Viewpoint: “It’s All in Your Head”—Medicine’s Silent Epidemic

Contradictory text. First, the author acknowledges that there are physiological abnormalities in the brain: "Over the past 10 years, neuroimaging research studies have consistently identified brain abnormalities in patients with medically unexplained symptoms—yes,biologically based changes in the activity and connections of brain regions, such as the amygdala, prefrontal cortex, temporal-parietal junction, and other structures."

Then, he says that we don't really understand what we see; but at the same time, he calls the observed abnormalities "software errors". That, of course, leads to the conclusion that the conditions are functional and that the best management strategy is re-programming (i.e. physical therapy, occupational therapy, and psychotherapy).

How does the author know that the abnormalities are the consequence of software errors, if he admits that we don't understand what we are seeing? Many of the abnormalities in ME/CFS studies—such as microglia activation and increased temperature and lactate levels—don't sound like software errors.

 

Many of the doctors I have seen have been caring but they are taught certain things as facts and never revisit them. Instinctively they know that dismissing patients is not why they went into medicine.

This sort of article soothes those doubts by saying that it is the way it is being done which is the problem and causing the rift with patients. The unspoken message is that the underlying theory is valid while the real cause is that the underlying theory is pseudoscientific rubbish and patients know it.

 

RE: having phantom pains in a limb that never existed
Thanks @Andy for finding the article, it links to this paper from 2012: https://sci-hub.se/10.1080/13554794.2011.556128
@Jonathan Edwards

 

For some reason I can't get your sci-hub link to work, but this one works for me (changed the .se to .tw):

https://sci-hub.tw/10.1080/13554794.2011.556128

 

Hi all, keep in mind, the author of this paper is a disciple of Ted Kaptchuk and his "powerful placebo" pseudoscience.

https://onlinelibrary.wiley.com/doi/10.1002/ana.25387 (Burke and Kaptchuk)
http://www.tmslab.org/tms class slides/067.pdf (PLACEBO EFFECTS & TRANSCRANIAL MAGNETIC STIMULATION by Burke)

More on Ted Kaptchuk:
https://sciencebasedmedicine.org/du...ool-and-the-curious-case-of-ted-kaptchuk-omd/
https://sciencebasedmedicine.org/du...nd-the-curious-case-of-ted-kaptchuk-omd-cont/

 

And the argument completely ignores the fact that those things have been available and offered for decades. That's what I don't get, it's not talking about making psychological support available to chronic health patients for the first time, it has literally been the default for the last century or so, "maybe it's all in your head, try therapy" is literally where we are right now and have been for decades. It wasn't always available but we have at least several decades in which psychosomatic hand-offs to therapy for chronic health problems have been the norm, available and in fact undertaken by millions of people.

If it worked at all there would be no need to make this argument, it's already in place. And in the UK and a few other countries they have been made specifically available for the whole MUS thing as part of an actual system of guidelines and there is no change whatsoever. In Germany it seems to be the only thing made available for many discriminated diseases and no change there either.

Yet the argument basically amounts to "why don't we try that instead?", when it is in fact the thing that's been tried and failed. And it's not as if technological progress or scientific understanding in regards to psychotherapy has changed in the past century, it's been completely stagnant this whole time because it's a complete black box and we still don't know how to do it any better yet.

 

Extraordinary claims require extraordinary evidence...

The woman in that phantom pain case study had a hand previously and the burning pain could well have resulted after there was peripheral regeneration of the nerves formerly connected to the hand, leading to sensitivity to things they shouldn't normally be sensitive to (peripherally). The resolution of the pain, may well have been natural recovery, we don't know as there was no controlled trial.

Effort perception is a brain phenomena - the mind models limb movement because proprioceptive feedback is too slow to control precise movement in real-time. Pain on the other hand is reliant on afferent nerves.

 

Neither works for me.

A message comes up in Russian: для просмотра статьи разгадайте капчу. Google translated: solve the captcha to view the article.

After our U.S. last election, I'm not sure about this. Is it safe to enter the caption?

 

I have no idea about the captcha thing, I can't see that. I've just tried both the links - the one that didn't work for me earlier and the one I linked myself. And now they both work! I have no idea what is going on at all!

 

I get the captcha too.

 

It's safe. If searching for or downloading a new paper (one that isn't in the Sci-hub library) you need to enter the word in the box each time.

 

This guy is going to be shocked when someone tells him that there is still much to be learned about the human body.

One might even suggest he stroll over to the Harvard ME/CFS Collaboration and observe what's going on there.

 

No surprise to learn that one of the mentors of the author is our 'friend' Jon Stone
https://twitter.com/user/status/1173635128813334528


ETA: Got rid of an unwanted apostrophe.

 

https://twitter.com/user/status/1174577745436786688

 

https://twitter.com/user/status/1176893801782239233

 

ME is caused by malfunctioning machines left behind on Mars by an ancient and now extinct alien race. There, I have "explained" ME, or so the logic of BPS theorists goes.

Whether anyone finds this plausible and convincing, and whether there is any evidence that this is true is a different story. Just because I can construct a story in my head doesn't mean I have explained anything. I have just constructed a story.

 

I still cannot tell the difference between "explaining from a BPS perspective" and making stuff up. Yes, it is an explanation. A made-up one. Just like astrology. The natural philosophy equivalent of this or that god or spirit did it, quit asking. Replace with any belief system in existence, it is completely interchangeable.

I've read enough BPS literature so far to have a sense that this is all there is to it, making up explanations for the sake of having one, not caring about whether it is even at all relevant, with the belief that all that is needed is an explanation, any explanation, confidently told by a reassuring medical professional. In a nutshell: complete BS. I have not seen anything contradicting this. I have read several explanations of this "rousing reassurance" BS. This is all there is to it. Even the supposed "taking the individual as a whole" is complete BS, the whole thing is obsessed with a tiny slice of reductive, and mostly made-up, magical psychology, one that disregards everything the patient says so it cannot even be said to actually take it into account, it's a monologue, not a dialogue.

BPS is the opposite of science every bit as much as a cult is: being satisfied with an explanation for phenomenon X because "do you have a better explanation?" as a false dichotomy. The thought leaders of this ideology appear to be as ethically bankrupt as they are scientifically and display casual disregard not only for the scientific method and its value but especially to the consequences of their work, to which they pay no attention and cherry-pick only things that reaffirm the belief system.

I do not like this pseudoscience. It is a demented waste of everything. And frankly any system that takes this seriously at all is fundamentally broken and needs complete reform. It's not enough to see it fail and move on, the conditions that lead to this have to be thoroughly fixed.

 

It occurs to me that the only explanation they feel they need is that the patient has an emotional problem that can be cured by the patient accepting they have an emotional problem but no actual disease. Treated by CBT

In other words they answer the question "Why does this patient appear to have a medical disease when they don't?" with the explanation that there must be an emotional problem. Simple as that, treat with CBT.

 

Re MUS
https://twitter.com/user/status/1178220953551200256

 

It seems highly likely that there is, in some cases, an emotional problem.

It's just that it is the psychiatrist who has it.