Mind and Body in the Guardian again

As someone who has done an MA course in philosophy I can say no to that. 'Continental' philosophy, with scare quotes, is defined as a particular stance. It was popular in Germany and France, yes, but so was analytic philosophy in some circles.

 

Pity she had not done some rheumatology. Steroid injections often produce permanent resolution of symptoms probably because they have a potent local shrinking effect on tissue matrix. She probably had a tongue of soft tissue nipped between some bony healing spurs and the steroid shrank it back and stopped the pain - or something along those lines.

 

Got the same impression when looking into psychosomatic theory for other diseases.

It was usually presented as a progressive view and contrasted with genetic determinism. People like Kubler-Ross and Bettelheim believed that patients with schizophrenia/autism had no biological abnormalities (they treat this like an insult) but that they were normal people reacting to an abnormal situation (parents were blamed a lot). In a caring and trusting environment of the psychologist they would be able to be fully cured.

It was often a romantic and hopeful view coupled with the idea that studying these diseases would tell us more about the nature of human kind and society. It wasn't so much about medicine but about psychology and sociology as well. In the early days of CFS, some argued it was a reflection of a neoliberal and individualistic society, like a burnout.

All these view seem to come from the political (center) left and progressive side. It wouldn't surprise me if people like Wessely, Sharpe, Moss-Morris, Chalder, Rosmalen, Wyller mostly have background like this rather than a rightwing view that patients are degenerates or lesser people.

 

They first say dualistic approach is misguided, and then they say everything is dualistic ("everything is physical and psychological"). It sounds more like an attempt to foist psychology into somatic diseases than anything else. The problem is that it takes legit category of functional disorder and extrapolate to all physical disorders without any proof, turning FND science into BPS philosophy in the process.

 

The irony being their research is used to justify exactly those views. Additionally, reinforcing the individualist neoliberal stereotypes that individual action can solve nearly any problem, thus unsolved individual problems are a quasi-moral failure, and since you can do anything if you try hard enough, your worth is measured by your achievements.

 

Is there anythjng legitimate about that category? It seems like a category that takes idiopathic clinical presentations and assumes the problem is behavioural (functional) in nature with little evidence.

Edit: Just to be clear I’m questioning the legitimacy of a clinical categorisation that seems to be synonymous with a psychobehavioural interpretation, not that people have idiopathic illnesses or the reality of their symptoms.

 

A good number of people, some very sensible, regard the traditional core of people labelled with FND as a meaningful clinical coherent grouping of unknown aetiology. There are patients feel this is a helpful category and undoubtedly they experience very significant symptoms.

The problems arise when you introduce an unevidenced psychosomatic or conversion disorder theoretical underpinning, and/or expand the definition to include an ever growing range of diverse symptoms and conditions without any good justification.

It is important to remember there are a core of patients experiencing life impacting symptoms and that we don’t belittle their lived experience even though we are sceptical about the theoretical explanations put out by a growing number of clinicians and researchers. As people with ME we should be sensitive to the experience of having a frequently misdiagnosed and poorly defined syndrome that frequently is high jacked by those who want to promote their own pet theories.

 

I don't think functional necessarily means behavioral. FND is often defined as sensory/motor function problem, and it is science as long as you can diagnose and treat. There are number of legit cases that falls into that category: certain movement disorders like tics or seizure, or sensory disorders like certain loss of vision/hearing. The problem, of course, is when people take unexplained symptoms and write it off as functional without proof or treatment. That's what gives "functional" a bad reputation, imo.

My optometrist once got frustrated when my prescription changed as soon as I put on a pair of glasses. He would measure precisely, get me the correct glasses, and then my corrected vision would be worse than it should be. My eyes automatically adjusted as soon as I put on the glasses making the prescription inaccurate. It wasn't something I was doing consciously. I didn't need perfect vision, so I didn't bother to fix the problem. But I later found that I could see better if I wear my glasses upside down. I'm no expert on FND, but something like that has got to be functional.

 

My dislike for psychological and psychosomatic approaches was the result of its failure to help and the harm it caused.

Claiming that a person has the ability to learn to control their symptoms, without actually knowing whether this is true for an individual, puts patients in danger.

Once my cultural inclination to believe in these ideas was overcome, it became easy to see how unscientific they were. They are often not far from esotericism, medical superstitions, and wishful thinking. The enthusiasm for these ideas is because the thought of being able to understand, of being able to control a terrible situation, of being able to fix everything is too hard to resist. People believe in them because the act of believing feels good.

This sort of idealism gets in the way of dealing with reality. And we need a honest discussion about how the psychosomatic treatments and theories don't reach an adequate quality standard.

 

Here's another news article last week for balance.
Doctors refused to remove young woman's ovarian tumours 'until symptoms got worse' Daily mirror 22 Jan 2025, a 22 year old woman

 

Then what does “functional” mean?

To me calling an illness “functional neurological disorder” is akin to calling it psychobehavioural or stress-mediated neurological disorder.

Just to be clear I’m not questioning whether these cases are legitimate, but whether there is sound evidence to label them as functional.

(Unless proven otherwise, if that is even possible, I assume all cases diagnosed as FND are legitimate physical illnesses)

 

Functional has a bad name because it was devised and is universally used by doctors to mean behavioural/psychological despite the fact that they deny this in writings they know may be read by patients.

Seizures are not classifiable as functional but there are recognisable groups of movement disorders whose origin we do not understand at all (so we don't have a scientific explanation either) that could reasonably be called functional if the term had not been purloined to mean behavioural/ psychological.

 

I meant to say "legit functional cases". Would you call it sound evidence if the problem can be fixed via non-physical means such as CBT or non-somatic modification?

 

I'll have to disagree with "is universally used" if you mean there is no (legit FND cases,) legit diagnosis and legit treatments. Otherwise, it could be a semantic disagreement of what "behavioral/psychological" means that gives rise to the problem.

[edit: I'm striking out "no legit FND cases" since it's clear the OP did not mean that.]

 

I don't understand that sentence. I meant that the term is universally used to imply that the clinical features are due to inappropriate thoughts, secondary gain, so-called conversion disorder or whatever. That is what doctors mean. That has nothing to do with what is actually wrong - which we don't know. And there are no reliably validated treatments as far as I know.

What does 'legit' mean here?

 

The current prime minister in Norway, Jonas Gahr Støre, is from the Labour Party (Arbeiderpartiet). They are a social democratic party at the centre-left. He wrote the foreword to Landmark’s book about LP when he was the health minister. Presumably, they are in the same social circles.

Wyller is from a family of academics and although I can’t find anything in particular regarding his political views, his family has a history with the centre-left as well. The Wyller ancestry is from Germany.

Vegard Wyller’s brother, Torgeir, has long been critical of Evidence Based Medicine (EBM), and they wrote an opinion article where the amongst other things, criticized Archie Cochrane.

Torgeir has also gone out against what he refers to as Evidence-based superstition and Guidline Medicine. It’s about over-activity and over-treatment. Here’s a highlight:

Evidence-based medicine was initially launched as a well-intentioned counterbalance to the pharmaceutical industry's hegemony in the production of knowledge and the emphasis on drug interventions. Unfortunately, the result has been in many ways the opposite (4) .

Producing evidence of such high quality that it is accepted as valid by today's knowledge managers has become so demanding that it is extremely difficult without a financially strong pharmaceutical company behind it. The evidence is therefore built primarily for pharmacological and technological solutions. It is demanding to obtain acceptable evidence for the benefit of more restrained measures, such as observation, de-medication or relying on one's own clinical judgment.
(…)
Many doctors openly state that they do not consider an examination necessary, but that they have requested it “for legal reasons” or to avoid the risk of facing criticism. The health service’s escalating control and reporting regime is causing widespread anxiety, especially among young doctors, about facing sanctions if they have not ensured sufficient diagnostic certainty or implemented necessary treatment. Few seem to be anxious about being criticized for the opposite. A debate is needed on how necessary supervision can be ensured without contributing to escalating medical overactivity.

It seems to me like the familiy is in favour of Eminence based medicine, as opposed to Evidence based medicine.

 

Maybe one of the many reasons why the mind-body dualism never ends is simply because "thinking" feels non-physical, immaterial to healthy people. You don't have to read any of the thousand and one faces of dualistic thought across history to adopt the view, it will come spontaneously, - provided you don't give it much thought.

But an illness like ME hits you in way that makes it impossible not to feel how physical thinking is. How bodily the so-called mind is. It can crash just like the rest of that body. It's all just… one and the same!

 

The problem with mind body is that they take the «thoughs are physical»-paradigm way too far. It’s the age old mind over body spiel that has been around as long as humans have existed. They are currently branding it as something new and groundbreaking, mostly based on pseudo-neuropsychology.

 

It repeats this lie:

"FND is the second most common reason to see a neurologist, after headache."

This has been debunked in the letter I organized to the journal NeuroImage: Clinical (co-signed by Jo, among others):
https://pmc.ncbi.nlm.nih.gov/articles/PMC10864787/

 

The Guardian is a tabloid disguised as a broadsheet. It almost went under before Kath vainer brought it back from the brink with affiliate links and rage-baiting. It trades on its past reputation. It’s closer to the Daily Mail than you would think.