Psychosomatic medicine and the psychologising of physical diseases

Does psychosomatic illness exist?

We all know that ME/CFS is NOT psychosomatic. And we know that a lot of studies into psychosomatic stuff (like MUS stuff) are bullshit. But I would like to know, is there any good quality research indicating that psychosomatic illness exists? Any type of psychosomatic health problem.

 

The most important condition with regards to modern psychosomatic illness is not me/cfs but non-epileptic seizure. This is a seizure without the electrical activity in the brain associated with a seizure when it occurs. Followed would be functional movement disorder.

The proof here is assumed to be the absence of said electrical activity.

However, my belief is the act of seizing is a behavior that may be produced by several mechanism, including epilepsy, but not limited to it. There are case reports of dysautomia producing seizure like symptoms.

Someone on the forums will likely understand these 2 conditions far better than me, and hopefully give you a better answer or understanding.

For your second question, I have never seen any convincing high-quality evidence of the pathology of what would be psychosomatism.

 

Good question! I think that hypochondriasis does exist, although the label is often used erroneously for conditions that are not well understood. I think that behavioural and psychological factors obviously play a large role as triggers for burn out and post-traumatic stress disorder. However, I seriously doubt that any severe chronic condition may be perpetuated by thoughts accessible to the consciousness and may be reversed by simply changing thoughts, attitudes and beliefs. If anyone has a good counterexample, I would be very interested.

I think that proponents of a biopsychosocial view on chronic illnesses often confuse modulate and perpetuate. It is probably true that psychological factors may modulate a wide range of chronic conditions. That doesn’t mean that these conditions are perpetuated by psychological factors. MS may for example be modulated by high temperatures—it may trigger a relapse. That doesn’t mean that you can reverse the illness by cooling off the patients.

 

It all depends on what 'psychosomatic' is taken to mean. In other words what mechanism is proposed?
We have no understanding of the brain mechanisms that control behaviour at a level that allows scientific theories of complex behaviour control to be tested. So I am not sure anyone can say what they mean by psychosomatic. I guess it is supposed to mean that thoughts that the person is not aware of cause symptoms. But if even the person is not aware of the thoughts it is a bit difficult to see how would could know they are there.

There is no doubt that some people are hypochondriacal in the sense of believing they have medical problems they do not have, just as people believe all sorts of things. There is also no doubt that some people malinger for financial gain. Others self-harm to make it look as if they have medical problems. But none of these would be classed as 'psychosomatic' as I understand that the term is intended to mean.

I guess that to show that psychosomatic illness occurs there needs to be evidence of symptoms appearing reliably in relation to certain stimuli in a way that could only work through perception and brain response, with very convincing evidence for the person's denying any knowledge of the process.

The nearest thing that I think we all accept is stuttering. Stuttering is quite clearly a psychosomatic problem in a certain technical sense. But is it what any of us really want to mean by psychosomatic illness?

 

It is worth looking at Harold Wolff. He is said, at least by some, to be the founder of psychosomatic medicine. He was a migraine sufferer and tendered explanations. I have pointed out in another thread that his obituary in the Lancet indicates an upright scientist looking for causal mechanisms in a reasonably normal manner.

Sadly, as he was practising and researching in 1950's America, there is another side to this as set out initially in David Marks' Search for the Manchurian Candidate. Marks seems to have been not a "conspiracy theorist" but a well informed reseacher. There will however no doubt be errors. There always are. Wolff worked closely with the CIA and in 1956, along with Hinkle, produced "Communist Interrogation and Indoctrination". He then went on to set up, with CIA funding, the Socity for the Investigation of Human Ecology, in which Gregory Bateson and Margaret Mead were involved and this was used as a front to pass CIA money to researchers. It all gets much too complicated for me.

This is from records at Cornell
The human ecology program was established in 1954 as a joint program of the Departments of Medicine, Division of Neurology and Psychiatry. Dr. Harold Wolff was the head of the program, which studied the interaction of people and their environment and its impact on their health. Some of the research was funded by the Society for the Investigation of Human Ecology, which had connections to the CIA. After Dr. Wolff's death in 1962, Dr. Lawrence Hinkle, Jr. took over the program, which became a separate division in 1963. One major project, led by Dr. Lawrence Hinkle, Jr. was the heart study in which male telephone employees were studied. The program was disbanded in 1988 when Dr. Hinkle retired
https://library.weill.cornell.edu/sites/default/files/human_ecology.pdf#:~:text=The human ecology program was established in 1954,Human Ecology, which had connections to the CIA.

Wolff appears to have made facilities available for CIA experimentaton and was prepared to countenance research which might lead to harm of patients provided it was not undertaken at Cornell.

There are connections between these operation and the Cybernetics movement funded by the Macy foundation which was also used by the CIA.

Interestingly Bandler and Grinder who founded NLP which was in turn a source for Lightning Process were influenced by Bateson.

One begins to understand where all the circular diagrams orginate.

 

It is for all these reasons that I am deeply uneasy about the fact that the psychosomatic explanation of ME came from from Imboden, Canter and Cluff's work at Fort Detrick, where the Chemical Corp, who funded the work, through the SOD worked hand in glove with the CIA's TSS.

There is probably no way of ever knowing what went on, but nothing should be taken at face value.

 

So for example, a character in a TV show has a psychosomatic limp. Is that a real thing?

 

The limping is real. Not sure what you mean by 'thing' though? Or why use this particular example?

 

To use the language of PK Thomas, is the limp "simulated" or "volitional". Presumably it is because it is an actor playing the part, unless the actor has a "real" limp, in which case is he simulating a simulated limp?

I'll shut up now.

 

Notably, all demonstrated psychosomatic phenomena (namely, where the mind is a key trigger for a physical symptom to develop, with a characterised mechanism) are transient. Symptoms that are invariant/continuous for months or years have never really been demonstrated (with a clear mechanism) to be psychosomatic.

 

The late 1940s through 1960s were the psychoanalytic high water mark in the USA. Were Wolff and others using (consciously or not) Freudian assumptions that were in the air? I don't go a bundle on Nabokov (famous for Lolita), but he was on the money about Freud, "the Viennese witchdoctor". One of the psychs' journals even claimed that pulmonary tuberculosis had a psychosomatic component after the MRC streptomycin trial.

ETA
Just checked, and the TB research that I vaguely recalled belonged to Thomas Holmes, who was mentored by Wolff. Some useful history here:
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.831.9790&rep=rep1&type=pdf

 

It could be that psychosomatic illness is in the head of the doctor who doesn't want to believe or treat the patient he's looking at.

 

It is hard not to view the term "psychosomatic" as a direct relic of ancient body/soul dualistic conceptions. What we call emotions, perceptions, cognitions, consciousness, dreams and the "unconscious" if one wants to hold on to that one, do not exist in some immaterial dimension called the "psyche" that would be distinct from the "soma". All have bodily substrates. Neural substrates. Their very fabric is that substrate. I'm an unrepentant die-hard monistic materialist as far as our body goes (the universe is another matter) and cast my vote in favour of retiring the term "psychosomatic" from medical vocabulary once and for all! In favour of a fully integrated physiological monism. Moving away from psychosomatic approaches and, instead, for example, studying how the central nervous system interacts with the immune system.

 

I apologise for being miserable, but I do wonder whether "Does psychosomatic illness exist?" may be the wrong question and one which may be unanswerable.

What conditions would have to be satisfied to answer "yes"? There would have to be an illness, presumably defined by criteria, which are probably artificial and arbitrary. It would have to be shown that, in addition, that the "illness" was caused by mental or psychological factors. But we were told by Hume that you can never prove causation, only invariable association. In these circumstances what proof would be considered acceptable?

What then is meant by "exist"? does satisfaction of those criteria constitute existence, or is it merely a verbal concept? And does conformity with a verbal concept constitute existence?

I have no idea. Perhaps another glass will help.

 

Hume is a nice cuddly writer good for bedtime reading. However, his argument about causation doesn't really work, and perhaps more importantly has probably been misconstrued by almost all philosophers.

Science accepts that we can never prove any account of causation to be 100% true as judged by future events. But all theories in science accept the fact that if Ivan Ooze were to cover the world in purple goo tonight nobody would observe the sun rise tomorrow. It is not a real problem.

All we want is the best fit theory for what will happen next time and we have ample evidence for one being better than another.

On a more metaphysical note, if nothing caused anything we could not observe anything, because to observe is to be causally influenced by the world. The fact that we noted the sun was up this morning shows cause. What may be uncertain is the precise mathematical structure of the causal power. And in a way the fact that we might be surprised only to find purple goo tomorrow would not be expected to alter the truth of a theory. It would simply indicate a particular set of circumstance that the theory would cope with very well.

I realise that one could argue round and round about this for ever, but I have a personal reason to raise it. That is that I have just written a paper about causation and a referee has raised Hume on spurious grounds. Philosophy these days seems to consist almost entirely of such spurious ramblings.

 

Apologies for being spurious then. But not having read the paper I can comment no further.

 

Unless Kant was onto something, and causation is nothing more than perspective, a human "tool" with which to better navigate life. I think that was Kant. Sorry if I am misremembering. Sorry, too, if I am bungling what he or whoever said about causation.

As for psychosomatic illnesses, just because something can have a label affixed to it, doesn't mean necessarily it exists in any meaningful way. I find this true with many psych constructs.

 

Historically and in fiction the supposed signs of ‘psychosomatic illnesses’ overlap with the signs of ‘malingering‘ and potentially include:

- doesn’t make medical/scientific sense, eg paralysis when there is no evidence of nerve damage
- involves voluntary actions, but not reflexes, eg blinking when object approaches the eye in hysterical blindness
- inconsistent or variable presentation, eg a paralysis that disappears when no medical observer is present or disappears when needed to prevent a fall, or the presence of mutism when talking to some people but not to others

In the world of popular culture, if not psychiatry, these concepts grew out of Freudian Psychoanalysis and the First World War understanding of shell shock.

However, I don’t know if there are any clear cut demonstrable examples of illnesses involving the above, and in most real life situations things are much more complex.

For example to say something does not make scientific/medical sense depends entirely on our current state of medical knowledge and ignores conditions like MS that were previously understood to psychiatric but are now known to be neurological. Because a complex condition is currently poorly understood this is not of itself evidence that is psychosomatic. Also variability of does not necessarily mean a psychological basis, it may as likely mean we do not understand the triggers or causes of the symptoms. Because we currently fail to identify the patterns does not mean that patterns do not exist.

 

I think Parmenides had got there and of course Plato with his cave and Leibniz with his well founded illusion. Kant merely said rather badly what others had said better, to my mind.

But all that was said was that our idea of causation is just an idea of whatever it is an idea of. The intuitive billiard ball model of causation is of course hopelessly inconsistent, but the account of causation in modern field theory I find pretty good. It handles Parmenides, Zeno and Plato pretty well I think. The mistake was to think that there are enduring objects that travel. The man who did most damage to philosophy was Aristotle. Plato should never have taken him on.

 

But is that just another idea of what it is an idea of? Where is the point of distinction?