Poll - Have You Ever Believed In Psychosomatic Illness?

[DigitalDrifter]

I use to believe in the concept when I was 21 based upon little more than some body in authority saying it was real and also being fooled in to thinking I was experiencing it, which I'm now embarrassed to admit.

So what about you guys, have you ever believed in it and if so, what convinced you? If you left the faith then what de-converted you to a non-believer?

 

[DokaGirl]

I use to believe in the concept when I was 21 based upon little more than some body in authority saying it was real and also being fooled in to thinking I was experiencing it, which I'm now embarrassed to admit.

So what about you guys, have you ever believed in it and if so, what convinced you? If you left the faith then what de-converted you to a non-believer?

Good poll @DigitalDrifter

Experience changed my mind.

Maybe there is a tiny smidge of something to the psychosomatic concept of illness. However, it is likely all BS, and the remainder may fall with more knowledge and technology.

I've seen stress debunked as the cause of ulcers. Probiotics and diet help IBS - another condition that is still blamed solely on stress by many.

I used to question whether I had CFS due to stress. Even though I had tested positive several times for acute stage EBV. Then, over time, I had several tests that show abnormalities, just as described in the Canadian Consensus Criteria for ME/CFS Overview.

I can also look back on many years of gaslighting, when in fact, my health problems were eventually validated as physiological.

It was tedious, and frustrating, to say the very least to recount symptoms on almost anything I had, and be denied testing (unless I persevered), be told it was nothing, and be fobbed off in whatever way possible.

There may be a tiny sliver of truth or fact to the psychosomatic BS, but this small remainder may fall with more knowledge and technology.

ETA: I was diagnosed as having CFS, way back when it was unfortunately called that in Canada.

I call it ME, but for the purposes of my comments here, I used "CFS", as that is what I was initially diagnosed with.

Although, much later, a ME specialist of the biomedical persuasion said I have ME.

 

[livinglighter]

I voted yes because I think psychosomatic illness does exist and I haven't done enough research to satisfy denouncing it completely. However, I do not believe ME/CFS is psychosomatic. The problem for me is when the psychosomatic module is applied to conditions where symptoms are likely to have organic pathology that hasn't been ruled out.

 

[Hutan]

I think I have been a skeptic for a long time when it comes psychogenic illness. It may possibly be the result of having childhood asthma. My first memory of encountering someone thinking a disease was psychosomatic and me thinking that idea was stupid was when I was sitting in the school sick bay in primary school, struggling for breath. Some inane woman was trying to convince me I didn't really have asthma because I hadn't clearly told her if I was having trouble breathing in or out. Only one of those two options was correct, apparently. (I had just forgotten my Ventolin inhaler that day; they had spare ones in the sick bay.)

Of course I have wondered at times. I wondered if my allergy to cats was just in my imagination. Then I visited a place that had a lion cubs in a room - we were allowed to file around them, surely wouldn't be allowed now. And some minutes later, I started wheezing and my eyes itched and realised the cause. That made me think that I should trust my body.

Whether I believe in psychosomatic illness depends on how you define it. I have a pretty high bar on the definition. I don't think it is when emotional stress makes someone feel that their illness is worse, or when that stress reduces someone's tolerance of their symptoms. Of course, physical illness is usually easier to cope with when everything else is calm and sorted and comfortable.

I don't think it is when someone gets a diseased liver because they have drunk too much alcohol for too many years because they want to forget a horrible reality. There, there is a psychological issue, but the physical issue has a clear organic cause.

I don't even think it is when someone breaks out in a rash when they are stressed. Because everyone gets stressed, but they don't break out in a rash. So, the issue isn't the fact that the person feels stressed, and the answer isn't mindfulness training. It's that something about their physical reaction when they are stressed, maybe the sweating, the increase in blood pressure, an increase in cortisol, or whatever causes the rash. So, sweating or the increase in blood pressure or an increase in cortisol or whatever without stress would also cause the rash. Therefore, it's not a psychosomatic problem.

I remember picking up a book in a doctor's waiting room that had ideas like people who get earaches want to not listen to criticism, stuff like that. That just seems ridiculous superstition.

I don't think I have ever come across something that is unequivocally and unquestionably a psychosomatic disease. Every time I think there might be one, a bit of investigation suggests that it isn't. So I voted 'no'. Actually, I think it is possible, so I have a very slightly more nuanced view.

But, I am sure that telling someone that they have psychosomatic disease and treating them as if they have a psychosomatic disease is not helpful and often does harm - because there's no evidence that the standard therapies for "functional diseases" work, and plenty of evidence that things like not doing good investigations, and gaslighting, and denying people the support of loved ones cause harm.

 

[livinglighter]

You raised some really good points @Hutan.

Is it that psychosomatic problems by definition only require mindfulness training as treatment?

I don't even think it is when someone breaks out in a rash when they are stressed. Because everyone gets stressed, but they don't break out in a rash. So, the issue isn't the fact that the person feels stressed, and the answer isn't mindfulness training. It's that something about their physical reaction when they are stressed, maybe the sweating, the increase in blood pressure, an increase in cortisol, or whatever causes the rash. So, sweating or the increase in blood pressure or an increase in cortisol or whatever without stress would also cause the rash. Therefore, it's not a psychosomatic problem.

I think the patient whose stress causes them to break out in a rash may benefit from a drug that reduces the duration and symptoms of the rash if it is long-lasting or leads to other problems and some form of therapy that reduces the stressful impact of the triggering event.

I don't think I have ever encountered something unequivocally and unquestionably a psychosomatic disease. Every time I think there might be one, a bit of investigation suggests that it isn't. So I voted 'no'. I think it is possible, so I have a slightly more nuanced view.

I'm cognitively challenged quite a bit so every time I think there is a case which is a psychosomatic problem, I don't get the chance to probe further to decide otherwise.

 

[Wyva]

I heard about it just in general when I was a teen, without knowing about any specific conditions. I did believe it was a real thing but in my mind I automatically put it in the "X-Files" category of psychology, along with stuff like split personality (based on my movie experiences of course!) etc. The weird, surprising things that you mention in "Did you know...?" sentences. I never really read about this in depth, so I didn't have detailed knowledge though.

I only became more familiar with this subject when I fell ill. First I thought maybe psychosomatic diseases exist, mine is just misclassified for some reason. Then as I found out more about the methodology etc, I started to question this entire field in psychiatry.

 

[oldtimer]

When I was young my parents' friends were medicos of all varieties, so when I announced at about age 15 that I wanted to become a psychologist or a psychiatrist - I didn't have a clue what they were - my mother put a quick end to that by telling me that all psychiatrists were mad. (Apologies to any psychiatrists reading this who aren't mad.)

When I started noticing psychobabble in the media in the 1980s and 1990s I think, I ended up not fully trusting that the way I felt with ME/CFS was real. I answered no to the poll because deep down I could not bring myself to believe there was such a thing as psychosomatic disease. I was driven to read a huge amount of psychology and philosophy over several years at the time. I can't recall much of it now but my belief was confirmed without a doubt. It was a relief to tick that off and trust myself again.

 

[Hoopoe]

Yes, because I was young and had never experienced any authorities being totally wrong before.

It was a weird, self-destructive experience to believe in psychosomatic causes of my illness, trying my best to do what I was told would help, but only feeling like a failure when it did not help.

Psychosomatics seems to revolve around trying to impose a negative self-image on patients (this is believed to be curative or something). It's almost like it's infused with negative ideas about patients and the goal is to get the patients to agree to them.

Ideas such as:
The patients can't handle their emotions, so they somatize.
The patients are deconditioned and hysterically confusing this with a real illness.
The patients are sick because they have false beliefs about reality.
The patients don't want to get better because they enjoy secondary gains so much.
And so on.

 

[livinglighter]

So there is this one case that I have been reluctant to share because it is unpleasant and could cause stress. I will enclose it within the spoiler. I think in order to to have the type of conversion disorder people are perpetuating to exist; the trauma has to be significant such as in this case.

Spoiler: ***The contents relate to young people being harmed***

A young person is sexually abused, for some reason, maybe due to fear and a defence mechanism, the young person defecates themself. Over time the young person may learn the act of defecating avoids the abuse. However, once the young person is physically removed from the traumatic situation, they continue to defecate. What kind of intervention would be required? If the young person needs emotional trauma therapy rather than gastrointestinal treatment to address the learned behaviour, would that be a psychosomatic illness?

 

[Trish]

would that be a psychosomatic illness?

Without discussing the individual case, as I'm not qualified to suggest what treatment might be appropriate, I'd question calling it an 'illness'. Rather a symptom of psychological distress/trauma.

I think of psychosomatic illness as a term used for diseases and syndromes like ME/CFS where I can't see how any thought process, whether stress or trauma or wanting to be sick for secondary gains can make someone get PEM.

I would call feeling nauseous or muscles tightening or sweating when stressed symptoms of stress, not psychosomatic illness.

Similarly I think burnout is a set of physical and mental symtoms resulting from a stressful and demanding situation which when the person is removed from it and allowed to relax gradually goes away.

Contrast that with ME/CFS where the symptoms continue regardless of whether the person is in a stressful or comfortable life situation.

 

[Hoopoe]

would that be a psychosomatic illness?

If there is a clear relation between a psychological trigger and continued symptoms then it would fit.

But that's not how psychosomatic illness seems to be used in the (vast?) majority of cases where that label is applied. It's used in the absence of evidence, in the absence of a clear relation between a psychological stressor and symptoms, and in cases where chronic illness has persisted for years/decades which should be enough time for stress responses to return to normal.

I'm not sure it's helpful to describe stress reactions and continued inappropriate stress reactions as illness. Illness means something different in everyday language.

 

[Hutan]

would that be a psychosomatic illness?

It's an interesting question. Maybe some easier to talk about examples: we fostered some SPCA rescue dogs for a while. Some of them had been traumatised and had problematic behaviour. Maple, the little Jack Russell, cowered under the bed; Frankie, a sweet collie, peed on the bed. They pretty quickly got over those habitual behaviours with rewards for good behaviour and repetition.

Maybe that's what the BPS people think we have wrong with us (well, a version of that). It's not really thoughts being converted to an actual illness. It's faulty learned behaviours and a lack of awareness to realise that things could be different. We've fallen into unhealthy behaviours, because they benefited us in some way. Same for the person who has psychogenic seizures.

But, in that case, I would expect to see a much higher success rate from the treatments. I guess that's why they so doggedly tweak their treatments, because they are sure that some version of their answer will work.

 

[Trish]

But that's not how psychosomatic illness seems to be used in the (vast?) majority of cases where that label is applied. It's used in the absence of evidence, in the absence of a clear relation between a psychological stressor and symptoms, and in cases where chronic illness has persisted for years/decades which should be enough time for stress responses to return to normal.

I think that's the key point. Psychosomatic illness isn't usually used to describle symptoms with a known traumatic origin, it's used for people who have no known past or present trauma who have symptoms without a current physiological explanation.

Because the psychiatrists and psychologists involved want to attribute it to psychological causes they go digging into people's past experience looking for trauma and/or they assume there's something wrong with our current thinking that is perpetuating illness.

 

[Sean]

But, in that case, I would expect to see a much higher success rate from the treatments. I guess that's why they so doggedly tweak their treatments, because they are sure that some version of their answer will work.

IIRC, phobias are generally among the most treatable of of psych disorders and which CBT has the most success with.

Yet it fails completely with ME, which is at least partly viewed in the psych model as a phobia of exercise/activity (i.e. cognitively distorted interoception, a fear of 'normal' body sensations).

So either ME is not a phobia and CBT is inappropriate, or the version of CBT used to treat it is ineffective.

 

[V.R.T.]

I believed in it, though I didn't think it applied to me for a long time despite what some docs had said. Then I became convinced I might be suffering from it. I tested the hypothesis and destroyed my life.

After learning on here and elsewhere about the flimsy evidence for these conditions I literally feel like I have been the victim of a con. Utterly humiliated.

 

[livinglighter]

Here are some further accounts of what a neurologist describes as instances of psychosomatic illness.

'You think I'm mad?' – the truth about psychosomatic illness

Yvonne went blind overnight, Matthew couldn’t walk, Shahina lost the use of her hand – but doctors found nothing wrong. Were they faking it, or was the mind playing tricks? A neurologist on her most intriguing cases

https://www.theguardian.com/society...-im-mad-the-truth-about-psychosomatic-illness

 

[Solstice]

I voted yes because I think psychosomatic illness does exist and I haven't done enough research to satisfy denouncing it completely.

Isn't the burden of proof inverted when put like that though?

 

[Hoopoe]

Here are some further accounts of what a neurologist describes as instances of psychosomatic illness.

Yvonne went blind after having cleaning fluid spashed onto her eyes. The manufacturer says it can cause nerve damage if absorbed by the eyes. The neurologists can't explain the blindness and decide the only reasonable explanation left is psychosomatic blindness.

(what about saying "we don't have much experience with toxic damage of this kind and can't explain what is happening.")

The neurologists seem to have lost contact with reality and are dragging the poor vulnerable patients into a fantasy world.

 

[MeSci]

I used to believe in all sorts of psychological stuff and other weird things (e.g. aliens visiting us!) but I don't really believe any of it now. Having studied science to Masters level I think I became able to dismiss most of it, although I'm fascinated by the weirder theories about astronomy - for example we don't know what most of the universe is made of!

But since the health service nearly killed me by assuming that the symptoms of my severe hypoglycaemia (low blood sugar, caused by a medication) were psychosomatic and ambulance staff leaving me untreated and afraid that I might die, I am pretty dismissive of psychosomatic theories.

https://www.s4me.info/threads/do-you-see-a-dr-regularly-for-me.10599/page-3#post-188792

 

[Hubris]

Yvonne went blind after having cleaning fluid spashed onto her eyes. The manufacturer says it can cause nerve damage if absorbed by the eyes. The neurologists can't explain the blindness and decide the only reasonable explanation left is psychosomatic blindness.

(what about saying "we don't have much experience with toxic damage of this kind and can't explain what is happening.")

The neurologists seem to have lost contact with reality and are dragging the poor vulnerable patients into a fantasy world.

The thing about neurology is in papers they clearly write a large subset of patients with neurological illnesses can be negative in the tests and imaging. In conferences, they talk about how even in the positive patients there is microscopic damage and dysfunction that the imaging doesn't see, which is actually what is causing most of the symptoms (this also adequately explains why some patients with significant MRI lesions don't have symptoms or have very minor ones). The picture they paint is that clearly, these technologies are only able to see the tip of the iceberg.

But at the same time, if you are negative to those tests they say nothing's wrong with you and must be psychosomatic with absolute confidence, even if there is significant circumstantial evidence like the one you cited. Somehow this is not a contradiction?