocking any conversation or personal reflection. Why bother if it's impossible right?

 

My response to that is that it doesn't really mean anything, just as biopsychosocial doesn't really mean anything. The intention is the same I think - to evade.

 

Thank you for your replies. Sorry I didn’t explain the context of my friends comment - we weren’t talking specifically about my ME at the time. It was actually made in response to an exchange we had about about a relative of hers who suffers with anxiety (I’ve no idea what type). I guess the comment is still problematic though, in any context.

 

It may have been well intentioned but it might be more honest to just say 'I don't know'.

 

I agree it is a general wide category of illness as you describe so clearly. That they truly believe in and would likely feel an unpleasant amount of foolishness if they were to allow themselves to realise this is not as sound or solid a theory to base ones professional outlook on as they had supposed.

I do not agree that we would be granted compassionate care if they believed us delusional. A history of the treatment of patients in psychiatric wards says otherwise.

I think too that they absolutely do come to believe we are delusional. As and when it suits their purpose to. They don’t care to be consistent about this. Sometimes we are sometimes we aren’t as is their whim. Somehow this delusion is rarely considered serious enough to warrant expensive treatment. Unless children are involved.. …

 

Do you need to know all the causes and mechanisms behind an illness to treat it effectively, though? From my understanding there are a lot of illnesses that are treated with medication that there are just RCTs showing that it works, without any sound knowledge of the mechanisms behind the effect. Hypotheses maybe, in some cases, but nothing solid. Perhaps trying to understand all the mechanisms behind an illness is a red herring in some instances - at least in short time frame that could be an unrealistic goal?

 

I've participated in an anxiety & depression GWAS study run by Ulster University (Northern Ireland). Obviously that's an attempt to understand underlying (genetic) predisposition ---- and genetic traits that may protect?

So yea anxiety seems to be poorly understood ---- the whole "unknown/complex/multiple physical and mental causes" can be stated because we don't know.

 

JE is correct, that the statement is evasive. But more to the point, explaining the mechanistic relationship between the aspects is the primary purpose of the scientific approach - to deny this is to deny the scientific basis of any illness.