Psychosomatic medicine and the psychologising of physical diseases

It is a more consistent idea. It resolves all the problems with infinite gradients that Zeno and Leibniz pointed out bedevil the more intuitive approach.

 

This might be so or not, but its´s useless in the discussion anyway, at least at first instance:

Because there is a normal sense of causation, which is used in everyday thinking and language, we just ask if psychological things would cause something like physiological things do. And this "something" is any somatic thing.


In respect of the philosophers and their theories, it may be important to see, that a theory which denies the entity for which it pretends to be a theory, may well turn out to have just failed. A theory on causation, that tells there is no causation, must be considered dubious, for now I for instance may not not cause this writing.

If this goes for Kant, I don´t know. His approach was, to find the techniques by which the soul perceives the things in the world. And here he says time, space and causation are such techniques (so the soul would rather stretch into the world, by these categories).

And the correlation for the perceiving soul, are now the things not viewed anymore on their own, because they are now viewed in respect of the perceiving soul, as part of a special reflection (his theory). But if one reflects further, one may ask: what are the things viewed on their own without any perception. And here the answere is: nobody knows. - Note that "a thing viewed on its own" with being perceived is the normal case, which we share with animals (in so far we indeed don´t reflect on such relation).

But Hume has failed, because he simply says, there is no causation, and we only would build such a relation after we have looked into the world. He even didn´t notice that he needs to say (and indeed says explicitly), that his causation is "caused" by the regularity we experience in the world.

 

Very well put!!

 

I should probably introduce Wittgenstein, but knowing the contempt in which he is held in some quarters, will not.

How is Dr Pangloss doing these days?

 

My answer to this question is, with caveats, no.

These are my personal views, written at three something a.m. with blurry eyes and a fogged brain, but I have been putting off answering this but feel further comment is needed.

Let us take "psychosomatic". It literally implies a connection between mind and body. That is where the problems begin.
Exploring the connection between mind and body is a valid discipline. Its not science though. Its metaphysics.

We have to backtrack to what is mind. Classically its some thing, some entity, separate from body, but connected to body somehow. There are lots of sophisticated arguments as to why this is so, but the simple answer, and in my view much more likely to be correct, is there is no mind in this sense. Mind is just what we observe of brain function. What we call mind arises out of the activity of the brain.

Psychogenic is something else again. A psychogenic illness would be one in which the mind, the psyche, causes the illness. In the case of physical illness there would have to be a concrete mechanism connecting mind to the many physiological abnormalities we find in these patients ... like for example in IBS or ME, though in past times we can include claims made about so many diseases its almost universal, including heart disease and cancer. No such mechanisms have been provided. If such mechanisms are ever provided then most likely they would connect brain and disease, not mind and disease.

So in its literal sense, there is no evidence that any psychosomatic illness exists. Taken in a broader sense, in which what we call mind is a property of brain, a emergent function, its a whole other issue. Brain disease clearly exists. So this might fall under that category. However this creates a further caveat on mental disease.

Mental disease is a misnomer. Mental disease is so broad a category, and so badly founded in science, that once its framed as brain disease there are problems. Some clearly would be brain diseases, and require better understanding of brain, and how it goes wrong, to find cures. Yes, cures. If there are no cures, then we don't really have a proper understanding. So you should be able to go to your doctor, be objectively diagnosed, and given a cure, and you don't see them again.

On the other hand, some of what a few might want to call brain disease are just where normal operation of brain is askew ... the brain has learned the wrong things. These are more properly psychological disorders, not a disease, and in particular not a disease of the brain. Its also socially dangerous to define some of these things as diseases, because that would cover things from cult brainwashing to being loyal to a local sports team, or your favourite celebrity. I would not want to call those diseases.

If you allow psychosomatic disease to include brain disease, and psychological disorders, and not to include psychogenic disease, then yes, psychosomatic illness exists. Otherwise, no.

Psychosomatic, and worse, psychogenic, imply a range of hypothetical ideas that are unproven and may be just wrong. When you start from a basis of psychosomatic and psychogenic, and take these ideas seriously, then you run the risk of making spurious inferences, and then claims based upon those inferences. In my view its pseudoscience.

Psychiatry needs enough research development so that patients can be treated for brain disease, which is neurology, or patients can be treated for psychological disorders, which is psychology. There will also be some who have both of course, which is either comorbidity or a hybrid discipline psychoneurology or neuropsychology, though psychiatry might in the end find a home there. In my view psychiatry exists right now because we still don't understand brain. It has trappings of science, but is largely unscientific, and hence mostly pseudoscience.

I do think that will change, but I think its still a long road ahead. Objective diagnostic tests are a critical step in getting there. Just like they are for ME or any disease or disorder that is not understood.

 

Perfect. Couldn't be better.

 

I think there are some reports around, but they will stay anecdotical, I guess. One cancer patient was given an additional placebo by a doctor, who well noticed that his patient was going to leave the world. The doctor said, that the new drug has not already gone through all the trials, but it happened that he has access to it. And then the miracle happened that the cancer went to vanish. But a bit later the patient read in the newspaper, that the drug had turned out to be without any effect - and he got his cancer fully back. He was in anger when he told it his doctor. But his doctor said, it would have been misinformation. And with the placebo the cancer again shrunk. Finally, though, the patient died.

Maybe this story is true, though I think well known. There are some points though.

Great influence is only reported here and there.

Even if a psychological entity (a believe) causes a physiological entity (vanishing cancer, on top of another treatment at least), it remans questionable, if there ever will show up a regularity which would allow for a description and a particular theory. After all the influence might be that complex as the single person is, in each case.

Then the question is how much a placebo can do. I think, placebo have been shown to work only for a while, sometimes with a former real medical which gets imitated (but it looses its power later). However, any transitional effect may be at work, when in cancer therapy some additional success from CBT is reported (if I remember rightly).

Taken together, I personally doubt that on a regular basis the psyche has such a big influence as it is claimed in psychosomatic "theory" (stub of it). It may be better to keep the different layers of our complex being separated, and to admit that single examples of our complex being do not indicate any regularity. And there are a lot of "mentally ill" people, and they are not physiological ill.


I think our illness is a nerve disease. And at some points - as ever - there will be an influence of deeds and believes. But this doesn´t qualify for a psychosomatic disease. It is clear to me that there has been an impact on the machinery.

 

The connection between mind and body seems to go under the term psychosomatic. Then based on mental conditions with somatic symptoms.

We know that mind and body and body and mind work across each other in a very complex system.

So what about the connection between body and mind then, based on somatic conditions with mental symptoms?
Does it have a name? Somaticpsycho?

Maybe it should have it's own name. For now, most things go under psychosomatic, and are therefore misunderstood.

 

Is the word psychosomatic, as used with reference to Wolff, used in the same way as it is with reference , to ,say, for the sake of argument, Abbey?

 

Hume: " The idea of cause derives from the experience of constant conjunctions.

- Kant: David, you would not apply the idea of cause to constant conjunctions in the first place if that idea did not already exist in your mind. It’s there prior to all experience. Causality is an a priori concept.

- Developmental psychologist: And at what age may I ask does this « a priori » concept appear in our minds? At 6? 3? Surely you are not suggesting we are born with it...

- Kant: Your question is insignificantly trivial. My discourse pertains to the transcendantal. The universal.

- Darwin: Sorry Emmanuel, I think the psych is onto something. It had to begin sometime, if not individually then certainly at the species level: Did we have this a priori concept 20 000 years ago? 50 000? Surely our primate ancestors had no clue of nor language for the concept of « causality » (but they noticed constant conjunctions for sure, all animals do, I kinda like this Hume)

- BPS philosopher: Gosh these evolutionary biologists are vexatious... Biology and philosophy don’t mix.

- Nietzsche: You’ve got that wrong, mister! All philosophies and in fact all human activities are all about certain biological forces seeking their own growth. Everywhere: Life forces. That was my groundbreaking intuition.

- Spinoza: No groudbreaking there, Friedrich, I had that intuition way before you did. See my theory of the universal conatus.

- Derrida: All this is so logocentric...

- Moderator: Jacques, stay the hell out of this, you are going to bore everyone to death! Just go write your hundredth book and since you don’t believe in meaning itself, it will be as meaningless as all your previous ones. At least Wittgenstein who was a philosophical killjoy as much as you are had the decency to stop writing at some point.
Now, the question was: does psychosomatic illness exist? "

(My apologies to @Sarah94 for this digression! And I would like to thank @chrisb, @Jonathan Edwards, @duncan and @spinoza577 for having reawakened in me dusty philosophical musings from a distant pre-ME life)

 

Yes. But we are going in circles. I asked whether it was the right question. Could we ask Wessely and Sharpe to draw us a diagram?

 

I don't know if that's true. When especially fatigued and having to push to do things, I sometimes stutter and sometimes have tourette like symptoms. The moments this happens are PEM and push related for me.

Also I have a good friend who stutters. he has a neurological condition that affects the way his body moves. His body is jittery. The way i see it happening it seems related to that, than a psychosomatic issue.

I've also noticed it when working in a clinic where some of the patients were or had been heavy drug users. It seemed related to their drug use or possibly changes or damage done to their brain from the heavy use.

Edit:
Some of what I now looked up about stuttering.

https://www.nidcd.nih.gov/health/stuttering

Interesting info on Wiki about it too. I'm too fatigued to quote and don't want to derail.

https://en.wikipedia.org/wiki/Stuttering

 

The history of laetrile that I looked into 20 years ago is much to this point. I think they were calling it B17, its a cyanide based poison. They claimed it was effective against cancer. A clinic in Israel claimed they cured a whole lot of cancer patients. If I recall this right, a UK reporter interviewed them. Wonderful, fantastic cure! A year later he went back for a repeat story. All dead, of cancer.

 

Maybe look at this in the other direction?

Maybe the term “psychosomatic” applies to any physical illness that psychiatrists (and others of a certain persuasion) believe they can treat by manipulating the sufferer’s mental approach?

Thus no background knowledge of aetiology is relevant.

Simply “prove” the treatment “works” and so “prove” the illness is psychosomatic!

Edit: Sorry - I don’t think much of the term psychosomatic. I honestly don’t think the psyche can produce physical symptoms of disease, and I don’t think psyche treatment can really alter physical ailments. That said I don’t deny that there are some individuals who overreact to minor sensations, and those people could I’m sure benefit from helpful mental training to ameliorate their heightened concerns.

 

I think this is what has happened, though "prove" can be from patients not coming back, or patients endorsing an improvement with no objective evidence of improvement. I wonder how many said they felt improved just to get away? Or we have the other end of the spectrum, the PACE trial, with improper manipulation of statistics on top of many other small biases. Do they hope if they put enough biases in a trial they will get the results they wish for?

 

I agree that there are various causes of stuttering. I am referring to the common type that occurs from childhood known as stammering, which can be demonstrated to be due to brain events of the sort we call mind.

Maybe that applies to being tired or having a stroke too. That may not be what is ordinarily thought of as psychosomatic but in technical biological terms maybe it counts. After a stroke the mind does not function properly.

 

There is no good reason to believe they exist. There are always viable alternative explanations that don't require believing in unobservable things.

It seems to be mainly a category where frustratingly incomprehensible phenomena are put in so we can pretend we understand.

 

I suffer from what I call 'verbal dyspraxia' but could be seen as 'stammering' to an observer, I just cannot get my tongue around common words, so this makes it hard to communicate verbally especially when I am in a stressful situation (I also have a diagnosis of general dyspraxia). However, in my case I don't think it is 'stress' causing the problem, rather cognitive overload (I am also autistic). From the outside people think I am showing anxiety and 'being emotional', but that isn't what I am feeling on the inside. I am simply overloaded and my brain feels like it is 'shutting down'. Any emotional aspect is a result of having to deal with the problem and other people's inappropriate response to my 'verbal dyspraxia', not the neurological problem in itself.

 

If people want to learn more about the cognitive processing problems often seen in autistic individuals, I suggest reading the books by Olga Bogdashina:

 

Yes, I get that too, but it is recognisably different from typical stammering.
Maybe this just demonstrates that the original question is a bit hard to pin down.