Sickness behaviour – useful concept or psycho-humbug?

This reminds me of a hypothetical game I played in the early years of ME. On a good day I would be able to walk down to the local shops but it was a struggle. On the way back, as I was nearing the house and barely able to lift my legs, I would ask myself "if there was a lion chasing me, would I be able to sprint for the door?".

 

@Skycloud In my experience ligament damage takes longer to resolve than bone damage, but I haven't noticed any pattern linking the ligament pain with the weather - the ligament ankle pain is more frequent than the ankle bone pain, but rarely do they hurt at the same time. It's not bad pain, just a bit annoying
I'm sure you're right about your dog, I only really know the working dogs round here and not well enough to read their body language. I'm really impressed at how smart the sheepdogs are, I guess if 3 year old kids can sham for attention or to get a treat then a dog can too.

I'm overly cautious when it comes to assuming I know what another person or creature is thinking - mostly because when people tell me what they think I'm thinking they are usually wrong!
And I got it badly wrong with little @Pickle when she had urinary frequency issues at about 6 or 7. The doctor said she'd just got into a bad habit after a urine infection and needed retraining, now we're fairly sure it was part of her ME.
I was raised to believe in psychosomatic theory, it influenced my parenting in ways that I'm uncomfortable with now.

There's a lot of poor health in the maternal side of my family, but everyone seems very quick to label one another a hypochondriac rather than accept that there is something not right genetically. To accept the ill health is seen as giving in.

 

I often wonder if concealing illness (placebo effect?) is perhaps a way of ensuring that the carers in a tribe situation still will think it worthwhile to continue caring for you. Show some progress or "improvement" (no matter how small or imaginary) and there is still hope you will continue the trend of recovery. Declare decline, or lack of improvement and you might be regarded as a lost cause. Historically/evolutionarily, I am sure there were times when care might have been withdrawn when all hope seemed lost. Allowing nature to take its course was perhaps both seen as a kindness to the individual, and a protection against using up valuable resources on no return.

Modern civilisation might deny this was ever a case, but I suspect much of our prehistoric existence programmed our brains this way.

It might also explain why friends/relatives are so reluctant to allow any talk of declining health, always trying to steer you to pointing out some way in which you have actually improved?

 

YES! Looks like you got there before me (I didn't read the whole thread before responding. )

 

You put it better than me @Keela Too
I lost a friend when I relapsed after brief phase of partial remission, she'd been with me during results from MRIs that concluded I had numerous lesions but not enough for MS. Therefore relapse had to be my fault somehow.
Until the relapse she'd been a great support, she was offering to be my carer if I needed one.

The psychobabble sickness behaviour theory is just what people choose to believe because it's more comfortable than accepting an uncomfortable truth and confronting the consequences.

 

Up until fairly recently chronic illness probably didn't exist, if you couldn't walk/keep up you probably stood a good chance of being eaten - hopefully with the positive consequence of passing on the lurgi to whatever ate you, thus reducing the predation of your group.

Therefore, unlike with transient illness/injuries, there may have been no need to evolve instincts with regards to chronic illness, and TBH anyone who did would probably be left with the chronically ill, be eaten, and used as an example to children as to why such behaviour was undesirable

Probably hogwash - but comforting hogwash, as it means it's not their fault.

 

Isn't that stress hormones that make that possible?

 

I blame propaganda.

In the medieval period the peasants weren't allowed to get sick ...medical care was only for a small selection of the rich and powerful...so most people worked hard then you died if you got sick

In the industrial revolution, industrialists started recognising the benefits of some sort of healthcare for "the workers" but this was limited and definitely an investment that had a finite cost vs benefit.

In the 20th century wars we had the biggest amount of propaganda and "war time spirit" self sacrifice being organised by government.

After the war we had the NHS or other healthcare models which really only sorted itself out by the early sixties.

So within our lifetime there are a lot of people who have been brainwashed into this sort of thinking.

It's been in the interest of leaders/those in power to inforce a "stiff upper lip" approach to being ill. It's miles cheaper.

Not much different from the "austerity measures" being touted around today.

 

Limping dogs is classic. I have seen it in horses too.

When I look they limp. When I do not look they move normal. When I look they start limping again. When they are suprised by my looking, many times they started limping with the wrong leg.

 

It seems to be becoming clear that the term "illness behaviour" is strongly associated with ideas of symptoms feigned to obtain secondary gain, whether or not that is the intention, or, indeed motivation, of proponents of the concept.

 

The important question about sickness behavior is not whether it exists or not (there is no doubt that it does occur — just ask and observe anyone with the flu).

The important question is whether sickness behavior occurs in ME/CFS, and thus might explain some of the symptoms of ME/CFS. Sickness behavior symptoms include fatigue, brain fog (cognitive impairment), malaise (flu-like feeling), decreased social interaction, etc.


In the general context (outside of ME/CFS), sickness behavior is the theory is that the behaviors triggered in animals (including humans) during illnesses such as infection are purposely designed (by evolution) to help the animal recover from the illness — by for example conserving energy so that the immune system can fight the infection. It is possible that the presumed in-built repertoire of automatic behaviors and responses found in sickness behavior may also be a means to help prevent spread of an infection to other animals in the pack, since sickness behavior involves animals lying low for a while, during the time they are ill, with a decreased desire for social interaction — a behavioral response which will certainly help prevent the spread of the infection.

As an area of study, sickness behavior would probably come under evolutionary psychology — the study of how animal behavior is shaped by the same evolutionary forces that also shape biology and the physical body.

Personally, though, I wonder how much of sickness behavior is purposely designed by evolution, and how much of it just occurs by accident. For example, if you feel fatigue during an infectious illness, is that fatigue feeling purposely triggered by an in-built response to illness designed by evolution, or does the fatigue arise just incidentally, simply because you are drained of energy through fighting an infection? Hard to say, but in any case, the fatigue is definitely present during an infectious illness. But that is a digression; let's get back to the question of whether the symptoms of ME/CFS might in part be caused by sickness behavior.



For me, one piece of evidence that sickness behavior might be involved in ME/CFS comes from the fact that ME/CFS symptoms like fatigue and brain fog are often made worse by Th2 to Th1 immunomodulators such as oxymatrine or inosine. We know that sickness behavior arises when the body fights infections, and with these immunomodulators, you are ramping up the antiviral immune fight against viral infection, making the battle against the virus more fierce. In making the fight against the viral infection more intense in this way, you would expect an increase in sickness behavior symptoms, because sickness behavior is triggered by the cytokines released during the fight against infections.

So the fact that immunomodulators often increase ME/CFS symptoms is perhaps suggestive that those symptoms might be caused (at least in part) by sickness behavior.



On the other side of the coin, if we assume ME/CFS symptoms are not caused by sickness behavior, but are instead caused by weakness in energy metabolism, as several studies suggest, you would not necessarily expect that the increased immune response ferocity produced by immunomodulators would worsen this energy metabolism dysfunction (although having said that, I can think of one way in which it might).

Thus the increase of ME/CFS symptoms caused by immunomodulators does not fit in that well with the energy metabolism impairment model of ME/CFS; rather this evidence from immunomodulators to me tends to suggest that sickness behavior might be involved in ME/CFS, even if there are might also be other factors simultaneously prevent in this disease such as energy metabolism dysfunction.

But I am not presenting this as a strong argument for the existence of sickness behavior in ME/CFS, because it's not. It's just suggestive that sickness behavior conceivably might be involved.

 

The concept of sickness behavior is predicated on problems with communication. It is no surprise the idea was promoted by a veterinarian.

In a way, embracing sickness behavior as an approach can be argued to be little more than creating distance between a patient and doctor. As a patient, when sick I have symptoms. I communicate those symptoms to my doctor. If I were regularly unable to communicate, my doctor would have to deduce my symptoms by studying labs and signs.This is what doctoring entails, at least in part. There is no need for looking through a sickness behavior prism to accomplish this.

Moreover, by introducing "behavior" as a variable, we open ourselves up to all sorts of potential nastiness by folks such as the BPS crowd.

 

No, sickness behavior does not cause the symptoms. Symptoms are caused by biological processes . Not by behavior.

 

The immunemodulator I use shifts the response more in the direction of Th1 but it does not worsen the symptoms.

 

I am interested in the idea of sickness behaviour being purposely designed by evolution. It sounds rather teleological to me.

 

erm....evolution doesn't design anything, ever.

I could propose a mechanism that would lead to its evolution, however it'd probably be wrong. It exists, therefore it must have evolved, probably quite early, probably as a result of organisms inadvertently wiping out whatever colony they were in, ones that showed it would reduce this effect, hence more survivors available to breed, hence, after a "while" they become dominant.

Or it could just be an effect of being ill, that as far as evolution is concerned has no negative effect on group survival.

It's been bugging me a lot in the last few years, the approach taken by people these days, ill, don't worry, we have a medicine/product that will keep you going, keep you working, who cares if you make everyone else ill, we have a product to keep them working as well. Bloody stupid IMO.

 

I think you may be misunderstanding what is meant by sickness behavior. The theory of sickness behavior posits that an infectious illness will trigger off certain behaviors, and what we perceive as symptoms (eg fatigue) are actually behavioral responses that, like automatic reflexes, are activated by the infection, and that those behaviors are there for specific purposes.

As mentioned, I question this theory, and wonder whether fatigue may just appear incidentally rather than purposefully; but that's the theory as it stands.

Much of human and animal behavior is automatically kicked off by various factors, even if we like to think that we are completely in control. For example, if you see a member of the opposite sex that you find attractive, that stimulus will tend to trigger various behavioral responses, both in humans and other animals. Millions of years of evolution created those responses.

If you believe that the forces evolution created all forms of life on Earth, which I am sure all of us here do, then by extension, it follows that evolution must have created all the intrinsic behavioral responses (those behaviors which are hardwired into the brain).

The behavior we learn from our environment is different though: if you have learnt to behave in a certain way from your cultural and upbringing experiences, then that's not intrinsic or hardwired, so would not be created by evolution.



But I don't think we need to get hung up on psychology here, as ultimately it is not an issue of psychology.

The basic question I think is whether the symptoms / behaviors / actions or whatever you want to call them that occur during an infectious illness like the flu, and the biological mechanisms that drive them, are the same biological mechanisms that drive some of the symptoms of ME/CFS. In other words, is ME/CFS just like a flu that never goes away?

 

Behaviour doesn't have to be a conscious process. Flinching at a fake punch is behaviour. Shivering when it's cold is behaviour. As far is illness concerned, some conditions may be associated with sickness behaviour, others not.

Sickness behaviour is associated with certain infections, perhaps with some forms of depression, perhaps with some cancers and perhaps with ME. Anyone enduring an illness can communicate their symptoms to their doctor whether experiencing sickness behaviour or not.

Anyone who has had a flu like illness knows what sickness behaviour is. You don't decide to have it. It's just there.

 

I think you are conflating symptoms with behavior. Behavior is observed. Symptoms are experienced. The concept of sickness behavior serves a purpose, certainly, but it can also be dangerous to us by virtue of its nature as a function of observation.

 

Yep.