The Times: "The Sleeping Beauties by Suzanne O’Sullivan review — how the human mind can make us sick" by Tom Whipple, 2021

Snow Leopard said:
I've never seen anyone phrase it quite like that. But I wonder if there are still a few people who claim just that (or the equivalent with a different symptom)? (but even if they claim it, that doesn't mean it is true)
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Well Paul Garner seemed to claim that his being wimpish and following the advice of ME losers made him go on being fatigued. But of course at the time he was not aware of that!
 
My focal epilepsy can create sensations that are never felt otherwise and do not obey the usual rules of what I'm normally supposed to be able to perceive. It is very much like a dream in that aspect.
 
Mithriel said:
Psychosomatic illnesses by contrast keep evoking the power of the mind without ever explaining what that power is or by what process the brain can create and maintain a real, crippling illness. How and why can the brain stop impulses being decoded as they pass from the eye to our consciousness? At what point does the brain block a signal along the nerve to move an arm. Why does it happen? Why can the conscious mind not overrule it? Invoking the "subconscious" is not an answer.

Maybe such things are possible but they are so unlikely and so against our experience that the evidence must be extraordinary and compelling yet too often it is exceptionally weak.
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For me, the last point you make here is the most important point. It is possible but we don't have the evidence. We just don't know and we have to be ok with not knowing. The body (including the brain) is incredibly complex. A few years ago we would have thought it impossible that the gut microbiome could have an effect on mood/immune system yet this seems now to be the case. Unknown interactions between different organs including the brain are possible.

The problem, as I see it, is basing treatments on the psychosomatic model before the evidence is there and simultaneously not listening to patient feedback. History shows that labeling an illness as psychosomatic when there is absolutely no evidence this is true is incredibly risky. If you're going to do so and implement treatments based this, you better 1. Closely monitor and study the efficacy of your treatments, 2. Listen closely to patient experiences. Psychiatrists working on the premise that an illness is psychosomatic should be constantly reviewing and reflecting on their practice and taking into account patient views.

This is what ME psychiatrists have failed to do. They have come up with this model of ME, devised a treatment based on their model, carried out poor quality research and refused to listen to patient experience. I don't blame them for coming up with the hypothesis that ME is psychosomatic. I trust in science and therefore I think that anybody should be able to ask any question so long as they test it properly. I'm fine for people to go ahead and form a hypothetical model of ME based on psychosomatics so long as they then research it well and are humble and professional enough to hold the awareness that it might be wrong. The problem in my mind is not the hypothesis itself but the action of basing treatments on this premise, running substandard studies and refusing to listen to patients who report that your treatments are harming them. I can't fathom the arrogance of somebody who in this position would bulldoze over the patient experience. It seems that in areas like this when there is no objective evidence, patient experience should be at the forefront.
 
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Jonathan Edwards said:
The mind can make people seem sick. The most obvious example is malingering, which is obviously a real phenomenon.
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Maybe I have misunderstood the meaning of "malingering", but isn't it by definition an act, something you intentionally choose to do? I don't follow, how would that be the mind causing something when the symptoms are fake, simulated? Isn't it just conscious, voluntary behaviour in order to deceive others? In other words, in other people's minds you might seem sick, but you yourself are aware that you're not really sick?
 
mango said:
In other words, in other people's minds you might seem sick, but you yourself are aware that you're not really sick?
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Exactly, malingering is the mind making someone seem sick (to others).

This is excluded from the usual understanding of psychosomatic but perhaps it is the only real situation where the mind is at least making people get diagnosed with an illness. And various sources suggest that 'resignation syndrome' might some of the time be no more than that.
 
Tia said:
If I remember rightly, Swedish psychologists had set up a centre where these girls could go and be gently nurtured and cared for by kind nurses and psychologists and with support and guidance they would gradually heal.
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Tia said:
If psychological treatments work with the Swedish girls,
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I note again that this was not a condition exclusively of girls - there's this paper that reported on 46 consecutive cases of Resignation syndrome:
46 consecutive children with RS grade 2 (n = 46, 22 boys, 24 girls) were included during the years 2010 to 2018.
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https://link.springer.com/article/10.1007/s00787-019-01427-0


(note that that paper was co-written by a doctor who became well-known as a result of her work with the children with resignation syndrome. It was not only the families of the children who benefited. An article followed that particular doctor as she did her work - here are some excerpts from the article:
https://www.newyorker.com/magazine/2017/04/03/the-trauma-of-facing-deportation
At the recommendation of neighbors, Georgi’s parents called Elisabeth Hultcrantz, an ear-nose-and-throat doctor who volunteers for the charity Doctors of the World. Three days after Georgi took to his bed, Hultcrantz drove to his home
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Hultcrantz, who has treated more than forty children with apathy, empathizes with her patients so viscerally that answers to routine questions can make her cry.
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As Hultcrantz sees it, her most important task as a doctor is to be a good writer, constructing a coherent narrative from her patients’ physical symptoms, which she interprets as metaphors for psychic distress.
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A chipper, gray-haired grandmother, Hultcrantz seems unaware of her power. She sometimes encourages families to “get their tubing”—the feeding tube—as quickly as possible, in order to emphasize their suffering to the Migration Board. Her iPhone is full of photographs that she has taken of refugee children lying in bed.
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Nurije led Hultcrantz into the bedroom, pulled off the girls’ quilts, and undressed them, leaving their blouses draped around their necks. “Oh, Djeneta,” Hultcrantz said, in a maternal tone.
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When Hultcrantz gave Ibadeta a breast exam—one of her patients had developed cancer, which remained undetected during the months that she lay in bed—I began to feel faint. The girls looked uncannily beautiful.
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The girls had a cousin who had become apathetic, and I asked Muharrem and Nurije, through a Romani translator who helped with the interview, if they thought that the illness was contagious.
“No, no, no,” Hultcrantz interrupted, before the translator could relay the question. “They had never been in contact with the cousin when she was sick.” Hultcrantz refused to let the interpreter translate my question, which she seemed to consider an insinuation that the condition was somehow less real.
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Georgi’s next-door neighbor, a Russian girl named Revekka, was given a diagnosis of apathy three years before him. She had become ill when she was twelve, after the Migration Board rejected her family’s application for asylum. Ellina Zapolskaia, a friend of both families who lived nearby and had practiced medicine in Russia, told me that, after Georgi’s first day in bed, “I knew it was the same sickness.”
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Hultcrantz’s prescriptions also acquire the weight of prophecy. She is humble, selfless, and extraordinarily generous—she often lets asylum seekers stay in her house for months or years—but the story she tells about her patients’ illness is perhaps too compelling; she seems to inadvertently reinforce their symptoms.
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about a boy who was recovering said:
She ran her hand through his hair, as she often did, but he stiffened. She asked him if she could continue touching him. In a soft voice, he answered, “No.” She interpreted this as a good sign: he was redrawing boundaries around his body.
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Among doctors who treat apathy, there’s a widely circulated anecdote about a young patient who learned Swedish while she was unconscious.
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Hultcrantz seemed to worry that I was directing him down an inappropriate conversational path, and she interrupted to tell him, “If I’m understanding you correctly, you’re saying that, even if you had known this could save your family, you wouldn’t want to go in the cage again.”
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What is clear from the New Yorker article is that the Resignation Syndrome cases were happening in a very political environment. The cases were used, very vigourously used, to change Sweden's treatment of refugees.
A hundred and sixty thousand Swedes signed a petition to stop the deportations of apathetic children and other asylum seekers. Five of Sweden’s seven political parties demanded amnesty for apathetic patients. On the television program “Mission Investigate,” Gellert Tamas, one of the country’s best-known journalists, reported, “The issue is only a few hours from bringing down the government.” The Swedish Parliament passed a temporary act that gave thirty thousand people whose deportations were pending the right to have the Migration Board review their applications again. The board began allowing apathetic children and their families to stay.
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Jonathan Edwards said:
However, my memory of Sacks's books was that he presented the strange world of neurology with genuine sympathy and no claim to explain with psychologising.
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I thought so too, until I picked up an old copy of his book on migraines - I talked about it here:
ME/CFS SKeptic: A new blog series on the dark history of psychosomatic medicine
 
dave30th said:
Isn't she just positing "conversion disorder" by another name, with a similar lack of explanation of how it happens?
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Yes, I think there must be a similar concept of some unconscious phantom consciousness that works out that it wants to have fits. My point is that if its unconscious it isn't phantom or a consciousness but just a brain computing results. She does of course given explanation of how it happens, unlike Freud, in terms of 'predictive coding'. Predictive coding theory is all worked out in computer models by people like Karl Friston. The only problems that these models do not actually predict anything like this. Mark Edwards wrote something about FND being due to predictive coding and his argument was plain back to front.

So these people's theory has the advantage of being demonstrably wrong rather than indeterminate, as for Freud.
 
@Hutan that's a fascinating article, thanks for sharing it. Quite different to the one I read last year which I think might have been from the BBC, I'll have a look and see if I can find it.
 
I was enjoying Sack's book until I read the section on migraine. He used the example of a woman who developed a migraine every night when her husband was due home but stopped having them when she was divorced (or something like that). He said the migraines were a way of avoiding him but they could just as easily been due to tension and stress.

He then explicitly said that one or two migraines a week were physical disease but more than that were psychosomatic or hysterical.
 
Jonathan Edwards said:
This I would actually disagree with since it is the area of neuroscience I work on. We have very plausible mechanisms for brains producing pains or fits or fatigue or whatever you like.

All the things we are aware of are patterns of symbols that the brain constructs using inferences based on sensory inputs. When I see that my black lacquered piano is all the same colour it is because my brain calculates that all the complicated patterns of colours on the piano are reflections from furniture and curtains and flower vases and airbrushes them out unless I deliberate look at the light pattern.

Brains create dreams. Something that can create an extended complicated story with moving pictures and other sensations that are not there can create pretty much whatever you like. And since all these colours and sensations like touch and smell are all symbols the brain invents to talk to itself there is nothing surprising or implausible about any of it. The deep puzzle is how electrical patterns in nerve dendrites are 'felt' as everything from the red of a tomato to the concept of GDP. But Descartes understood the nature of that puzzle and also the fact that it is only surprising because we instinctively believe that red is out in the world rather than inside our head. If I live long enough I might manage to get a handle on how the connection does actually work. I have made significant progress this year but need help from other younger minds.
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I agree that everything we experience is because of the brain. It is a fascinating branch of science with the added awe of a physical organ being able to examine its own workings.

My point is that that is not enough to be the base for a medical diagnosis. In, say, MS it is not enough to say the brain works in mysterious ways, the exact mechanism has been researched. How does the brain interact with bodily systems to cause them to go wrong?

Either all diseases are just the brain interpreting things or other organs can stop working properly such as the bowel or bladder or a right foot. If you state that some diseases are purely interpretations by the brain while others have a separate cause you must present evidence of how you detect the difference and that is missing.

The brain can produce dreams and connections but why and how does it go wrong in some people?

Their position is also dubious and requires an extraordinary level of evidence because so many diseases have been stated with great confidence to be caused by the mind and thoughts only for the physical damage to organs to be discovered later. MEskeptics blog series has collected some fine examples of that and many cases of the 19th century proponents of psychosomatic medicine have been shown to be misinterpretations of physical disease.

These ideas of psychosomatic disease have practical consequences causing suffering for millions of people. They are as insidious as eugenics and racist theories and date from the same time. They are having a terrible effect on society and to see them being rolled out and become entrenched in medical thinking is frightening.
 
Jonathan Edwards said:
Brains create dreams. Something that can create an extended complicated story with moving pictures and other sensations that are not there can create pretty much whatever you like. And since all these colours and sensations like touch and smell are all symbols the brain invents to talk to itself there is nothing surprising or implausible about any of it.
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But those sensations/perceptions in dreams are flawed. They are not anything like reality. It is just the brain often doesn't care.
I regularly wake up from dreams simply because they are not real enough. Last night I woke up after trying to eat pizza in a dream. At the instant of "tasting" it, I knew it was a dream and woke up.
 
I don't think I have ever eaten anything in a dream - it's not something I dream about.

I also can't read in dreams, which isn't to say that I may not get the gist of what something written means, I just can't read, anything. TV is another one, I am aware of being in a room, in a dream, with a TV on, but I can't actually see, or hear, what's on it, even when I try.

The possibility exists that kettles, and other kitchen appliances, may also be among things that don't work in dreams.

The whole things appearing, and disappearing, with no rhyme or reason, the difficulty on focusing on anything which isn't a main point of the storyline etc.

these sorts of things make it easy to tell if something is a dream or not.

Of course, in 'reality' my glasses don't work all that well these days (needed replacing before the pandemic), and I often can't read/understand/process text due to cognitive issues - all make it much more fun.
 
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