Psychosomatic medicine and the psychologising of physical diseases

Yessica said:
I don't know if that's true. When especially fatigued and having to push to do things, I sometimes stutter and sometimes have tourette like symptoms. The moments this happens are PEM and push related for me.

Also I have a good friend who stutters. he has a neurological condition that affects the way his body moves. His body is jittery. The way i see it happening it seems related to that, than a psychosomatic issue.

I've also noticed it when working in a clinic where some of the patients were or had been heavy drug users. It seemed related to their drug use or possibly changes or damage done to their brain from the heavy use.

Edit:
Some of what I now looked up about stuttering.

https://www.nidcd.nih.gov/health/stuttering





Interesting info on Wiki about it too. I'm too fatigued to quote and don't want to derail.

https://en.wikipedia.org/wiki/Stuttering
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Very early in my disease I had problems with my speech even though I was still able to attend school. It would start with stuttering then stop altogether. There was no psychological input or situation when it happened though nowadays I would call it the first sign of a crash. It never happened at moments of high stress or anxiety.

It felt physical and went hand in hand with a lack of precision of movement.
 
Jonathan Edwards said:
I agree that there are various causes of stuttering. I am referring to the common type that occurs from childhood known as stammering, which can be demonstrated to be due to brain events of the sort we call mind.

Maybe that applies to being tired or having a stroke too. That may not be what is ordinarily thought of as psychosomatic but in technical biological terms maybe it counts. After a stroke the mind does not function properly.
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Many stutterers find that they can speak fluently if they wear headphones giving them delayed auditory feedback.
I don’t know if this works for stuttering post-stroke - but in my experience, stuttering after stroke is easier to treat than developmental stuttering.
I haven’t ever thought of stuttering as psychosomatic. Significant levels of distress can result from it, usually due to the reactions of other people to the stuttering and the pressure to be fluent. Stress/distress then ‘feeds’ the stuttering and the whole thing gets more complex.

I should try to find some research - but I haven’t the energy! My professional understanding, limited though it is, is that stuttering may be due to a problem with feedback loops.... a motor speech control problem - which I’m not sure you would call ‘mind’.
 
Jonathan Edwards said:
the original question is a bit hard to pin down
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Yes, "psychosomatic" is not a clear objective concept. Its waffle. Its a buzzword for many psychiatrists. We need specific treatable mechanisms, not generic and malleable terminology.

Sadly we see such terminology a lot in psychiatry. What the heck is "conversion disorder" in reality? One analogy of what is going on might be that the response to square pegs not fitting into round holes is not just using a hammer, but making the hole larger so almost everything fits. Medical terms need as much precision as we can muster.
 
Daisybell said:
Significant levels of distress can result from it
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This is one of the issues with psychosomatic claims. Distress arising from a physical issue is, classically, psychosomatic. That does not mean that the problem is. The problem causes the emotions, but those emotions are also present in a real physical brain. If some part of the brain is struggling to function then cognitive states might affect their function. This is exacerbation, not causation of the basic problem.

From time to time I keep thinking about changing my signature, getting rid of "psychosomatic" and replacing it with "psychogenic". "Psychogenic" is more specific and the real problem, but its less recognised.

I suspect autism and ME share the same issues with cognitive overload by slightly different mechanisms. If I am right then autism and ME together makes things even harder.
 
There's the example of hives caused by stress. If someone is stressed, then they might develop the itchy rash. Heat or cold or alcohol or some medicine might also cause the rash. Stress causes the rash to happen, so perhaps the rash can be termed psychogenic. However, the level of stress the person is experiencing may not be unusual. While training the person not be to be stressed so often or so badly could conceivably reduce the incidence of the rash, it is normal (and healthy) for humans to be stressed sometimes.

Really, the cause of the rash is not the trigger (the stress, or heat or whatever) if the trigger doesn't result in a rash in most people. Instead, there is some biological mechanism that isn't working normally, maybe an abnormal level of histamine or some other molecule is released. Or maybe the histamine that is released is abnormally effective in causing blood vessels to dilate and leak. Or there's something about the blood vessels that makes them more likely to leak, or less likely to stop leaking, or the leaked fluid doesn't disperse as quickly as normal. ....

I do think that stress can trigger an acute physical response. But that doesn't mean that reducing stress is necessarily the best way to manage the physical response. Sure, if stress is resulting in abuse of alcohol or lack of sleep and that's contributing to the medical condition, then there's work to do on behaviours. And sure, if the person feels that they have a high level of stress and wants to manage it better.

But, it's probably best to find out why normal stress is causing this abnormal reaction in the body. If the problem is something going physiologically wrong, then no amount of cognitive behavioural therapy is going to fix a person living in the real world, where stress happens.

I'm trying to think what point I'm making here.
I think it's that everyone has stress, people living in war zones for example typically have lots of stress. But not everyone has a particular 'psychogenic' condition. A condition that is psychogenic must surely have a biological underpinning - and finding that biological underpinning is what will identify a useful treatment. Not blindly applying a blanket prescription of CBT to tell the person to calm down.
 
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It is worth repeating that it was noticed that eczema and psoriasis are worse at times of stress. This would have led to them being called psychosomatic and treated by CBT but the researchers were biomedical so they investigated further and discovered the interesting fact that stress causes immune cells in the skin to move up a layer closer to the surface and that is what leads to the skin problems. They think it is possibly an evolutionary advantage if the immune cells are primed to fight microbial invasion in case of wounds.

Calling something psychosomatic or psychogenic is not an end point but a beginning.
 
Mithriel said:
It is worth repeating that it was noticed that eczema and psoriasis are worse at times of stress.
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I suffer(ed) from chronic eczema (from a young age, predates other symptoms) and I never noticed any difference with stress (uni exams, relationships etc). The only thing I have consistently noticed is that diet (milk products and nuts) seem to trigger it.

I suspect the narrative (of stress exacerbation) is more common than actual experiences.
 
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Mithriel said:
It is worth repeating that it was noticed that eczema and psoriasis are worse at times of stress. This would have led to them being called psychosomatic and treated by CBT but the researchers were biomedical so they investigated further and discovered the interesting fact that stress causes immune cells in the skin to move up a layer closer to the surface and that is what leads to the skin problems. They think it is possibly an evolutionary advantage if the immune cells are primed to fight microbial invasion in case of wounds.

Calling something psychosomatic or psychogenic is not an end point but a beginning.
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Interestingly I regard my eczema as a symptom of my ME. It did not begin until after the onset of my ME and gets worse when my ME is worse.
 
How would it be possible to show that it was the psychological attributes of stress, rather than any preceding physiological ones, which led to any increase in symptoms? Even if one could show an invariable correlation between "stress" and some symptoms constituting an illness, would that be proof of the existence of psychosomatic illness, and what would that tell us about the way the word "psychosomatic" is used?
 
chrisb said:
How would it be possible to show that it was the psychological attributes of stress, rather than any preceding physiological ones, which led to any increase in symptoms? Even if one could show an invariable correlation between "stress" and some symptoms constituting an illness, would that be proof of the existence of psychosomatic illness, and what would that tell us about the way the word "psychosomatic" is used?
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Robert Dantzer, author of The Psychosomatic Delusion, started his career trying to reduce stress in farm animals, which meant he didn't fall for patient-blaming in humans. He found a long time ago "that immune influences on brain functions were much more potent than brain influences on immunity."
https://faculty.mdanderson.org/profiles/robert_dantzer.html
 
When I was a kid in second grade, I became terrified my parents would die in a car accident or I'd be abandoned some other way. I had stomach aches every morning before going to school. Was that psychosomatic? Was they caused by anxiety and a stress response? Or was it just a normal sensation I paid more attention to? I have no idea. But the stomach aches were very real to me.
 
Isn't there a tautology in "they were real to me"? The sensations were experienced. The sensations were real. In what way could they be unreal? Is that a discussion about "reality" or causation?
 
Mike Dean said:
Robert Dantzer, author of The Psychosomatic Delusion, started his career trying to reduce stress in farm animals, which meant he didn't fall for patient-blaming in humans.
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I have read on another forum about people with pet dogs or pet cats being told by vets that their pet's health problems were psychosomatic. I'm not sure if it was the owner or the pet being blamed for the health problem.
 
Arnie Pye said:
I have read on another forum about people with pet dogs or pet cats being told by vets that their pet's health problems were psychosomatic. I'm not sure if it was the owner or the pet being blamed for the health problem.
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Pets and their owners, eh? Dantzer was definitely researching livestock before moving on to human endocrinology.
 
dave30th said:
When I was a kid in second grade, I became terrified my parents would die in a car accident or I'd be abandoned some other way. I had stomach aches every morning before going to school. Was that psychosomatic? Was they caused by anxiety and a stress response? Or was it just a normal sensation I paid more attention to? I have no idea. But the stomach aches were very real to me.
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I can remember similar reactions to anxiety as a child, and one of my children had similar for a while aged around 7. Of course the symptom was real, but in both my own and my child's case the symptom would wear off once the anxiety eased, either by distracting my mind to something else or the cause of the anxiety going away. It didn't become a chronic illness.

I think burn out could be classed as an illness caused by ongoing stressors usually work related. Again, it goes away after a time once the stressors are removed and the individual has a chance to rest and recuperate.
 
dave30th said:
When I was a kid in second grade, I became terrified my parents would die in a car accident or I'd be abandoned some other way. I had stomach aches every morning before going to school. Was that psychosomatic? Was they caused by anxiety and a stress response? Or was it just a normal sensation I paid more attention to? I have no idea. But the stomach aches were very real to me.
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When I first became ill one of my most troubling symptoms was a sensation of extreme ‘anxiety’ even though nothing had changed in my life nor had reason to be anxious. In an effort to makes sense of this it was like my brain looked for things in my life to explain it. Maybe work stressed me and didn't realize or something else I thought? Tranquilizers, ssri’s, or a change in thinking had no effect. Out of desperation after 8 months or so experiencing this non-stop I fasted. Within 2 days all the things I fretted about and thought to be the cause to the ‘anxiety’ I no longer fretted about and no longer felt the ‘anxiety’. Once I ate again it returned. After months/years of self experimentation I discovered as long as I kept my digestion moving, and stayed clear of sugar, I never felt this sensation of ‘anxiety’. I even had several years where I had things working so well in my gut that even things that should have caused nervousness or anxiety didn’t.

In my case whatever is happening in my digestion produced symptoms of anxiety and incorrect thinking. In your case perhaps the stomach ache and what was going on in there caused the thinking you were experiencing as opposed to the thinking causing the stomach ache.
 
Sarah94 said:
So for example, a character in a TV show has a psychosomatic limp. Is that a real thing?
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I used this example because the first time I ever heard the word 'psychosomatic' was when watching Sherlock (2010) and Sherlock says that Watson's limp is psychosomatic. (Which it then proves to be, because then later in the episode he leaves his cane behind during a chase scene and doesn't limp.) Of course this is all fictional, but I meant like can something like that happen in real life?

Oops I meant this to be a quote-reply to @Jonathan Edwards 's question but quoted the wrong post.
 
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