Psychosomatic medicine and the psychologising of physical diseases

[Invisible Woman]

I thought it's not that amazingly rare for people to feel faint on hearing news of the surprising death of a loved one, or something similar to that. Isn't that an example of 'psychological factors' affecting health?

Is that not simply shock? Something that can kick in before you even process the news?

My tuppence worth - I was a very young adult and the person closest to me in the world at that time literally dropped dead. Completely unexpectedly.

The first thing I felt was my stomach drop - a horrible, nauseous, heavy feeling. Then after that I thought that there must have been a mistake. I was at my uni and they were in the town near home but not in their home when they died.

So I had the reaction but then spent hours believing it was a mistake until a conversation with someone who was there and saw the body convinced me.

 

[Esther12]

So, Sharpe gets his right of reply but readers have no right to comment? Monbiot's article had comments enabled, Sharpe's article should have the same treatment.

Sharpe's was just a letter though.

But you are conflating. What is 'understanding of the world'. The philosopher of mind Tim Crane has written quite a bit about this but the key thing is that there are two quite different aspects to beliefs and other so-called 'propositional attitudes'. There is a dispositional state that is there even when you are asleep - so when you wake and go to the door hearing a knock you faint on hearing a relative has died before you have even thought about it. Then there are the states of belief that we are aware of - as when we answer 'I believe so, yes'.

Some years back I wrote a paper in Frontiers in Psychology dissecting the various forms of mental representation involved. Any meaningful causal analysis has to separate the various meanings of 'understand' or 'believe' before you can producing anything that has scientific value. Goodexperimental psychologists know all about this and work with it but clinical psychologists by and large have no clue.

Certainly, we faint on hearing that a relative has died. I cried when I heard that my daughter was born by caesarian in the next room. But strangely I felt no equivalent emotion. I was tired and relieved. The journalist I spoke to said that her hair fell out when her mother died despite the fact that she felt no stress, only relief. She suggested that the hair falling out must have meant that really she was stressed. But what could that mean, since 'being stressed' also means the feeling of being stressed that was absent.

In other words, even in familiar experience of major life events what turns out to happen does not even make sense in terms of folk psychology. If the cognition or emotion of being stressed is defined as that which makes one feel stressed then it isn't whatever causes something to happen without that feeling.

Because none of this is testable both the lay community and the clinical psychologists get away with these magic stories about emotions and cognitions. OK, there must be some processes that link up in a fairly predictable way but in fact if I look back over the numerous personal disasters I have suffered the common pattern is that the folk psychological account gets what happens wrong most of the time. And when you start talking about bipolar disorder it goes completely out of the window.

What everyone needs to see and maybe Mr Monbiot is getting taste of, is that Popper was right - right down to the boots. All this stuff about cognitions is bullshit big time. And maybe it is not so surprising that if you work in a speciality that is based entirely on bullshit that you bullshit about your research.

Wouldn't our dispositional states be affected by many of our states of belief? I can see the value of recognising the differences, but to me it also seems likely that these things affect one another and that there are times it will be appropriate to lump them together.

The labelling of different responses as being a result of 'hidden' stress, or something like that, may be problematic but that her hair fell out on hearing of her mothers death is, assuming this was not just a coincidence, surely related to matters that are widely viewed as falling within 'psychology'. Even if we were to assume that almost all psychology is rubbish, through our language there's still a shared understanding of what 'psychology' is intended to be examining and it would include matters relating to this and English words are largely defined by our shared understanding of their meaning. If you're shrinking what is considered as 'psychological' to the point where it doesn't include things like peoples relationships with others, their expectations of how life will continue, etc, then that's an unusual use of 'psychological' that I'd have thought is likely to confuse people.

I don't think this is right, but are you using 'psychological' to mean something that is genuinely understood by psychologists? I'm using it, and I think it's more widely understood as, matters that psychologists are interested in. In that sense, would you agree that health can be affected by psychological factors (even if you don't think that's a useful way of defining 'psychological')?

 

[Barry]

And isn't it still the thought process that would lead to the evolved response? How else would they know that they were about to go into battle? Anxiety can be affected by cognitions and behaviour (though that's certainly not to say that problems are just a result of cognitions and behaviour).

I'm an engineer, and like to understand the component parts of a problem as best I can. So yes, there is an awareness that leads to the evolved response, but that is not the same as saying it directly causes it. There is an indirection, and I think it is important to understand the various links in such chains.

 

[Invisible Woman]

I'm using it, and I think it's more widely understood as, matters that psychologists are interested in.

I am.put in mind of one of Brian Hughes blogs where he talks about people chatting and making judgements based on how people seem to behave and react. The fact that we all do whether it's about politicians, celebrities or the neighbour.

The problem, as he seemed to describe it, is the psychologists blur the lines between this after dinner type chat and the actual practice of psychology.

There had been significant mission creep.

 

[Peter T]

I'm an engineer, and like to understand the component parts of a problem as best I can. So yes, there is an awareness that leads to the evolved response, but that is not the same as saying it directly causes it. There is an indirection, and I think it is important to understand the various links in such chains.

Thank you @Barry for putting this so clearly. I had been struggling to put the idea into words.

What happens psychologically may have implications for physical health but that is not the same as saying it is directly causal of physical health issues. If someone who has a broken leg is also depressed they may not be getting adequate nutrition which impacts on the body’s normal healing process. Here it is not that the mental state directly impacts on the process of physical healing, but rather it impacts on their ability to maintain a situation that promotes optimal healing. However in the broken bone example both the depression and the malnutrition would have to be very extreme to have any impact on the bone healing.

Similarly with the deconditioning model of ME, the miscognitions and the deconditioning would have to be so extreme to have the consequences that the BPS advocates attribute them. When pushed advocates of psychosomatic diagnoses may think they are postulating an indirect or secondary causal chain, but in reality they have so little relevant evidence and the disparity between the postulated causes and effects are so great that I believe they are postulating an influence of cognition on biological processes that amounts to magic.

 

[Jonathan Edwards]

Wouldn't our dispositional states be affected by many of our states of belief? I can see the value of recognising the differences, but to me it also seems likely that these things affect one another and that there are times it will be appropriate to lump them together.

We aren't going to get anywhere with this on a forum list.

Just the bit I have quoted of you above glosses over fundamental conceptual divides that we have all been used to thinking we can just skim over. It doesn't work

The interesting thing is that in other bits of biomedicine, like inflammation, the shift in understanding only occurred in the 1980s. Up until then we were quite happy to accept that inflammation occurred because white cells 'sensed the need to go out into the tissues and made a beeline for the trouble using their pseudopods as feet'. Cells were treated like 'people' as magic packets that knew what they wanted to do and could d'decide to do it'. It was only with gene cloning in the 1980s that we suddenly realised that the whole thing could be described in terms of physical chemistry. There was no need for cells wanting to do anything.

I remember very clearly realising that biology was just physics in 1989. A referee of a recent paper of mine argued that I should not mix biology with physics because they were incommensurable levels of knowledge. That had been true before 1980 but I was able to point out that now all biology is physics.

The psychiatrists have just failed to catch up. And it is not just that they don't have the means to access the physical chemistry for their problems.It is that they still believe in 'mental causation' as different from physics. This is explicit in the BPS approach (mind and body interact) and remains something most people believe. I suspect you believe that somehow beliefs affecting things is not just physics. Maybe not, but this is the problem with journalists - which is what I posted in relation to.

 

[Hoopoe]

The labelling of different responses as being a result of 'hidden' stress, or something like that, may be problematic but that her hair fell out on hearing of her mothers death is, assuming this was not just a coincidence, surely related to matters that are widely viewed as falling within 'psychology'.

Can a psychological therapy stop the hair from falling out? I don't think it could.

 

[Jonathan Edwards]

The labelling of different responses as being a result of 'hidden' stress, or something like that, may be problematic but that her hair fell out on hearing of her mothers death is, assuming this was not just a coincidence, surely related to matters that are widely viewed as falling within 'psychology'.

We have absolutely no reason to think it was other than co-incidence. Credence to things like this is the problem.

 

[FMMM1]

We aren't going to get anywhere with this on a forum list.

Just the bit I have quoted of you above glosses over fundamental conceptual divides that we have all been used to thinking we can just skim over. It doesn't work

The interesting thing is that in other bits of biomedicine, like inflammation, the shift in understanding only occurred in the 1980s. Up until then we were quite happy to accept that inflammation occurred because white cells 'sensed the need to go out into the tissues and made a beeline for the trouble using their pseudopods as feet'. Cells were treated like 'people' as magic packets that knew what they wanted to do and could d'decide to do it'. It was only with gene cloning in the 1980s that we suddenly realised that the whole thing could be described in terms of physical chemistry. There was no need for cells wanting to do anything.

I remember very clearly realising that biology was just physics in 1989. A referee of a recent paper of mine argued that I should not mix biology with physics because they were incommensurable levels of knowledge. That had been true before 1980 but I was able to point out that now all biology is physics.

The psychiatrists have just failed to catch up. And it is not just that they don't have the means to access the physical chemistry for their problems.It is that they still believe in 'mental causation' as different from physics. This is explicit in the BPS approach (mind and body interact) and remains something most people believe. I suspect you believe that somehow beliefs affecting things is not just physics. Maybe not, but this is the problem with journalists - which is what I posted in relation to.

Your comments remind me of a feature on "Trust me I'm a Doctor" or some such - Michael Mosley was one of the presenters. Anyway this Doctor did a feature on autoimmune NMDAR encephalitis [presented much like schizophrenia] i.e. which was treatable by immuno-suppressants. She said that when she studied medicine (she wasn't that old) she was taught that there were physical illnesses and psychiatric illnesses. For her that theory had been entirely blown away by this treatable "psychiatric" disease. I can recall thinking "what a peculiar theory".

 

[Esther12]

We have absolutely no reason to think it was other than co-incidence. Credence to things like this is the problem.

I have no idea about any evidence around hair loss and shock/emotional distress, but as you'd only criticised the attribution to 'stress' I thought it was that labelling that was the problem.

I guess that with claims about emotional responses playing a role in things like this my tendency is to shrug and just say 'I have no idea

I suspect you believe that somehow beliefs affecting things is not just physics. Maybe not, but this is the problem with journalists - which is what I posted in relation to.

No, that's not it. Pure materialist here, though in a lazy and somewhat indifferent way (its implications for things like 'free will' don't trouble me in the way it can some people). It think it is more semantic differences combined with my starting assumption that there's so much we don't understand about the way humans work that it's difficult to rule anything out. Though I'm sure there are lots of specific cases where you do just know more than me, the broad claim that 'psychology' doesn't influence any illness seems too strong to me, or to require 'psychology' to be defined in an unusual way that's likely to confuse people.

 

[Hoopoe]

The narrative of psychosomatic illness may also be a way for some to express how difficult some events and experiences in their life were.

"It was so bad that it caused my thyroid disease".

From this angle psychosomatic illness may be almost exactly how somatization is often described: a way to express emotional suffering via physical symptoms. The small and important difference is that "psychosomatic illness" is just a narrative and not a real thing. The illness is an ordinary one, not caused by emotions, but the narrative wants to make a connection between emotions and illness so that the emotional suffering is better understood and taken more seriously.

In Garner's case the narrative of psychosomatic illness instead serves to express just how manly and fearless he is. "I looked into the barrel of the gun and disarmed it" says it all.

 

[Sly Saint]

In other words: physician/psychiatrist manqué, heal thyself.

‘Alternative facts’: A psychiatrist’s guide to twisted relationships to truth
March 2, 2017
https://theconversation.com/alterna...guide-to-twisted-relationships-to-truth-72469

 

[SNT Gatchaman]

Alternative facts’: A psychiatrist’s guide to twisted relationships to truth"

I've posted a related anecdote in the members-only area.

 

[Mithriel]

I expected him to talk about the medical idea, borrowed from the psychologists, that patients misrepresent their symptoms all the time.

I told a doctor my eyes snap shut and I can't open them and he said they didn't. Where do we go from there? No examination, no further questions, nothing.

 

[DigitalDrifter]

Optic neuritis

There are still some quacks like Suzanne O’Sullivan who claim hysterical blindness is real.

 

[Mithriel]

Now lets take type 2 diabetes, caught in time, how you perceive it and manage it can reverse it. Is it psychosomatic though? No, I don't believe it's generally considered that way these days. Plus, the improvements can only be maintained if you continually alter your diet and lifestyle to stay well.

I've reread this thread and just wanted to say something about this. When I was diagnosed with type 2 diabetes I kept to a very strict diet and took medication from the start. My blood sugar became lower, but it fluctuated wildly. It turns out that your blood sugar rises when you are ill so the effect of my diet on my blood sugar was swamped by my ME.

My physical situation overrules any behavioural effect.

Thoughts are a small component of physical health if they have much of an effect at all.