Psychology Today blog platform: "It's All in Your Head - The relationship between contested illnesses and psychiatric illnesses"

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Webdog

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It astonishes me this was written in 2019. No mention of ME/CFS biomedical research papers, but Elle magazine is cited. So there's that.

Chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivities, and chronic Lyme disease are all lumped together as "contested illnesses".

It's All in Your Head
The relationship between contested illnesses and psychiatric illnesses.
Sara Gorman, Ph.D., MPH, and Jack M. Gorman, MD
https://www.psychologytoday.com/us/blog/denying-the-grave/201906/its-all-in-your-head
Psychology Today blog platform said:
Contested illnesses have uncertain causes, unclear treatments, and disputed medical, legal and cultural definitions.
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Psychology Today blog platform said:
These conditions are called “contested” because some people, including physicians and scientists, dispute their existence.
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Psychology Today blog platform said:
One of the things that many people with contested illnesses dislike is being told that their symptoms stem from an underlying psychiatric disorder.
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Psychology Today blog platform said:
Diagnosing Depression Seen as Insulting.
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Psychology Today blog platform said:
We do not know if contested illnesses like CFS, chronic Lyme disease, and fibromyalgia are in fact forms of psychiatric illness
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Psychology Today blog platform said:
It is time, then, to get over the fear that a psychiatric cause for an illness is somehow a dismissal of its “realness” or severity. Instead, we need to remember that psychiatric illnesses are themselves real and serious, even if they are mostly “all in the head.”
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There is a place to leave comments at the end of the article.

Edit: Title changed to show this was a blogger on the blog platform, and not strictly Psychology Today.
 
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What is concerning, however, is the notion that suggesting something might be a psychiatric illness or that a person with chronic pain can also suffer from depression is interpreted as akin to dismissing the patient as a faker, someone who isn’t really sick. For example, an article in Slate states that “There’s actually ample evidence against the theories that [chronic Lyme disease] is all in one’s head." Interestingly, the evidence for that statement that the authors discuss includes abnormal proteins in cerebrospinal fluid (the fluid that bathes the brain), antibodies directed against neurons (the main type of cell in the brain), and abnormal results from brain imaging studies. So even though the authors first say that chronic Lyme disease isn’t “all in one’s head” the studies they cite to show that the condition is a distinct illness all involve abnormalities in the nervous system and brain.
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Oh, great. So now if you have a brain tumor, you should be OK with your doctor telling you "it's all in your head," because, you know, that's a technically accurate statement.

People with ME/CFS clearly don't object to the notion that the disease involves "abnormalities in the nervous system and brain." Perhaps the author hasn't been keeping up on current events, but patients' preferred term for the disease is "myalgic encephalomyelitis."
 
Psychology Today has two platforms - a magazine type platform and a platform which provides blogger space to hundreds of therapists and practitioners - often used to generate clients or advertise books. Bloggers are subject to different editorial policies.

This blog is the blog of Sara E. Gorman, PhD, MPH, a public health specialist and Jack M. Gorman, MD, former Professor and Chair of Psychiatry and Professor of Neuroscience at the Mount Sinai School of Medicine, and on the faculty of Columbia University's Department of Psychiatry for 25 years. He is CEO and Chief Scientific Officer of Franklin Behavioral Health Consultants. He is co-author of Denying to the Grave: Why We Ignore the Facts That Will Save Us (Oxford University Press).

The content of this blog won't have had the editorial oversight of Psychology Today. Its relationship to Psychology Today is the same, for example, as the relationship between Dr Edward Shorter's blog and Psychology Today.

So instead of quoting extracts as "Psychology Today said" - it should be "Gorman and Gorman said".

Allen Frances MD has blogs on this platform (DSM 5 in Distress and Saving Normal) to which I contributed content. Bloggers publish their own content, as you would, for example, on a WordPress blog; once content is published, bloggers retain access to edit, add additional content or remove entire posts; they also screen/moderate the comments and can hold back, delete or close their comments facilities (as Shorter did when it became too hot for him).

Bloggers are expected to maintain certain editorial standards but Psychology Today does not take responsibility for the content of these blogs.
 
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Extract:

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This seems a very muddled article to me.

I think they are saying we object to ME being classed as psychiatric, then they argue against that by saying psychiatric means to do with the brain, and ME might be caused by some malfunction in the brain, so therefore we shouldn't object.

I have no objection to the idea that ME might be caused by physiological problems in the brain, or caused by something else that leads to brain dysfunction. There's interesting research suggesting that might be the case.

My objection is nothing to do with that. My objection is to ME being classed as a psychosomatic condition - in other words one where our thoughts cause our physical symptoms and can therefore be manipulated to cure those symptoms. My objection is that such thought manipulation (CBT) doesn't work and causes harm.
 
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Trish said:
My objection is nothing to do with that. My objection is to ME being classed as a psychosomatic condition - in other words one where our thoughts cause our physical symptoms and can therefore be manipulated to cure those symptoms. My objection is that such thought manipulation (CBT) doesn't work and causes harm.
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I agree. What I think this sort of piece shows (I wouldn't flatter it with the term article or even blog) is that the psychotherapeutic wing of psychiatry, the people who have made ME/CFS their domain, do not understand their own terminology when it comes to psychiatric, psychological, psychosomatic or 'in the head'. So they write anodyne garbage that makes things worse - a bit like a botanist trampling on the endangered orchids he has gone out to document.

My impression is that the underlying problem is that these people have gone in to psychotherapy precisely because they are tone deaf to any valid analysis of cause and effect.

I don't think this is a blog ('a regularly updated website or web page, typically one run by an individual or small group, that is written in an informal or conversational style'.) It is part of a sophisticated professional team bonding exercise designed to increase sales for a very large group. Others using the same format may be blogging but this piece is so anodyne it cannot possibly have any function other than marketing. It is just the Gormans waving like Kylie Minogue saying 'hi we're still here and in business'.
 
Again it's this straw-man meme that the thrust of patients' objection is reflexive opposition to psychological/psychiatric classification. Painting objecting patients as mentally-ill ignorant anti-mental-illness bigots. This is all in their minds.

When the actual objection has been to incorrect theories, unhelpful/harmful treatments, and hindrance of other lines of research.

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And other than that just a bunch of word-garbage.

Particularly the word games with the phrase 'in the head'. Pathetic.
 
The article creates stigma by negatively stereotyping patients in various ways.

I agree that patients are definitely not afraid of having a brain condition. I think we are afraid of being labelled as having a psychosomatic condition because then we would be shunted off to Alice in Wonderland medicine, or the medical equivalent of a ghetto, "cared" for by people who seem to be a little crazy or perhaps just very incompetent. It's a bit hard to describe but you get the idea: with this label, patients are suddenly treated very poorly, for example by denying them sensible research, asking them to overlook flaws in published research, asking them to think themselves better, treating them like children, being subjected to what could be described as brainwashing programs, etc. In practice the psychosomatic label seems to indicate that a patient does not deserve to be treated with the same respect and rights as others.

If a psychosomatic label didn't have such negative consequences, people wouldn't resist it. Although it would still only be a label because in reality nobody knows what's causing ME.
 
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Well, for what it's worth, I've posted a comment.
It will be interesting to see if they allow it.
It seems you are saying people with ME object to ME being classed as psychiatric, then argue against that by saying psychiatric means to do with the brain, and ME might be caused by some malfunction in the brain, so therefore patients shouldn't object. This is a straw man argument and not worthy of professionals treating such patients.

If you listen to patients you will find they have no objection to the idea that ME might be caused by physiological problems in the brain, or caused by something else, such as problems with energy metabolism, that may lead to brain dysfunction. There's interesting research suggesting that might be the case.

The objection is nothing to do with that. The objection is to ME being classed as a PSYCHOSOMATIC condition - in other words one where thoughts cause physical symptoms and can therefore be manipulated to cure those symptoms. The objections to this are very simple. Such thought manipulation (CBT) doesn't work and causes harm. Clinical trials of CBT for ME have only ever shown small, clinically insignificant and transient improvements on subjective outcome measures in unblinded trials. Such poor results would never be accepted as evidence of efficacy for any drug, especially when large patient surveys show such treatments cause harm. The treatments do not work.

ME or ME/CFS is not the same as the symptom chronic fatigue which occurs in many different diseases. The cardinal defining symptom of ME is post exertional malaise (PEM), which means serious worsening of all symptoms after activity beyond that individual's current limits. This can be as little as getting out of bed in the most severely affected patients. CBT for ME aims to persuade the patient that their serious symptoms are somehow caused by fear of exercise, and to ignore symptoms and gradually increase activity. This leads inevitably to PEM and in many cases, if the patient ignores symptoms and pushes through, leads to serious long term worsening of symptoms.

It is both disingenuous and potentially dangerous to characterise ME patients in the way this article does. I hope the authors will educate themselves about the current biomedical research showing, for example, something in blood serum that affects cells' ability to respond to energy demands.

And please, no more nonsense about ME patients being anti psychiatry.
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Trish said:
My objection is to ME being classed as a psychosomatic condition - in other words one where our thoughts cause our physical symptoms and can therefore be manipulated to cure those symptoms. My objection is that such thought manipulation (CBT) doesn't work and causes harm.
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Precisely. ME is not perpetuated by unhelpful beliefs, and cannot therefore be fixed by changing patients' perceptions of their illness. True no matter where the physiological reason turns out to be, including if it is the brain.
 
Three comments have been posted, including Trish's - but keep an eye on whether any are subsequently taken down.

Gorman and Gorman are in the U.S. Given the time difference between the U.S. and GMT, they may have their blog set to let posts through without pre-moderation. But they will have the option to remove them.
 
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