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

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.

 

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.

 

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?

 

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.

 

Isn't she just positing "conversion disorder" by another name, with a similar lack of explanation of how it happens?

 

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.

 

Maybe I should look at it. The great majority of reviews are positive and from migraine sufferers. It seems that Sacks does not give an answer but reviews the history? Presumably that has to involve mentioning psychosomatic theories.

 

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.

 

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.

 

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.

 

Here’s a book going cheap if you want it

 

Seemingly has happened elsewhere too

 

See also BMJ Opinion “Functional disorders”: one of medicine’s biggest failures (2023).