Psychogenic fever: how psychological stress affects body temperature in the clinical population (Oka 2015)

Not brand new, but I just came across it and had to share!!

https://www.tandfonline.com/doi/full/10.1080/23328940.2015.1056907

There was an idea banging about in the 1930s that fever can be "psychogenic" - in women of course - and it seems there are still advocates of this idea today. The author of this 2015 paper laments the fact that some physicians seem to be resistant to the idea:

He notes in this article that virtually all reported cases are females, particularly young females (the author is a Japanese male). And here is some of the evidence he presents. This is a temperature graph of one "obedient and good" schoolgirl (his words). You can see how her temperature goes up when she is at school:



What was the terrible stressor at school that brought on these attacks? We get the idea that they did a lot of questioning to uncover this, and what they came up with was "some classmates teased and bullied a friend who had a physical handicap".

This case report will also make you smile - or cry:

And what account of "psychogenic fever" would be complete without a mention of low grade fever in CFS?

The article goes on to show that the woman's temperature also went up when she was asked to discuss her stressful life. Here is a graph showing how her temp was higher at work, and correlated dwell with her ratings of fatigue:



And the cherry on top: we've got to think of a more palatable name for the poor dears:

 

I think I have a fever from the stress of reading this.

 

Then why do the stressors of a severe flare not give me fever?

I am still waiting for a good fever.

 

I think there are two problems. The first, and largest, is co-opting the literature to promote a strongly personally held view (the author is a specialist in "psychosomatic medicine"). The effect has been a cobbling together of studies, some that have clear alternative explanations (e.g., high activity levels), and others which are foregone conclusions because if you look hard enough, you will always find some "stress" in a person's life which can appear to account for their presenting symptoms.

I can't speak for whether the animal literature is solid or not, but I don't think a single human observation or study cited here provides any evidence to support the author's view. So I'm not holding out a lot of hope for the animal stuff.

The second more specific problem is confusing causation with modulation. The symptoms of lots of diseases can be influenced by emotions, especially ones that dramatically alter the autonomic nervous system (e.g., fear or anxiety). It doesn't mean that the illness was caused by psychological factors and that therapy can cure it. How's that going to go down anyway? Create a stress-free life - or assume the person is kind of messed up about their emotions and needs some sort of correction.

 

The people in the paper do seem to have something wrong with them. The high temperatures are pretty high and are periodic.

 

Is there an experiment that can reliably induce fever through what can be reasonably called psychological stress?

 

From the Annals of Psychological Medicine:

I must write of a most compelling case, brought to my doorstep by my good friend Arbuthnot just this month past. The patient presented with a strange lassitude, malaise and some manner of fever. A thorough investigation with sphygmomanometer and stethoscope, and a letting of blood for the purpose of regarding its colour, revealed no physical dysfunction whatever. Arbuthnot and I were perplexed. But then, possessed of a sudden inspiration, I bade the patient disrobe, whereupon the nature of the disease became clear. “Arbuthnot!" I cried. "I know what ails this creature. It is a female!” The mystery solved, I prescribed a period of confinement, some light housework (to be increased to its proper amount by degrees), and an absolute proscription against engaging in discussion of politics or matters of finance, which I understood the patient to have been lately attempting (quite overwhelming its small female brain). Further, I recommended the patient keep company with gentle ladies for an hour or two each week, and be encouraged to smile more and wear vestments more appropriate to her sex. Arbuthnot reports that the patient has scarcely complained since, and when glimpsed at an attic window was looking “most decorative”.

- Annals of Psychological Medicine, May 2018

 

This was brilliant.

 

My mother's CFS doc in the 1990s (who was firmly in the bio camp) told her to reduce all levels of stress in her life. "So shoot your husband and give up your kids," he added, and they both laughed themselves sick (pun totally intended).

 

PUBLISH. IT.

 

thanks I would tweet it, but as my Twitter account has one follower (an economist — I don't know how that happened) it would be like printing it out and hiding it under a rock.

 

If you tweet, I shall re-tweet.

 

So how do I tweet at you? Do you have a Twitter tag? (I'm a bit rubbish at Twitter).

 

Add @exceedhergrasp1 and I will see it