Psychological therapies. Discussion thread.

Talking about longcovid on another thread, one of the problems with the BPS approach is that they ignore the patient's concerns for what they think is the problem, like summarising a long list of symptoms into "fatigue"

I read somewhere that the problem with psychologists is that they offer simple solutions (think sleep hygiene!) when patients actually go to them when the simple solutions didn't work.

I found this when I went to the baby clinics. They would answer your questions with what you had read in the Boot's baby book and just ignored you if you wanted to know more. Yet what good were they if they could not give knowledgeable help?

 

I would think that depends on the individual psychologist... some are good, some are bad...

 

Not much use at all as you state. Ignoring patients symptoms etc is kinda v weirdly backwards versus the main modalities of therapy. Sad really and not doing what they should be learning in clinical training, though I'm getting the impression that this is quite variable.

 

Your point is forcefully expressed and I would think many on here sympathise with that force of feeling. I take a different view

1) Your own description of the mind as an abstract construct referring to some of the products of bodily function makes a definition of the mind as the same as the body contentious. "Mind" and "body" are words in any case. Even if the body and mind are one and the same, the word "mind" will not necessarily meekly fall in line with this reasoning. I think it would be difficult to apply your definition across numerous languages which do not tend to show 1:1 correspondences as to mind;spirit;soul;intellect etc.
See also the italicised in 20 below

2) I think you are wrong to say that a condition can only have a psychological component when proven. A condition may have a mitochondrial component, but the fact of such a component is not dependent on its discovery, whereas the discovery is dependent on the fact and the same goes for psychological components. They may be there but not yet discovered.
The psychological component of a disease may be far from small. A dangerously psychotic individual may be in desperate need of anti-dopamine medication, but that does not render the psychological component small. Their delusion may be what occasions them to murder. That is not small and in no way negates or diminishes the biophysical component. Components should imo be divided into cause/occasion, perpetuation, process and best treatment, and physical of psychological may be considered at each level.
If we replace the term psychological with mental and mental applies to mind and mind and body are one and the same, then we deprive the term psychological of any meaning other than physical and vice versa, rendering your point and mine moot in any case, and depriving doctors of a useful distinction in practice, whatever the philosophy.

3) Addressing thoughts and feelings may benefit health, but if you've just had a heart attack, the ICU or A and E is where to be so are they saying addressing thoughts and feelings can benefit health or cure a given condition? Make them be specific, just as Gerada should have been forced into specifying how exercise could improve e.g. alopecia - all alopecia.
They might then talk sense about e.g. some patients with skin conditions but not patients who acutely need doulbe bypassess.

4) I understand you sentiment entirely. MUPS bears, arguably, a greater stigma than psychological dysfunction and in any case the idea that exacerbation of physical symptoms by psychosocial circumstance necessarily indicates psychological dysfunction is unjustified. Plenty of of people with MS worsen under psychological stress/in psychological distress, but that does not indicate psychological dysfunction but the effect of circumstance and perception of circumstance on the body, which may occur in a mentally robust individual with no apparent psychological dysfunction. I would press them on specifics.
Again, I would find it difficult to express this point in the above words , if I accepted your "mind and body are one and the same" view. I do not know how I would express it or what words to consistently and meaningfully if I took your view, so I find your view problematic.

I am also worried that psychologisers may use the "mind and body are one and the same" line for their own nefarious purposes.

 

As I understand it we are mostly agreed that the situation in psychosis is not 'psychological' in the sense of 'biopsychosiocial'-type psychological. This is where the confusion comes in and I think Woolie is wanting to make the distinction too. By 'psychological component' in the BPS scheme is meant that symptoms are generated or amplified by thoughts like anxiety. If you have a lump come up and start worrying it is a tumour you are pretty sure to start getting itching or pains around the area. That would be psychological. But in psychiatric illness such as psychosis we are talking about abnormal thoughts being due to some unknown disturbance of brain function - something more or less totally unrelated.

In other words psychiatric illness is generally not psychological in the common usage and BOPS usage sense. In fact even for depression nobody is likely to say that someone's low mood is 'just psychological'. Grieving isn't 'psychological'.

I don't think anyone is saying that mind and body are one and the same. Your arms are not mind. Mind is a very special part of body. So 'mental' will cover a special subset of bodily processes. And following what I say above,'psychological' will cover a special subset of mental processes - those in which our perceptions are influenced by preconceptions or emotions.

I agree that we want to have terms for mental illness that can be separated from those used for other bits the body. But the usage of psychological that the BPS people use to justify their treatments - basically that you are imaging things are wrong because of an idea you have latched on to - needs to be shown to be valid in specific cases. The default assumption is that it does not go much further than itchy lumps and white coat hypertension.

 

Sorry Jonathan, I wrote a considered response (imo) but I wiped it by poor keyboard technique.
Reprising as best I can:

I would prefer "input" to "component". Dopamine or other imbalance may be the main input i.e. treatable proximate cause in a case of psychosis, but thinking you're Ivan the Terrible may be seen as a major component of the malady.

I do not see mind as a special part or bit of body, but, in a medical context, as arising from body in context of outer stimuli and inner process. It cannot be described in biophysical terms alone though it may be wisely considered from that aspect alone in context, or from the psychological angle, as pragmatic for treatment.

It seems that your distinction between mental and psychological with "psychological"as a subset of "mental" is sensible but I don't have the expertise to say much on how the terms are used by specialists.

Wollie does claim that mind and body are one and the same thing". "Mind and body are one" is open to abuse by BPS -when they want to use it fro their own ends to "show" without nuance that psychological means are "justified" to treat physical disease, but also, in contrast, when they wish to attack us for monist "reductionism". It gives them another angle of attack, if they can no longer label us "dualists". I don't personally agree with "Mind and body are on and the same" and I think it is politically unsound.

I agree with you that BPS needs to validate its claims - and also its terms. If a process is claimed to treat "ME", what do they mean by "ME" is imo as important as whether they have helped anyone. As to validity in specific case or condition, we won't get that in the world of anecdote and that is where we are and imo, with a symptom based diagnosis, we will remain there for some time. My approach, which I think you may disapprove of, is that patient testimony counts for ongoing debate. I have done no sort of BPS except CBT/GET which was inappropriate for me and no use, but I have done "alternative" medicine which, I believe has helped, but I'll never prove it. I don't, unlike numerous BPSers, make claims that what I have tried successfully will help all others or that those who don't do what I have done do not want to get well.

Your default assumption may, in fact, be shared by most medics, BPS influence notwithstanding. However, as I repeatedly say (sorry) any default bias to the biophysica, even if held by 99% of medicsl, is effectively subverted by BPS assertions that ME is only symptomatically biophysical, so they do not have to prove that they have rectified anything beyond a "white coat hypertension" type condition, just one that is magnified x-fold. That is why I go back to the question of "what do you mean by "ME"? BPS claim is basically that ME is qualitatively akin to white coat hypertension, though quantitively different i.e. in extent and intensity of symptoms. They just dodge the bullet of "you can't cure biophysical ME" by claiming it is not really biophysical in the first place, and then they row up their anecdotal successes.I might accept (some of their anecdotes) but I reject their definition of ME. They treat what they describe not ME as suffered by many.

Sorry, I always end up making the same point.

 

Hi @richie, thanks for engaging.

My point here is that the whole "mind and body are connected" claim is based on the notion that they are somehow separate entities that "talk to each other" in some unspecified manner. I was pointing out that this type of claim does not make a lot of sense when you consider what the "mind" really is - not a separate entity, but a name we give to some of the cognitive functions the body perfoms (I say body rather than brain, because the whole body is involved in cognition).

I'm not referring to the specific terms "mind" and "body",I'm referring to the concepts that underlie them, as they are understood in the vernacular. Whether they overlap with spirit/soul/intellect or whether they translate into other language is beside the point. But you are highlighting yet another problem with "the mind". Its a very vague term.

Fair point in terms of logic. There could be an "undiscovered" psychological component to illness X, Y or Z. But then there could be an "undiscovered" family of fairies living at the bottom of my garden. But until its backed up by some evidence, its nothing more than speculation, and can be harmful speculation at that (as we have seen here with the treatment of PwMEs). I would like everyone, doctors included, to refrain from such speculation.

I glossed over this, but the term "psychological component" is usually used to refer to that part of the problem space of the illness that is the consequence of thoughts/feelings/behaviours, and that part of the problem space that can be addressed through psychological/behavioural interventions.
I do not think it is theory-neutral to divide causal factors into cause/occasion and perpetuation. It assumes a certain model of how illness works that may or may not be true. I prefer proximal and distal causal factors.

My biggest problem is with the nominalisation of psychological processes, referring to them collectively as "the mind", which leads to to a trap where we start thinking of it as a separate entity, giving it the capability to somehow "talk" to the body. We wouldn't fall into this trap if we used more precise language.
On the point of denying doctors a "useful distinction" between mind and body, I think we would be much better off if they refrained from attempting to apply that distinction. I have no confidence in their ability to do so, and the outcome is a mess.

I personally doubt whether allopecia has anything to do with thoughts and feelings, but maybe there's a space for behavioural science professionals to help people manage some illnesses (I think I made this point in the post too).

I also have my doubts about whether the worsening of MS is ever due to psychological distress, and suspect the direction of causation is in the reverse. I think it could be harmful to tell people with MS that they need to stay calm and happy to prevent their MS getting worse. Then those who have a flare will feel somehow responsible for it.

Sure you could. The "mind" as a term isn't that useful, when you think about it. If you want to talk about mental processes, then better to be specific. Talk about memory for past events, or fear conditioning, or reinforcement or reward, or even sad mood. They're all much better than "the mind", and there's no trap to fall into - people aren't like to make the claim that "sad mood is connected to the body". Because its really obvious when you use such as specific terms that that's stupid. The sad mood is generated by the body.

Your last point is a good one!

(edited for typos)

 

Possibly off topic. I have known a lot of people with MS and most of them feel that a period of stress brought on their first major attack. It was not the other way round, though, of course, that also happens. My friend with bad IBS also felt it was caused by stress at work - she was forced to do the work there had been three people doing so it was not the IBS causing it.

Stress does cause our bodies to change. It makes perfect evolutionary sense that immune systems rev up during periods of stress. It gets the body ready to fight off microbes that get into wounds if there is an attack.

Also the fight or flee reaction changes the body to be ready for those preventative options as well. It is a beautiful coordinated system.

But none of this validates the BPS theories all it does is make them plausible to outsiders. To simplify too much, stress does not break bodies, the system has evolved to save bodies. However if the body is already broken it will not be able to deal with the changes that stress brings so slight damage will become overt disease.

Neither is it a reversible process. A car crash can break a leg but a car crash can't join the bones together again.

If anything, the stress systems of the body bring psychology into the physical rather than the other way round which is how it is dealt with nowadays. To say something has been caused by a stressful situation is the start of diagnosis not an end point in itself.

 

Sorry I can't do the quotes so I will answer in ablock,. Apologies.

Our thoughts and emotions etc feed back onto some of our bodily functions. What I refer to as "mind" does not simply arise from bodily function but influences it in turn. This does not imply separation but contradicts identity.

"Vague" can still be useful and I would say that "the mind and body are one and the same thing " is vague, which you must agree with, since you view the word "Mind" as vague. The problem with mind-body identitarianism is that it tends to internal contradiction. We may both be concerned with concepts but neither of us can avoid the use of words. I do not think it is correct to claimthat my issue with translation is besides the point, since you yourself are referring to concepts by using words. which are nevertheless understood and used in one vernacular or another in different ways. (I tried to translate M Sharpe's defence of MUPS as "illness without disease" into one or two foreign languages and it came up as nonsense. A good if not impeccable test imo.)

Evidence often starts as anecdotes and the various BPS approaches have their anecdotal successes as do dietary interventions etc etc. As a patient, I am grateful for speculation as long as it is not accompanied by "this is the answer to all ME" It can be harmful but so can ignoring itwhile we wait for "evidence" and I do not fro my part wish people to refrain from speculation just to avoid stupid fundamentalism. Whether a higher standard of evidence is required of that which is deemed inherently unlikely is another matter, but sometimes the "unlikely" is in fact the case and what is deemed inherently unlikely is often down to a preexisting viewpoint about issues or the school tie of the advocate.

"Psychological component" may usually used to refer to "that part of the problem space of the illness that is the consequence of thoughts/feelings/behaviours, and that part of the problem space that can be addressed through psychological/behavioural interventions". Fairly said, but I think it should also be used in reference to weighting of symptoms. As I said, a paranoid schizophrenic symptom may have little to do with t/f/b as to causality and t/f/b interventions may be of little or no use as treatment, but the symptoms, as thoughts, are a massive psychological component. It is the symptoms that define such a condition as "mental" and that is useful pragmatically - though it may say nothing as to the aetiology, except that if you've never heard of Ivan the Terrible, the content of your disordered thought will not "contain" him.

I divide illness into into cause/occasion, perpetuation, process and treatment/cure. It's one way of looking at things and I think t is helpful. You prefer causal factors - proximal and distal causal factors, but thesee may not be static. A perpetuating factor may become the proximal cause of current symptoms in chronic illness while the original problem may have resolved while the symptoms at origin and later may all be considered as part of one syndrome.

Nominalisation of psychological processes, referring to them collectively as "the mind", is legit, if , as I do, one accepts feedback of mental processes, arising from/in the body, onto the body..

"On the point of denying doctors a "useful distinction" between mind and body, I think we would be much better off if they refrained from attempting to apply that distinction. I have no confidence in their ability to do so, and the outcome is a mess"

My bet is a mess can be made either way, and would be if the conditions permit or call for it. Call me cynical.

As to allopecia I was attempting a bit of humour at CG's expense. I wouldn't advise walking into a headwind, losing your wig and then having a breakdown as good medicine. Guess she would call the exercies "immoderate" - but you could blame the wind.

"I also have my doubts about whether the worsening of MS is ever due to psychological distress, and suspect the direction of causation is in the reverse. I think it could be harmful to tell people with MS that they need to stay clams and happy to prevent their MS getting worse. Then those who have a flare will feel somehow responsible for it"

Ah but now you are speculating!.

"Sure you could. The "mind" as a term isn't that useful, when you think about it. If you want to talk about mental processes, then better to be specific. Talk about memory for past events, or fear conditioning, or reinforcement or reward, or even sad mood. They're all much better than "the mind", and there's no trap to fall into - people aren't like to make the class that "sad mood is connected to the body". Because its really obvious when you use such as specific terms that that's stupid. The sad mood is generated by the body".

Generally I am in favour of being specific in a given matter. But whereas sad ood may be generated by/in the body, it is experienced in a person, the experience feeds back on the body. The word feed back specifies the nature of the connection, somewhat.

Thanks very much for your detailed response.

 

I'm weighing in waaaay above my weight class here but it occurs to me to wonder why even if 'mind' is special and more than the sum of it's parts why does it of necessity (according to some) need to be invoked with regards to illness and specifically ME?

One doesn't invoke the effects of mind with regards to having cancer or of cancer continuing to rage throughout a person's body. Or is that where this invoking mind is supposed to lead?

So why then with regards to ME is the materialistic view unacceptable to some and that we simply have not yet discovered the specific physical mechanisms that are leading to continued ill health.

Be advised that any responses to this will not likely get a response from me. I have very limited capabilities in this regard.

 

Not bad for a @Snowdrop I would say.

Somewhat offish topic I have just bought and read Metazoa by Peter Godfrey-Smith in Sydney, which is all about the evolution of the mind. A very lovely book because it is all cast in terms of his passion for Scuba diving and sea creatures. Well worth getting - only about £20 hardback.

Of course he gets it wrong, but he does do justice to the debate. Rather sneakily, as book reviews editor of Journal of Consciousness Studies I thought I would do a book review to say why Descartes was right after all, possibly co-authored with one of the people P G-S quotes at the high point of the book (on octopuses).

I was pleased to see that P G-S does discuss whether or not plants are conscious. There might be consciousness in plant cells but that shouldn't put us off eating leeks.

 

Because the BPS approach to ME, fibro etc. is that the conditions are not of physical aetiology so when we say mind can't cure cancer, they will answer that MUPS and cancer are different since they are committed to the idea that mind can create e.g. ME or fibro consistent symptoms but not e.g. cancer. Personally, I am happy for people to report recovery or improvement from this or that BPS approach but object to the notion that what they have had is the same thing as what other with l ME or fibro etc. have.let alone the notion that all MUPS are BPS issues.

 

A man with your surname could not think otherwise.

 

Not at all off-topic, @Mithriel.

I'm not as confident of this as you. I think its part of the human condition to seek events in our history that co-occured with the onset a terrible illness. For people that live a life with the usual pressures and ups and downs, its very likely they would have been facing some sort of pressure to perform and/or distress at the time of onset. I think people ignore the third cell - how many times they were under pressure or distressed about life and don't get sick. Its not that I think stress should make us sick every time, I just think it means the evidence for a link is not strong when you take into account the other cell. You are left with the explanation that the stress must have been worse because we got ill. Which is all a bit circular.

I know for myself I was working hard when I got sick (doing my PhD), but if I had got sick two years earlier, I could have said the same thing (pressure to get first class honours to get a scholarship to do the PhD). I think that period was actually way more stressful. Therefore, I think the evidence for stress being an important causal factor in my case is not strong.

And yes, as you say, reverse causation is very likely too. It was extremely stressful when I first fell ill. I was severely ill (unable to lift my head from the pillow) and in a foreign country, with no family to look after me, no way to get even food without asking favours of friends (and no phone!), and there was the threat of my scholarship being taken away from me if I couldn't get back to work, which would mean no money.

I thought the general view was the opposite - that stress compromises the immune system, leaving one more vulnerable to infections. If we are responding to a major threat to our body or life, it would make sense to divert resources from the immune system to the central and autonomic nervous systems to gear up for that "fight or flight". A few people here have talked about how a large acute physical stressor, like moving house or taking a long haul flight, relieves their symptoms. I have experienced this myself following sleep loss related to long haul flights, and my condition is definitely immune-related (I've been diagnosed with an autoinflammatory disease).

My point here isn't to come up with an answer as to how stress affects the immune system, I'm just saying I don't think "it makes perfect sense" is a good argument here, because the argument makes just as good sense the other way around.

I also worry about the word "stress", because it is such a general word. It can slide from grief and despair from the loss of a relationship or loved one, to the experience of being under intense performance pressure, to physical "stressors" such as contracting an infection, incurring an injury, undergoing surgery, etc. These things may challenge - or enhance - the immune system in the same way, but it is also very possible that they do so in very different - and possibly even opposite - ways.

It makes me particularly uncomfortable when people cite evidence from the effects of physical stressors (like surgery, shock therapy, injury, acute overexertion or infection) to argue for a role of psychological stress in illness. There's really no reason to think those two categories are anything the same.

 

@richie, in case this is useful to you in the future:

If you want to quote someone, you type this text at the beginning of the quoted string:

And then this text at the end of the string:

Sorry for misreading your point about allopecia!

 

Something that really annoys me -

People with physical problems that aren't always easily understood, managed or cured such as pain or fatigue are effectively being told to simply live with it. Adjust your attitude and accept it, there's no reason for it to affect your life significantly.

Yet, more and more, people who have perfectly healthy and normal reactions to life events, are stressed and worried (but still capable of functioning) about things they should be worried about etc are being told they need help.

As well as the obvious contradiction, when you suffer pain or fatigue of unknown origin & are then told to live with it, it causes significant worry and distress. However, because your worry & stress is caused by physical symptoms of unknown origin then you should really just be more mindful and accept it as there's nothing really wrong with you!

It's absurd!

 

I think this is the main thing I find difficult with so called psychological explanations. It’s the taking of a practical word like stress and broadening the meaning so that it becomes almost mystical.

when I think of stress (as a scientist ...well an ex-scientist) I think of cells that maybe have osmotic stress or a force being exerted on a solid, or a population of plants or animals that are experiencing environmental stress. In the human body it can be equally physical or metabolic governed by biological processes.

when people generalise and say they are ‘stressed’ it kind of diminishes the word (like using flu for a cold) or saying that a worry is affecting my mental health (another overs-used and meaningless comment) It’s so insubstantial as to be meaningless.

I have no doubt that when the human body is put under “Stress” this can have a biological effect (e.g adrenalin temporarily stopping gastric secretion in the stomach etc.) but the muddling appears to be around over generalisation and attributing more cause than is warranted to simple biological processes that have evolved to help us.

Perhaps we can lead a better life without “stress” but to put an abnormal behavioural spin on something that is normal seems perverse.

so I guess this comes back to how do we distinguish “abnormal behaviour” from normal biological processes? Surely it would be better to measure something tangible?

however this would dispel the mystical fortune teller magic I suppose.

 

I really don't think so.

Some people like a bit of stress and pressure. I think we all have different levels that we're comfortable with.

ME aside, I perform much better under a certain amount of stress. Too little and I tend to get a bit bored and don't manage quite the same level as enthusiasm. Put enough on and I have a little whinge and moan, roll my sleeves up, get stuck in and thoroughly enjoy myself. I used to find the pressure of a tight deadline sharpened the mind beautifully.

Another thing about this stress business.... from a female perspective of a lass who had the luxury of a good education & who had the opportunity of a rewarding career, even if there were obstacles, I simply do not believe my life is more stressful than that of previous generations of women.

I simply cannot imagine how some of them coped. Unless they were very fortunate they had a lot less choice than I do, had no choice but the tedium of staying home and doing the household chores and looking after the kids - whether they wanted 'em or not. Lots of responsibility and no power.

 

Yes me too...most of my career has been working to tight deadlines. When I don’t have one it is definitely more challenging to stay motivated nowadays. Recently though adrenalin-driven sharpness of mind is something that I have to avoid else I become more foggy due to the raised heart rate (which is ironic no?). I’ve had to learn to say “no” more and spend much more time managing expectations/negotiating deadlines whereas before I would just fit it in. If I got rid of ME tomorrow I would be back to it like a shot though ...makes you feel alive etc. I might take some learnings though.

I believe our bodies normally are quite resilient to everyday stresses like this by design (running a bit, resting a bit etc.). That doesn’t stop people attributing all their woes on it if something isn’t right or medical professionals using it as a blanket diagnosis though (stomach ulcers etc)

Equally though, I think modern society can put unnecessary pressure on some to “perform” physically and mentally where resting is foregone to meet a pressing deadline where we choose to ignore what our body is telling us (sleep, rest etc). I’m thinking hospital workers at the moment. It’s society that is creating this stress in the main (unrealistic expectations, lack of resources etc). I think there is a limit where differences between us level out.

I felt a bit of this unreal “stress” with my last employer when asked to carry out 3 peoples jobs for a time (6 months or so). Having 4 hrs sleep and working nearly every waking hr apart from those spent eating and showering with even the commute to and from work and travelling to clients on the phone sorting things out.

this is manageable for a day or two or even a couple of weeks but 6 months was definitely my limit and adrenalin can only mask things for so long.

I think in days gone past when there were far more physically demanding jobs we did rest more but agree that some of the “mental pressures” society feels are important (Exercise obsession, body image/looking nice, being competitive, etc etc) are a little bit bonkers from a biological point of view.

 

I know of similar stories in numerous illnesses. My take is that genes, health status, exposure to toxins, pathogenic organisms may all play a role in various immune related conditions in given individuals and over time may get involved in the life experience, even if irrelevant to cause. To consider psychosocial stress as causal factor does not diminish physicality of illness. No one denies MS is physical. BPSers would love what I am saying, but I am honest. They are often thoroughly disingenuous in that they quote MS or e.g. diabetes as stress related undisputed physical conditions which may respond to one or other BPS approach to some degree and then use that very argument to dispute or deny the physical nature of ME, since it -according to them- responds to their therapy. We are then vexed by their insulting inconsistency and they then label us "vexatious"..........

This is a minefield. Acute stress may elicit changes contrary to those seen in chronic stress, measuring stress is challenging, cross species interpretation is a further matter, the "same" exam stress may be accompanied by certain cytokine changes in the anxiety prone and by other or fewer changes in those not prone to anxiety - in other word the "same" stress is not the "same". Pop chat on TV sofa forgets that bio-stress is also "stress" - it's not all socio-psychological. Stress + fear has been alleged to reduce antioxidants (paratroopers post jump may show lower glutathione than pars who have done another non-hazardous form of demanding exercise). It really is extremely complicated.

My view is that this is possible but it can lead people into long periods of self accusation if the stress was self induced e.g. supposed over-training,over-work - admittedly hard to gauge, what "over-" means, as hindsight is involved. People can think "If I had had 30% less stress, I would have been OK". I say, firstly no one knows, least of all in an individual case; secondly a lot of bad luck is likely involved - genes, exposures at the wrong time etc.; thirdly as per the examples above "stress" is difficult to assess as to quantity and quality. A genetic proneness to anxiety might be far more relevant than the actual "level" of stress. 70% of the stress might have been enough anyway and 70% effort might not have been enough to obviate another source of stress - the job might just have needed doing. I also think that, if there is any ongoing self accusation as to stress, the sufferer should think in graded terms- your condition may be a bit worse for stress but not deterministically caused by it. That is the experience during the course of many illnesses - they may get worse under stress but do not disappear in better times- so why not apply the to onset too? Stress involved - if a case can be made - but not a necessary contributor. Further, if any psychological issues are felt to be involved, accept that and deal with them but not because they are the cause, but simply because they exist and as such may benefit from being addressed. This approach has helped me, even though, in my case, the number of possible biophysical contributors is legion.

This is where the problem arises with BPS fundies. They just describe a condition which they claim responds to their protocol and then label it as "ME", "fibro" whatever. It's not a broken leg, but a person who that is doing brokenlegedness or sb who is experiencing brokenleggedness as a result of unaddressed emotional needs You can't argue with them beyond pointing out that not all those with symptoms of ME, fibro etc are doing the symptoms or in states of emotional denial, which they may or may not believe but will not generally engage with.

Glad of your second sentence. The first on its own would be open to exploitation by BPS fundies.