BPS/Psychosomatic Theories and Sexism, discussion thread

I realised there wasn’t a specific thread for the link between BPS/psychosomatics and sexism. So I’ve created one.

The thing that prompted me to create this thread, was that I was looking at a review of “CBT for Cancer”, and noticed that CBT is very outproportionally studied in breast cancer (which primarily affects women) compared to other cancers.

It seems women’s illness automatically comes with the assumption of “mental fragility” hence increased funding for mental interventions. Seems questionable to me.

source: The efficacy of cognitive behavioral therapy for cancer: A scientometric analysis, 2022

 

See also thread Functional Neurological Disorder is a Feminist Issue (2023)

 

I didn’t venture far into that thread but Chadler being an author made me very skeptical.

 

There exists a strong link between the bps/psychosomatic movement and sexism/misogyny.


It’s a bird flight view (I still have a lot to look at, for me this stuff is contextual to my main focus atm), but I think that in essence this is the gyst:

Spoiler: Elaboration/mini lecture

The ultimate goal of the American psychosomatic movement (which todays movement is an offspring of) is to Make Medicine Great Again by making it adhere to psychosomatic doctrine: every illness is in essence psychosomatic. Medicine has lost its way by centering the field around pathology and germ theory, around physics, chemistry and mechanics - or so the story goes - and makes a mistake if it does not accept and incorporate the superior insight and ancient wisdom of psychosomatic believers that psyche played an equal and (if allowed) even dominant role in the development and course of disease. The believers in the psychosomatic movement envisioned “a revival of old prescientific views in a new and scientific form”.

It emerged from a mixture of religion and Freudian beliefs in the early 20th century, and had its first peak in the 1930s and 40s. The American psychosomatic movement of the 1930s and 1940s seem, in theory an on paper at least, surprisingly unisex. (They’d of course have to be if they wanted to reshape the whole of medicine according to their beliefs.)
However, because it was heavily influenced by Freudian ideas, views based on misogyny had a place within it. For example, the term “somatization”, emotions “expressing themselves” through physical symptoms, was created by a Freudian fanboy in the early 20th century. The case he describes that he applied his new term to is grossly creepy and misogynistic, but in essence what he is describing is conversion hysteria: the woman has physical problems because she deeply desired oral sex while denying it herself, and had throat problems because she actually wanted to strangle her husband. “Somatization” found its way into the official lexicon of psychiatry via the psychosomatic movement: when it was at its peak in the 1940s, during WWII, a high-ranking US military psychiatrist, who was part of the psychosomatic movement, used the term to replace the word “psychoneurosis” to describe soldiers with what we'd now call PTSD (with possibly soldiers with chemical poisoning mixed in as well), and it was his psychiatric classification list, published in the Technical Bulletin of the US Army, which was then subsequently used to create the first DSM.* Here we have an excellent example of how disablism that was misogynistic in shape and origin is subsequently used on men as well.

The second layer of misogyny was added when the psychosomatic movement, that often had psychiatrists as its most vocal believers, actively crowbarred itself into UK medicine in the 1980s & 1990s, because they used psychiatry and the psychiatric framework as their entry point. And psychiatry itself already had, and continued, a long and dirty history of serving white patriarchy via giving its views justification by the pseudo-scientific framing of misogynistic, racist, disablist and homophobic views as authoritative.
The further misogynistifying of the psychosomatic narrative went two-fold:

Firstly via claiming undetected mass neurosis and using psychiatric terms and classifications that already chiefly targeted women (hysteria, somatization disorder, somatoform disorder (=hysteria)) to describe it.
The neo-psychosomatic movement uses typical misogynistic views, disguised under professional-sounding psychiatric terminology and claims, to uphold the framework of conditions like ME/CFS as in-essence-a-psychiatric-issue, neuroticism: functional disorder, central sensitivity, subjective perception, somatization, conversion, catastrophizing, secondary gains, care-seeking - a whole gamut of terms is set up to catch the patient in what boils down to a typical, traditional misogynistic caricature: as an unreliable narrator, mistaken on their own body, oversensitive, emotional and irrational, overreacting, exaggerating, seeking personal gain (usually money), attention seeking, manipulative.
(Try openly holding your rapist to account, you’ll get the same things hurled at you.) These were already present in hysteria writings and were further built upon.

Psychosomatic believers also continue to seek the same solution that was already standard in the unfine patriarchal and psychiatric tradition of painting women seeking medical help as poorly misguided and in need of someone setting them straight.

“Her symptoms bring her rest-pauses in her struggles and are cries for help, not pathological indicators. Sympathy, encouragement, practical suggestions from an effective husband-father figure help her where biochemistry fails.”



Secondly indeed, like Yann04 observed, when the neo-psychosomatic movement became established, the targeted conditions of this “revival of old prescientific views in a new and scientific form” were often female coded and/or as yet not well understood (which are usually also conditions seen most in women): ME/CFS, abdominal gynaecological pain (not a peep on endo of course), PMS, fibromyalgia, IBS, etc… And indeed breast cancer. (The idea then was that psychotherapy would increase survival rate of women with breast cancer, as it was theorized to depend on “psychological coping style”. In the 1980s there was excitement in the UK among the psychosomatic movement because a couple of publications on cancer seemed to confirm exactly what the psychosomatic movement was claiming from its onset: that psyche was the determining factor in the creation and course of illness. If you want to know more on this topic, I can heartily recommend the “Dark psychosomatic history” series by ME/CFS Skeptic; it also has a section on cancer, part 1 can be found here.)

Women were of course easy targets because medical misogyny was still accepted within medicine so it had a lower treshold for being believed, especially as in the 80s medicine was still heavily male-dominated and the notion of hysteria not quite dead yet; Because of the strides medical science was making in the second half of the 20th century, women as a group were only just getting out of the centuries-old habit of getting their health problems parked under “hysteric” when the male doctor could not figure out what was wrong, but old prejudices die hard. The psychosomatic movement balled as much of these conditions as possible together, declared them a neurosis with no actual “there” there wherever they could, and claimed them as their territory, a springboard to expand on.
Fanning the flames of existing prejudice while also producing publications claiming that psychiatric intervention was effective has proved to be very fruitful in practise.
(Sidenote that extends on this: the psychosomatic believers also regularly use being the victim of sexual assault or child abuse against a sick person as proof of their ideology, and, again, to be a victim of adult sexual assault is a situation most common to women.)

Today most fans of the psychosomatic doctrine would loudly claim they are not misogynistic at all (of course even if they were). I have no trouble believing that many honestly think this of themselves, as they apply their views on all genders and can be unaware of their history. And if I look at e.g. Rosmalen, current vice-president of Europe’s chief organization to promote the insertion and acceptance of psychosomatic dogma into medicine, she appears to be aiming for the unisex end goal of the movement, if I go by this study (although note how she and her friends highlight MS, which is dominated by female sufferers, to say that “there is evidence from research in patients with MS that there is a link between neuroticism and fatigue” – that bridge needs to be made and lifting along on existing prejudice against women makes it easier!) But the psychosomatic movement can easily be a playground for people who do actively harbour misogynist views on illness because it is woven through it and accepted within its doctrine.

The thing is that whether the psychosomatic views are followed because of misogyny or because a belief in a doctrine that was built on misogyny, the end result is the same: because the present day psychosomatic movement uses a framework and terminology stemming from psychiatric misogyny AND because it focuses on conditions that still need to be understood better (although one could certainly argue that this angle is a ruse in itself) which have a majority of female sufferers, you naturally end up with promoting medical misogyny and a majority of victims of it that is female.
(I don’t have UK numbers, but in The Netherlands 80% of people who got a SOLK (=MUS) label attached to them are women.**)

** I know I have the source saved on my phone but I can’t find it atm, very annoying.

So in short: the goal of the psychosomatic movement, to Make Medicine Great Again by making it accept and adopt psychosomatic doctrine, is unisex; the tools used to achieve that end, to gradually move the medical Overton window into accepting psychosomatic doctrine, are based on misogyny and are still expanded on today. Psychiatry was used as an entry point into medicine and due to the psychiatric framework and terminology and the targets most often used to make the psychosomatic paradigm shift happen, you end up with an amplification of medical misogyny whenever you enter an area psychosomatic believers try to claim.

 

if you click on the 'sexism' tag there are a lot of threads on this issue.

 

Fascinating thank you!

 

Yes fantastic read. Took me two or three goes with the brain fog but I really learnt a lot.

 

Yes it chimed with a lot of half-baked ideas I had, but hadn’t been able to think through, let alone read up on.
Good to know my paternalism antenna is working as it should.

 

Thank you for your compliments @Yann04 and @MrMagoo, it's much appreciated to hear.

Very nice in general, and extra so because I can at times be plagued by typical writing bugbears, especially because I do it so slowly and isolated. (I can at times feel so stupid for devoting the limited and precious energytime that I have, sacrificing my health in the process, to digging around in these topics, especially when I get hit by imposter syndrome and convince myself that no one will read it anyway.)

That might also have been exacerbated because of my writing style, so I'm sorry if I added to mush brain. (I know I have a tendency for too long or oddly built sentences because I try to cram in a lot of information in in one go and because of having cognitive dysfunction myself. I'm working on improving my writing clarity, but it's a work in progress.)

Also a special thanks to you for raising the topic. I just spent the last weeks looking at some old material from the psychosomatic movement; Earlier I had been writing and collecting about misogyny within psychiatry and the psychosomatic takeover. I saw your post and the answer sort of clicked into place and rolled out the next morning when in bed pondering it. So it was helpful in organizing my mind on this topic. After writing it down, I decided to post it here as well.

 

Btw, I had just looked at a 1980s psychosomatic conference where at least four of the talks were about the psychological influence (like suppressed anger, "fighting spirit", "emotional control") on the onset and survival rates of breast cancer.

Breast cancer is not just a common cancer but also easier to spin a psychosomatic narrative around because its patients are mostly women. (And I'd say that if you can get that established as acceptable then you can branch out.)

Just in the last couple of days major news outlets reported on the link of (breast) cancer to chemicals:

More than 400 chemicals in plastic products linked to breast cancer – study | Plastics | The Guardian
Formaldehyde Increases Your Cancer Risk No Matter Where you Live — ProPublica

In this light it sits uncomfortable with me that the 1980 conference was sponsored by CIBA-Geigy (a large Swiss chemical company) and the CIBA Foundation. The CIBA Foundation sponsored a lot of biomedical research, but also psychosomatic views. Its deputy director in 1980 was until at least 1974 (and quite possibly after) also a member of the council of the Society for Psychosomatic Research (she combined those posts earlier).

Anyway, just some loose threads which I will not be pulling on further for now. But supporting the neo-psychosomatic movement (and with it encouraging its mysogynistic and disablist framework in health care) might be very welcome to parties that can use a psychosomatic view of certain illnesses for their own benefit. (Think Eysenck and his claims of "cancer-prone personality" while he was being supported by the tobacco industry.)

 

I found this particularly interesting. And this led me to wonder if there was any link between psychosomatics and eugenics/facism.

The reality seems to be really complicated. Here’s my “mini lecture”/ notes I took. Please note these are my notes and sometimes my theories, don’t take unsourced statements from the second section as fact.

Spoiler

The link between psychosomatics, fascism, and eugenics


Intellectual Influences of 20th century Psychosomatics

While Freudian theories were central to the establishment of psychosomatics, in that their extension from only behaviour and thoughts onto the “soma” (body) were crucial, the influences of psychosomatics lie majoritarily outside of science or medicine.


Flanders Dunbar, sometimes referred to as the “mother” of the 20th century psychosomatics, was deeply influenced by her personal experience with illness and religion. She suffered from a young age with what was diagnosed as rachidic pseudo-paralysis, although she claimed later on in life it had been polio. She visited shrines to learn about how people used the mind to heal disease. She remarked that those that came in “hysterical” states to the shrines did not tend to have their improve, but those that had “deep confidence” in the healing power of shrines did.


She was educated in, among other places, clinical pastoral schools such as the Union Theological Seminary where her mentor was Anton Boisen, co-founder of the Clinical Pastoral Education movement. She believed in the power of “symbols” in medicine, such as religion. She eventually created the laws she called “emotional thermodynamics,” which were:

1. Psychological energy seeks an outlet through physical symptoms when it is not expressed mentally.

2. Permanent faults in personality can lead to disruption of energy and “somatic dysfunction.”

Her research commonly showed correlation but failed to prove causation. She believed psychosomatics would be valuable in all facets of medicine, for example by sketching out a “cardiac type of personality,” which was thought to lead to cardiac problems. She viewed personality defects as leading to specific organic illnesses, which was related to the overstimulation of the ANS and endocrine glands related to too much mental energy (it is worth noting this physical model does not hold with current evidence from neurology and endocrinology).


She founded the American Society of Psychosomatics in 1942 and was the first editor of the “Psychosomatic Journal of Medicine” founded in 1939.


Franz Alexander, sometimes called the father of psychosomatics, had similar beliefs. He viewed organic illness through psychoanalysis, forming a theory of “organ specificity,” where specific psychological stressors evoke specific organic damage to different organs. This was based on studying, among others, peptic ulcers and rheumatoid arthritis (we now know peptic ulcers are caused by bacterial infection).


The popularity did not immediately wane post-World War II

Eventually, in the 1950s, the first edition of the DSM (sometimes referred to as the “bible of psychiatry”) contained illnesses under the concept of psychosomatic. This included illnesses like ulcerative colitis and hyperthyroidism. Conversion disorders, however, maintained a specific category to themselves, because they weren’t seen as changing the biological reality of the body, like these psychosomatic illnesses, but only the functional reality of how the body “acts.”


To read more, see Psychosomatic Medicine: A Brief History by Martin (1978):

https://www.sciencedirect.com/science/article/pii/S0033318278709114?ref=cra_js_challenge&fr=RR-1


The takeaway from all this that is relevant to the next section is that 20th-century psychosomatics has pseudoscientific roots, and it seeks not just to explain a few select illnesses as mind-body, but large swaths, and if allowed, the entirety of medicine. Echoes of this can be seen in the 1980s, for example, where cognitive-behavioural therapy was increasingly thought to improve breast cancer outcomes.

Eugenics, Fascism, and Psychosomatics

The eugenics movement was strongly based on genetic determinism, to the point that they saw both biological realities and sociopsychological realities as being caused by genetic factors. They framed criminality, poverty, illness, “deviant states” (queerness), as being caused by hereditary factors.


Many chronic illnesses didn’t fit well into that paradigm. How could someone born perfectly healthy all of a sudden develop a vague and persistent state of disease, especially if that disease doesn’t follow obvious hereditary patterns? The psychosomatic movement offered a simplistic (and therefore “elegant”) solution to the disconnect between many chronic illnesses and eugenic theories.


Explaining chronic illness as a manifestation of personality and behaviours (which they saw as intimately linked with moral failures) meant it could be written off as resulting from defective genetics, which are assumed by eugenics to be the cause of personality and behaviours. Therefore, this state of being “hereditary by proxy” allowed eugenic rationalisation of sterilisations, euthanasia, and general mistreatment of chronically ill people. The reasoning went, just as it did for race-based and sexuality-based eugenics: if they are genetically inferior, it isn’t prejudiced to treat them as societally inferior; in fact, it’s perfectly natural.


Hence, we saw a substantial rise in the psychosomatic movement and psychosomatic medicine in the 30s and 40s. This was coupled with the financial difficulties following the Great Depression, demanding cost-effective medicine, which psychosomatic “rehabilitation” also offered a solution to.

In the United States, psychosomatics manifested through the classification of chronically ill individuals as “feebleminded.” These people were then affected by eugenicist laws, leading to consequences like forced sterilisation (US Gov Fact Sheet), which went on until at least the 1970s.


In Nazi Germany, this concept of “feeblemindedness” (Schwachsinn) was the primary label approved for forced sterilisation (Jewish Virtual Library). This broadly included illnesses that were judged by medical professionals to involve “insanity” or “weakness,” from schizophrenic presentations to cerebral palsy, deafness, and blindness. Thus, psychosomatic explanations for chronic illnesses with “somatic” symptoms helped cement them as part of the broader concept of “feeblemindedness.”

These programmes led more than 400,000 people to be forcefully sterilised (Proctor 1988 p.137) and over 200,000 to be murdered (Yad Vashem Shoah Resource Center 2017). Despite the killings operating more on a de facto than de jure basis, the decisions were highly formalised. The verdict on whether an individual’s life was “dignified,” and thus worth living, was based on a three-person panel of a psychiatrist, doctor, and judge. A negative verdict led to execution (often described as “forced euthanasia”) (Proctor 1988 p.558).


In Greece, eugenics was not implemented as overtly (after all, Greek people were seen as “inferior” according to Northern European and American eugenist movements). However, the regime of Greek dictator Metaxas (1936–1941) introduced strikingly similar theories. These theories focused less on race and more on the “inferiority” of deviants, chronically ill, queer, intersex people, etc.


Importantly, psychosomatic theories were central to the rationalisation of the inferiority of these “deviants.”

This was not new; the previous Greek social elite and ruling class often presented mental illness as the cause of all social problems, from diseases to poverty (Kouroutzas and Tzanaki). What was new was the scale and centrality of these ideas within their political theories and their use to rationalise oppression carried out by Metaxas’ fascistoid regime.

In the sense that psychiatric traits (caused by unchangeable genetics) are the core basis of every facet of suffering and oppression, psychoabsolutism—a radical form of psychosomatics and psychological determinism paired with eugenics—was central to the fascistoid worldview.

Metaxas (who was anti-communist) said:

Conclusion

While the roots of 20th-century psychosomatics lie more in religious and Freudian influences, fascist and eugenicist use of psychosomatics may have led to a large increase in popularity. Further exploring how this has affected modern psychosomatics is crucial.

References

Brown, T. (2023, August 23). Thirty Years of American Psychosomatic Medicine, 1917–1947. Oxford Research Encyclopedia of Psychology. Retrieved 21 Dec. 2024, from https://oxfordre.com/psychology/vie...0236557.001.0001/acrefore-9780190236557-e-641.


Jewish Virtual Library https://www.jewishvirtuallibrary.org/nazi-persecution-of-the-mentally-and-physically-disabled


Proctor, Robert (1988). Racial Hygiene: Medicine Under the Nazis. Harvard University Press. ISBN 978-0674745780. “Racial Hygiene: Medicine under the Nazis.”


Kouroutzas and Tzanaki, ‘[The work of Konstantinos Gardikas and his biomedical conceptualizations],’ 25–40.


Torrey et Yolken 2011 "Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia". Schizophrenia Bulletin. 36 (1): 26–32. doi:10.1093/schbul/sbp097. ISSN 0586-7614. PMC 2800142. PMID 19759092.


Tzanaki, D. (2022). Libido, Psychic Eugenics and Abnormality: Patriarchal Biomedical Rule and Metaxas’s Fascistoid Regime (1936–1941). Fascism, 11(2), 291-314. https://doi.org/10.1163/22116257-bja10044


US Gov Fact Sheet https://www.genome.gov/about-genomics/fact-sheets/Eugenics-and-Scientific-Racism?utm_source=


yadvashem shoah resource center 2017 https://www.yadvashem.org/odot_pdf/Microsoft Word - 6303.pdf

 

Fascinating. I’d like to think also about the intersection with capitalism but my brain isn’t playing.

 

@Yann04
Love that you dove into it, I'll read it soon with more attention, as I'm very interested. (Been digging into books on, and old publications of, the eugenics movement, but it's ben a while back, always curious to expand knowledge.)

Now running on the fumes of my fumes, so it'll have to wait.

Thanks for posting!

 

What is an Overton window?

 

The window of what is deemed politically acceptable. Anything outside of it is "radical". I guess it works for medicine too.

 

It's indeed a term from politics.

The idea is that your policy suggestions should fall within a "window" range of what is socially accepted to avoid being discarded or the person suggesting them as an extremist or nut job, "...the window frames the range of policies that a politician can recommend without appearing too extreme to gain or keep public office given the climate of public opinion at that time." Overton window - Wikipedia
See the picture from wikipedia attached.

What I mean when I say that the psychosomatic movement is trying to move the medical Overton window, is that it is trying to gradually persuade medicine to accept psychosomatic doctrine as part of it - so that it is no longer seen as unthinkable and radical, but acceptable, sensible, and -if possible- popular and policy. Because of the tools and field the neo-psychosomatic movement used as their entry point, medical misogyny gets amplified and encouraged.