Psychosomatic medicine and the psychologising of physical diseases

Very early in my disease I had problems with my speech even though I was still able to attend school. It would start with stuttering then stop altogether. There was no psychological input or situation when it happened though nowadays I would call it the first sign of a crash. It never happened at moments of high stress or anxiety.

It felt physical and went hand in hand with a lack of precision of movement.

 

Many stutterers find that they can speak fluently if they wear headphones giving them delayed auditory feedback.
I don’t know if this works for stuttering post-stroke - but in my experience, stuttering after stroke is easier to treat than developmental stuttering.
I haven’t ever thought of stuttering as psychosomatic. Significant levels of distress can result from it, usually due to the reactions of other people to the stuttering and the pressure to be fluent. Stress/distress then ‘feeds’ the stuttering and the whole thing gets more complex.

I should try to find some research - but I haven’t the energy! My professional understanding, limited though it is, is that stuttering may be due to a problem with feedback loops.... a motor speech control problem - which I’m not sure you would call ‘mind’.

 

Yes, "psychosomatic" is not a clear objective concept. Its waffle. Its a buzzword for many psychiatrists. We need specific treatable mechanisms, not generic and malleable terminology.

Sadly we see such terminology a lot in psychiatry. What the heck is "conversion disorder" in reality? One analogy of what is going on might be that the response to square pegs not fitting into round holes is not just using a hammer, but making the hole larger so almost everything fits. Medical terms need as much precision as we can muster.

 

This is one of the issues with psychosomatic claims. Distress arising from a physical issue is, classically, psychosomatic. That does not mean that the problem is. The problem causes the emotions, but those emotions are also present in a real physical brain. If some part of the brain is struggling to function then cognitive states might affect their function. This is exacerbation, not causation of the basic problem.

From time to time I keep thinking about changing my signature, getting rid of "psychosomatic" and replacing it with "psychogenic". "Psychogenic" is more specific and the real problem, but its less recognised.

I suspect autism and ME share the same issues with cognitive overload by slightly different mechanisms. If I am right then autism and ME together makes things even harder.

 

It is worth repeating that it was noticed that eczema and psoriasis are worse at times of stress. This would have led to them being called psychosomatic and treated by CBT but the researchers were biomedical so they investigated further and discovered the interesting fact that stress causes immune cells in the skin to move up a layer closer to the surface and that is what leads to the skin problems. They think it is possibly an evolutionary advantage if the immune cells are primed to fight microbial invasion in case of wounds.

Calling something psychosomatic or psychogenic is not an end point but a beginning.

 

I suffer(ed) from chronic eczema (from a young age, predates other symptoms) and I never noticed any difference with stress (uni exams, relationships etc). The only thing I have consistently noticed is that diet (milk products and nuts) seem to trigger it.

I suspect the narrative (of stress exacerbation) is more common than actual experiences.

 

Interestingly I regard my eczema as a symptom of my ME. It did not begin until after the onset of my ME and gets worse when my ME is worse.

 

That is certainly curious! Do you have any gut related symptoms when your ME & eczema worsens?

 

How would it be possible to show that it was the psychological attributes of stress, rather than any preceding physiological ones, which led to any increase in symptoms? Even if one could show an invariable correlation between "stress" and some symptoms constituting an illness, would that be proof of the existence of psychosomatic illness, and what would that tell us about the way the word "psychosomatic" is used?

 

Robert Dantzer, author of The Psychosomatic Delusion, started his career trying to reduce stress in farm animals, which meant he didn't fall for patient-blaming in humans. He found a long time ago "that immune influences on brain functions were much more potent than brain influences on immunity."
https://faculty.mdanderson.org/profiles/robert_dantzer.html

 

When I was a kid in second grade, I became terrified my parents would die in a car accident or I'd be abandoned some other way. I had stomach aches every morning before going to school. Was that psychosomatic? Was they caused by anxiety and a stress response? Or was it just a normal sensation I paid more attention to? I have no idea. But the stomach aches were very real to me.

 

Isn't there a tautology in "they were real to me"? The sensations were experienced. The sensations were real. In what way could they be unreal? Is that a discussion about "reality" or causation?

 

I also have IBS and food intolerances that post date the onset of my ME. The IBS varies with my ME; it is both a symptom of PEM for me and also triggered by food stuffs that I am intolerant too.

 

I have read on another forum about people with pet dogs or pet cats being told by vets that their pet's health problems were psychosomatic. I'm not sure if it was the owner or the pet being blamed for the health problem.

 

Pets and their owners, eh? Dantzer was definitely researching livestock before moving on to human endocrinology.

 

When I first became ill one of my most troubling symptoms was a sensation of extreme ‘anxiety’ even though nothing had changed in my life nor had reason to be anxious. In an effort to makes sense of this it was like my brain looked for things in my life to explain it. Maybe work stressed me and didn't realize or something else I thought? Tranquilizers, ssri’s, or a change in thinking had no effect. Out of desperation after 8 months or so experiencing this non-stop I fasted. Within 2 days all the things I fretted about and thought to be the cause to the ‘anxiety’ I no longer fretted about and no longer felt the ‘anxiety’. Once I ate again it returned. After months/years of self experimentation I discovered as long as I kept my digestion moving, and stayed clear of sugar, I never felt this sensation of ‘anxiety’. I even had several years where I had things working so well in my gut that even things that should have caused nervousness or anxiety didn’t.

In my case whatever is happening in my digestion produced symptoms of anxiety and incorrect thinking. In your case perhaps the stomach ache and what was going on in there caused the thinking you were experiencing as opposed to the thinking causing the stomach ache.

 

I used this example because the first time I ever heard the word 'psychosomatic' was when watching Sherlock (2010) and Sherlock says that Watson's limp is psychosomatic. (Which it then proves to be, because then later in the episode he leaves his cane behind during a chase scene and doesn't limp.) Of course this is all fictional, but I meant like can something like that happen in real life?

Oops I meant this to be a quote-reply to @Jonathan Edwards 's question but quoted the wrong post.