Comparing labels for persistent physical symptoms: A cross-sectional study among lay participants and healthcare professionals, 2025, Lebrun et al.

[SNT Gatchaman]

Comparing labels for persistent physical symptoms: A cross-sectional study among lay participants and healthcare professionals
Lebrun; Zablith; Stone; Vasilache; Gouraud; Ancellin-Geay; Kachaner; Ranque; Lemogne; Pitron

CONTEXT
Numerous labels are used to describe physical symptoms that remain for at least several months and cause significant distress (i.e., persistent physical symptoms, PPS). This study aims to assess attitudes associated with various labels among lay participants and healthcare professionals.

METHODS
Participants recruited via mailing lists of volunteers completed an online questionnaire assessing their views on underlying physical and mental causations for ten diagnostic labels accounting for PPS. Lay participants rated their feelings of offence associated with each label, and healthcare professionals their willingness to take care of a patient diagnosed with each label. Mixed regression models investigated the factors associated with feelings of offence and willingness to care.

RESULTS
266 lay participants (mean age: 43; 70 % women) and 126 healthcare professionals (mean age: 42; 69 % women) were included. Labels rated high on perceived mental causation tended to be rated low on physical causation and vice versa in both populations, although this effect was stronger in lay participants. “Long COVID”, “persistent physical symptoms” and “functional symptoms” were rated with higher physical causation by lay participants compared to health professionals (p < 0.001), whereas “somatic symptom disorder” and “psychosomatic” were rated with higher mental causation. Regression models showed that perceived mental causation was associated with feelings of offence in lay participants, while perceived physical causation was associated with less offence. Perceived physical causation was associated with willingness to care among healthcare professionals.

DISCUSSION
Some diagnostic labels provoke negative attitudes, both among lay participants and healthcare professionals, probably hindering clinician/patient relationships and treatment.

HIGHLIGHTS
• Views about ten diagnostic labels for persistent physical symptoms were assessed.

• Perceived physical and mental causation followed opposite patterns.

• Mental causation was associated with feelings of offence among lay participants.

• Physical causation was associated with willingness to care in health professionals.

• Diagnostic labels can provoke negative attitudes and impact care and treatment.

Link | Journal of Psychosomatic Research [Paywall]

 

[SNT Gatchaman]

This online cross-sectional study aimed to compare perceived mental and physical causations, feelings of offence and willingness to care associated with ten diagnostic labels accounting for PPS (fatigue, widespread pain and cognitive disorders) among lay participants and healthcare professionals.

Feelings of offence among lay participants followed a similar pattern to perceived mental causation and were inverse to views on physical causation. Perceived offence was maximal for “hysteria” and “psychosomatic symptoms” and minimal for “stroke” and “multiple sclerosis”. Perceived offence increased from “persistent physical symptoms” to “functional symptoms”, “bodily distress disorder” and “somatic symptom disorder”. “Long COVID” and “electrohypersensitivity” were rated with low offence. Willingness to care among healthcare professionals was comparable across most diagnostic labels, but lower for “electrohypersensitivity” and “hysteria”.

Among healthcare professionals, age and perceived physical causation significantly associated with willingness to care

Interestingly, in our results older age of healthcare professionals was associated with more willingness to care.

The data show the dilemma between a diagnostic label which conveys less offence but which may also negatively impact an individuals’ ability to benefit from treatment that depends on rehabilitation. If biological explanations of physical symptoms typically reduce negative attitudes, they can also induce pessimism over the course of the disease. Some diagnostic labels may provoke more offence or negative attitudes initially, but, if handled correctly, also create an opportunity to provide appropriate treatment.

Furthermore, beyond diagnostic labels, the explanation of underlying mechanisms also has a major impact on representations. In this study, representations greatly diverge between healthcare professionals and lay participants, which may lead to misunderstandings. Previous studies suggested that appropriate explanations about distinct labels designating chronic and distressing symptoms decreased feelings of offence. For instance, a diagnosis of “functional somatic disorder” might be well accepted in patients with persistent symptoms after COVID, as long as this label is used together with proper explanations of the putative mechanisms involved, in a non-dualistic, biopsychosocial perspective.

 

[Hoopoe]

The data show the dilemma between a diagnostic label which conveys less offence but which may also negatively impact an individuals’ ability to benefit from treatment that depends on rehabilitation. If biological explanations of physical symptoms typically reduce negative attitudes, they can also induce pessimism over the course of the disease. Some diagnostic labels may provoke more offence or negative attitudes initially, but, if handled correctly, also create an opportunity to provide appropriate treatment.

One needs to look at the bigger picture and not just at people's attitudes at one point in time. Attitudes can change over time, with experience and in response to events. How people feel about a label or approach may not reflect how they will feel about it later, when they have experienced what it leads to.

My symptoms were viewed as having some sort of obscure mental causation, while the possibility of a physical illness was denied totally.

This led to futile, demoralizing attempts to cure my symptoms via mental approaches. It never worked and with every failure, my psychological distress increased. In the end it felt like I had been led down a path of self-betrayal that had annihilated my self-esteem and sense of control, nad had made me sicker.

If the symptoms had been viewed as being caused by an incurable physical illness that required accomodation, I think things would have gone very differently.

Patients do not need a false-hope inspiring story that ultimately ends in devastating disappointment as the promises of recovery turn out to be false. They need something that really works. The hope will come from the intervention working. If the mental causation approaches worked, they would not be associated with negative attitudes or be controversial, and patients would demand them, instead of resisting them.

 

[Utsikt]

The data show the dilemma between a diagnostic label which conveys less offence but which may also negatively impact an individuals’ ability to benefit from treatment that depends on rehabilitation. If biological explanations of physical symptoms typically reduce negative attitudes, they can also induce pessimism over the course of the disease. Some diagnostic labels may provoke more offence or negative attitudes initially, but, if handled correctly, also create an opportunity to provide appropriate treatment.

It’s telling that they assume that there are appropriate psychosocial treatments for any persistent physical symptoms..

Furthermore, beyond diagnostic labels, the explanation of underlying mechanisms also has a major impact on representations. In this study, representations greatly diverge between healthcare professionals and lay participants, which may lead to misunderstandings. Previous studies suggested that appropriate explanations about distinct labels designating chronic and distressing symptoms decreased feelings of offence. For instance, a diagnosis of “functional somatic disorder” might be well accepted in patients with persistent symptoms after COVID, as long as this label is used together with proper explanations of the putative mechanisms involved, in a non-dualistic, biopsychosocial perspective.

Yes, the non-dualistic dualistic approach. Very good job guys.

 

[rvallee]

Interesting marketing focus group on the "everything wrong with medicine" side of things. And this is a marketing focus group, not a study. Their starting point makes it clear they know what's what, in asking laypeople about how offended they are, which they already knew is directly related to whether it's framed as mental or physical.

Although, to begin with, the fact that there are 10+ such labels for the exact same thing and it doesn't bother them is a big tell. I cannot accept that everyone involved in this doesn't clearly understand this is wrong. They are smart enough, and every single time they assess this they find the same thing. This is why here they jumped straight at it, and asked how offended laypeople are, and how willing to help professionals are, which always ends up the same way.

They are explicitly trying to find the label that allows them to get away with the most bullshit and the least accountability. Here it confirms the reason why 'functional' was chosen in the first place, which is explicitly stated in the papers supporting it: to laypeople it sounds more physical, even though it's explicitly defined as not, which professionals know, and since most are not interested in the mental side, for which they have no effective training, it's literally the worst of both worlds. Which is exactly why it was chosen.

So, things today are the exact same they were a century ago, when most of those labels did not exist. They are still tweaking their marketing to make it acceptable to consumers, but they have been aware the whole time that consumers don't want their bullshit, aren't buying it, but since they fully control a fully supply-side market, they can simply continue to impose their will, using kabuki studies like, marketing focus groups in all but name, to find the perfect way to bullshit.

Which they haven't found, and never will. Because although bullshit can convince people, it never works. Outcomes are entirely irrelevant here, only perception matters. Perception that can be altered by any means necessary, including lies, fraud and deceit. No different than assessing which rain dances convince the most people might bring rain, without ever bothering to check whether it ever does, because it's irrelevant to them, they've always known it doesn't matter.

It also reveals how despite decades of boast, all the promises of biopsychosocial ideology pretending that the physical and the mental side of things, not dualists though, are just as important, professionals and laypeople alike disagree on the same basis: they know that mental health care is largely a failure, barely any better today than during the Roman empire, when they had sanatoriums and other things that can be lobbed in the mind-body category of things. And yet they can present studies like this, explicitly emphasizing the split between both, while pretending to stand against dualism. Total bullshit.

Medicine is not biopsychosocial. It will never be biopsychosocial, because biopsychosocial is whatever someone wants it to be in a given context, not for what it means, but for what it pretends to be, which is mostly bullshit. This rotten ideology will never achieve a single thing other than making the rich richer and the sick sicker. It's textbook banality of evil, and these people are the devil's marketing department.

If biological explanations of physical symptoms typically reduce negative attitudes, they can also induce pessimism over the course of the disease.

This is bullshit. It's true when something is known to be biologically irreparable, which isn't the case for the vast majority of what is illegitimately labeled as psychosomatic. Even though there are plenty of incurable diseases, and you know what they put their hopes into? Biomedical research.

The exact opposite is true: it's when people suffer from illness that is mislabeled as psychological that despair is maximized, because we are smart enough to see through their transparent bullshit, their own studies and focus groups have proven it again and again, and get the message loud and clear, that no help is on the way.

Previous studies suggested that appropriate explanations about distinct labels designating chronic and distressing symptoms decreased feelings of offence. For instance, a diagnosis of “functional somatic disorder” might be well accepted in patients with persistent symptoms after COVID, as long as this label is used together with proper explanations of the putative mechanisms involved, in a non-dualistic, biopsychosocial perspective.

And those studies were bullshit. You can produce bullshit studies, but you can't make them be relevant. You can find the perfect rain dance that will make the judges hit the 'like' button, but it won't ever make it rain here and now. The key ingredient is always insincerity, and when you are that far into moral degeneracy, no amount of marketing will make up for systematically causing suffering and misery.