Let’s end the stigma of psychosomatic illness The Times (London) 22/04/2021

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JohnTheJack

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Column (paywalled) by James Marriott in The Times.

https://www.thetimes.co.uk/article/lets-end-the-stigma-of-psychosomatic-illness-whfdlwhph

Recently we’ve accepted the idea that the suffering of mental illness, though different from a broken leg or a virus, is real. The next taboo is surely psychosomatic illness (or functional disorder, to use the term doctors prefer). These are the physical illnesses that do not show up in scans or tests, whose causes appear to be “all in the head” but whose symptoms can be severe and terrifying: seizures, fainting, terrible pain, paralysis — even blindness.

A third of outpatients in neurology and gastroenterology suffer from psychosomatic illnesses and it has been estimated that in the US they cost more to treat than diabetes. Treatments are often unsuccessful and many patients find themselves shunted from specialist to specialist in search of the one thing in modern medicine that will buy you respect: a label for a disease and proof of its biological cause...
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Anyone know whether that 'a third of outpatients...' is right? Or where it's from? @dave30th perhaps?

I think the article shows what we're up against on this. I think Marriott is a decent guy and I generally like his columns. He is (like many journalists) an arts graduate. He reads about this subject as someone trying to be humane and understanding. The facts as presented seem convincing, he wants to be empathetic, so he buys the whole argument.
 
JohnTheJack said:
Anyone know whether that 'a third of outpatients...' is right? Or where it's from?
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Got it! It's from here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(98)08320-2/fulltext

Among medical outpatients, somatic complaints accounted for 25% of new referrals in a Dutch study3 and for 35% in a UK study.4
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That's about a third, and Sharpe so loves his rules of thirds.

I say Sharpe, but this has got SMC/W3ss3ly written all over it!
 
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Nah. It's not a valid construct so actually let's end it altogether. The people behind this are not serious and make absurd claims and assertions without any evidence whatsoever. And they have to use blatant lies such as asserting, without evidence, that 1/3 of patients have psychosomatic illness because of the simple algorithm where a cause must be easy to identify otherwise it's psychosomatic. This is not even close to be a valid process.

If anything, safeguards need to be implemented ASAP to prevent this nonsense from doing more harm. If they want it to be official, rather than off the record as it currently mostly is, then due process is needed, which is obviously not possible here.

And then there's stuff like this:
Our culture insists disease must have a biological cause but doctors know it isn’t that simple
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"Culture" does not demand that. Medicine does. Quit making stuff up.
 
Lucibee said:
That's about a third, and Sharpe so loves his rules of thirds.
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This looked so bizarre I had to at least glance at the paper. Technically somatic means body, hence physical, but they are playing loose with terminology and mean functional somatic syndromes, but then use the term somatic. They also fail to be clear that diabetes is a functional syndrome in large part, as the functions involving sugar, fat and hormone issues are disturbed. I also noticed that PMS has snuck back in after failing to get its own DSM diagnostic code (unless it happened and I did not notice). What is the point of diagnoses if you add anything you want without evidence?

Functional somatic syndromes, or just functional syndromes, should be treated with respect, including respecting that we have basically admitted we don't know what they are. If history serves as a guide, most or all will turn out to be literal somatic diseases we just don't understand yet.
 
The idea that resistance to psychosomatic explanations for illness is due to stigma and not any legitimate reasons is such a typical argument by proponents of psychosomatic explanations.

As if it's only people not wanting to admit that their illness is caused by emotions, and nobody disbelieves in this idea because it doesn't make sense, has no scientific basis and is historically speaking, a serial failure.

It's also annoying how "psychosomatic" de facto just means unexplained.
 
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Well, he is correct that functional illnesses, the way almost everything not known gets included in that group today, are certainly physical. He is also right that suffering from these, whatever trendy label you choose to give them, conditions are the next taboo, most doctors and people these days treat mental illness with higher level of understanding. He is also correct that a disease label and preferably proof of biological cause will buy you respect in the doctor's office. I can't read the full post, but I assume it would at some point advocate for BPS treatment approaches, etc. I'm feeling kind today so I'll give him some benefit of doubt.
 
JES said:
can't read the full post, but I assume it would at some point advocate for BPS treatment approaches, etc.
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Bingo!
One social change that might help is the removal of stigma. As Stone says, the important first step towards a cure (which might involve, for example, a combination of physiotherapy and psychological therapy) is for the patient to accept the diagnosis — not something that is always easy in a culture that so readily associates real disease with biological causes. Now that stigma against mental illness is breaking this could be our next big battle.
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JohnTheJack said:
Column (paywalled) by James Marriott in The Times.

https://www.thetimes.co.uk/article/lets-end-the-stigma-of-psychosomatic-illness-whfdlwhph



Anyone know whether that 'a third of outpatients...' is right? Or where it's from? @dave30th perhaps?

I think the article shows what we're up against on this. I think Marriott is a decent guy and I generally like his columns. He is (like many journalists) an arts graduate. He reads about this subject as someone trying to be humane and understanding. The facts as presented seem convincing, he wants to be empathetic, so he buys the whole argument.
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Might be worth asking BBC Radio 4 "More or Less" (not sure when the next series is) they run a statistical fact checker - facts which are in the media and whether they're accurate.
 
rvallee said:
"Culture" does not demand that. Medicine does. Quit making stuff up.
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strategist said:
The idea that resistance to psychosomatic explanations for illness is due to stigma and not any legitimate reasons is such a typical argument by proponents of psychosomatic explanations.
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Yep. They just make up this shit to suit their narrative. Shadow boxing at a foe who isn't there.

Unfortunately it works.
 
Arnie Pye said:
Yes, it was Sharpe.
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From the Interview, the quote was:
In the absence of good data, physicians usually fall back on the rule of thirds.
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From the talk, he said (about outcomes of Long Covid):
In the absence of really good data, physicians usually fall back, as you know, on the rule of thirds, so my guess would be about a third [of] these people won't do so well, about a third will do very well, and about a third will be somewhere between the two. And so if we say we've got five percent and we apply the rule of thirds, a guess would be something like one percent of these people may have some long-term disability - that is a guess and it'll depend on the care people get - but given the number of people with Covid, that could potentially be quite a lot of people.
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I don't think maths is his strong point.
 

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