A Medical Student Curriculum on Functional Medical Disorders 2025 Butt et al

I think the BPS proponents would say that the disease concept is basically one of a phobia. The person has ruminated, over-interpreting symptoms common after an illness, creating ruts in their thinking leading to their brain constantly assuming 'I am very sick, I will never get well'. And the responses (e.g. reducing activity in response to fatigue) can produce physical changes that reinforce the person's false beliefs.

That sort of paradigm accepts all flavours of symptoms - functional gastrointestinal disease, functional motor disease, functional fatigue disease.
 
Utsikt said:
Thank you.

So they are psycho or social because they mostly relate the concepts «psycho» and «social»?

Although wouldn’t gambling be a physical disease through addiction mechanisms in the brain? I also think the same could be said for most social media usage, it’s mostly designed to keep our attention through various means like frequent and instant gratification, emotions that makes us react (mostly anger and fear).

It could almost be argued that social media usage is more of a technological disease than a social one.
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IMO this is the only valid application of the vague notions of biopsychosocial. There is a biological element to all of those, but they can be entirely harmless, have zero impact on the individual, without a psychosocial trigger and maintenance mechanism. This actually makes sense.

It's absolutely certain that there is a biological element to people who become addicted to social media, or fall down conspiracy fantasy holes.

But they have absolutely nothing to do with being ill in a way that medicine doesn't understand. This is just the failed "there be dragons" mentality that medicine has forever adopted, and they have co-opted the valid ideas in a biopsychosocial framework to make it seem credible.

Things get complicated when some social factors can worsen illness, such as being in a noisy frenetic environment, but this will generally be true of anyone with a disease rooted entirely in biology. This is largely because medicine has abandoned the concept of convalescence, wants recovery to be an active process, and has refused any accommodations for when this expectation of linear progression towards full health does not work.

In the end the precise definition of the actionable parts of biopsychosocial/psychobehavioral models is one and one thing only: we don't understand why that person is suffering as they do. This is a completely invalid concept category, one that fails not just at basic philosophy, but essentially falls hook, line and sinker for the entire catalog of logical fallacies.
 
Hutan said:
That sort of paradigm accepts all flavours of symptoms - functional gastrointestinal disease, functional motor disease, functional fatigue disease.
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So arrogance disease, ignorance disease, credulous twonk disease can't be functional because the patient isn't even aware they have them, let alone are phobic about them.

Think I'm getting the hang of it now.
 
Jonathan Edwards said:
If there BPS people think the disease is a phobia they should say so. And it wouldn't be BPS!
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That's been the success of the ideology: they never say what they actually mean, because what they mean has no basis in reality. Putting it as some sort of phobias is probably the closest to what they actually mean, but they hem and haw about it because it has zero evidence so they can't really say it out loud.

Exactly the same as someone pushing a horrible political agenda, knowing that saying it out loud would make them unable to ever attain the power to achieve it, because it literally is that. At its core is the fact that millions of people have essentially been cast off as not worthy of any support, which is as disgusting as an overt eugenic agenda. No one can face that truth, so they see nothing wrong because they choose to believe that none of this is happening.

Which all should be easy to counter, but reason doesn't affect beliefs.
 
Jonathan Edwards said:
It strikes me that there is a basic fallacy in the idea of biopsychosocial or functional illnesses that goes something like this:

There cannot be any biopsychosocisl diseases or illnesses. There can only be biopsychodocial circumstances for an individual person's illl health.

This is because the idea of a disease or illness that affects many people is defined only by some common causal step P. P may come about through a range of paths like A>C>F>P or B>C>G>P or many other variants. P may also give tise to a range of effects P>R>V>Y+Z or P>Q>W. But the disease concept is simply the step P.

Someone with TB may have caught it working in a clinic in rural India. But being in rural India is no more TB than it is skin cancer or amoebiasis. TB is just being infected with M. tb. Someone with diabetes may have become overweight working in a cake shop but diabetes is only impaired glucose tolerance.

The point of this is that you cannot invent a disease that has no defined P or even a syndrome with no reason to posit a P. Any biopsychosocial story is not a P so cannot provide a distinct disease concept. It is by definition a mirage.

This educational material is written by people wanting students to take seriously nothing more tha a trick of the light on hot sand - and in this case deliberately induced by the profession to lure unsuspecting travellers.

If there is such a thing as irritable bowel syndrome it is either bio or psycho or social- not all three. And it cannot be defined simply as unexplained because there is no reason to think unexplained illnesses are all the same P.
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Yes I'd like to one day go through a few equations for what they've been trying to do with this biopsychosocial 'lump' because it seems to be being used to undermine two things, not just one. It has been used to remove practical support that used to be a key part of psychology that had a rule of 90% of issues are situational so deal with that first.

The only common part of the equation seems to be:

for reality and common sense to be acknowledged we need a connection between X and Y.

If we refuse to see Y for what it is, and instead suggest 'it can't be X until they have proven it isn't any of A, B,....Z' meanwhile removing anyone who would be able to investigate and confirm the connection between X and Y, then 'it' no longer exists. Instead the person has to prove it isn't the other 24 letter-of-the-alphabet failings

With an attitude of re-education that starts to be reminiscent of the idea poor people just need motivating and more stick, not services that acknowledge how if you get into debt it can be a pretty quick house of cards so need practical help to get control of it, but 'what's wrong with your thinking that you can't be alright like a not poor person isn't'.

I watched a documentary on a court case for something completely different but where people's lives would be wrecked from eg childhood by something that happened and one tactic being used in defence was suggesting the payouts were 'huge'. And was shocked how some who shouldn't have been persuaded by that were, as if it had been generous. But when you imagined a modest earning level across a lifetime were only about that, except in a lump sum.

Then I was reminded how those who aren't victims of somethng and definitely those who are responsible for an action that causes consequences very quickly switches mode into whinging about how they won't swallow that they actually have to pay for the full consequences they caused. It reminded me of the idea that if someone eg was unnecessarily injured and had to abandon a very good career, some who were the cause might indeed like to argue that rather than them being responsible for making up that difference it was down to said victim to 'get used to earning a call centre wage' and 'stop being greedy'. Unless it is them, when they always make sure they get made whole in such disputes.

My point in mentioning it is that what it has become seems to be entirely about muddying of responsibility and legal doubt. Not help. Which fits with the key feature of the model being that proper testing of whether things work or not should no longer happen, ie null hypothesis removed. It's the 'but what if' excuse to throw in something beyond common sense and suggest the common sense outcome can't be proven or proceed and people can't believe their eyes anymore 'because maybe it isn't' etc.

it almost to take it 'ad absurdium' (but you never know given where it is heading) reminds me of the idea of if someone was injured by something that used to be seen as straightforward like a heavy weight fell on your arm that shouldn't have been there, then the person responsible for that situation of said heavy weight can then suggest it would not have been as bad or would have healed better if it weren't for said victim having been x, y, z and needing their mind re-educated.

I've almost come to the belief that it is just a reframing tool used by those disingenuous enough or who prefer to change reality where it suits

and in illnesses is very much behind trapping as many as they can in situations where they are bullied 'because you can't prove it is x' by 'preventing them access to y, that is the only way they can prove it is x'. It doesn't exist because we won't look into it.

Maybe working in that uranium mine for 18hrs a day in the heat wasn't the cause if those people didn't do CBT and they can't prove they were doing their 30mins exercise a day and 5 a day fruit etc.

So what it has become at least certainly isn't actually a medical or science anything, but a convenient trojan horse label for a certain political tool and mechanism to be rolled out across all sorts - but without being honest.
 
rvallee said:
That's been the success of the ideology: they never say what they actually mean, because what they mean has no basis in reality. Putting it as some sort of phobias is probably the closest to what they actually mean, but they hem and haw about it because it has zero evidence so they can't really say it out loud.

Exactly the same as someone pushing a horrible political agenda, knowing that saying it out loud would make them unable to ever attain the power to achieve it, because it literally is that. At its core is the fact that millions of people have essentially been cast off as not worthy of any support, which is as disgusting as an overt eugenic agenda. No one can face that truth, so they see nothing wrong because they choose to believe that none of this is happening.

Which all should be easy to counter, but reason doesn't affect beliefs.
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The 'new' bit of the model is the removal of any interest in cause. Or any specificity, ie a move to genericisation.

Even in psychological or situational scenarios if you can imagine things were starting to roll along the lines of models that could be testable, then leading to more and more narrowed 'definitions' that could then be more testable.

Think for example of the chart where you have all the arrows pointing down going through it like a yes-no flow chart. So even if something like gambling could come in different flavours as what some might have could have a more social dimension, or situational aspect to it vs others having a more 'innate' issue then it could eventually be somewhat mapped as research moved on.

You could take an illness 'concept' that might have been impacted by eg social conditions and then approximately ascertain how significantly x condition leads to y outcome, for example if you thought about some of the old diseases that might relate to vitamin deficincies (and access to them if poor). Or cold damp housing/located in polluted areas for kids with asthma

And then end up with a new issue that was having x illness despite not having had said vitamin deficiency to narrow things down to another concept and then look at the causes perhaps by comparing whether for example there was a north-south divide or big differences related to socioeconomics, and then whether the driver was housing or overwork or other factors.

And if everyone in those situations wasn't getting ill then you could conclude that there might be other factors explaining it - be it genes, sex, or there was something more specific going on that not all those in said situation 'suffered'.

Quite a lot of conditions had got quite far in being understood.

Going by that type of method there would be stats approx showing that for covid those who were in crowded housing and doing manual jobs that they couldn't take time off from when they caught it explained for each of those x amount of differences in outcome.

The psychological factor side of things was always pretty weak tbh. I think in some illnesses they managed a little bit of descriptive research on the 'coping style' between a broad difference of functional vs emotional, by which they meant those who when hit with losing their job went to the pub or watched a film to cope with it first vs those who threw themselves into looking for jobs even though it was a saturday. But its full of assumptions really so not as amenable to proper testing. And there is argument for both because one is keeping the stress low so you seem cool at interview where the other might make you feel like you are solving the problem.

But... I guess it could include psychological situational factors like for example if you had a school using various behavioural pressure techniques to make kids feel they had to perform on an exam. Which could be tested by comparing different schools and eg short and long term exam results and also health outcomes.

And as they tested each then they would be able to actually more accurately layer these things on top of each other, ie it was based on controlling and testing each variable as much as any other part of science would.

Then came along the bps model with a big old circle. Saying 'don't bother finding the cause' and just pointing all the arrows for anything towards these circles, so nothing was ever tested for how much it contributes if anything for anyone.

And of course quite quickly they started subbing in their own narratives for the things that had quite a lot of data and research before, but now got wiped with a reframing of what the condition is - spoonfeeding the therapists ideas like personality instead of for example a model where they could narrow down different 'concepts' by looking at whether certain diets or medications causes improvements or worsening in different 'types' and so on.

The other thing I guess at the centre of it all was the pretence that their methods 'tested the effectiveness of their treatments' like the bps cbt. But not using the actual % effectiveness eg it improves a bit for 22% of people, but using that to suggest in anyone it didn't work for then it was the fault of the patient. When if it was a medication with that % improvement then you'd surely just try a different medication and say that one wasn't the fit for that patient/what they had.
 
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What psychosomatic ideology is becoming is an ideology in the service of inequality.

Its purpose is to justify withdrawal of support for a marginalized group, and it attempts to achieve this by attacking the credibility of that group as testimonials to their own illnss and by claiming that applying disbelief and abandonment to the marginalized group are virtuous, helpful and justified.

The psychosomatic ideology, not through words, but through their actions, also considers it acceptable to lie, mislead, manipulate and does not consider the patients worthy of reliable research methods.
 
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