Opinion Why inflammatory reductionism is a threat to psychiatry and the rest of medicine, 2024, Pollak

Why inflammatory reductionism is a threat to psychiatry and the rest of medicine
Pollak, Thomas A

A new world-view is emerging, one which attempts to explain all manner of ills as the result of inflammation or immune dysfunction. While motivated by some genuinely exciting science, this seductively uncritical reductionism is symptomatic of an increasingly widespread cultural uneasiness with nuance or uncertainty, and often disguises a disturbing new brand of anti-psychiatry.

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Thomas A. Pollak King’s College London, London, UK

 

It's really baffling to see the zeal of talking from a profession that is fanatical about being reductive, if not psychiatry in general, certainly everything psychosomatic/psychobehavioral, and comparing one thing vs one thing when it's only them who have one thing and one thing only, the magical fantastical conversion disorder, while biomedical hypotheses are numerous. Just because they describe the same thing dozens of ways doesn't change that they truly only have the same concept going back all the way to Freud.

Their ideas have all been tried. Because they have only one idea. It's been tried, overtried, and then excessively overtried again and again. And it's still growing despite literally never working. Also they are not increasingly dismissed as medical gaslighting, they always have. Their own literature is filled with identical whines like this going back a full century, with all the same useless arguments.

It's actually a huge tell that people with one idea and one idea only are trying to pretend that there is also one idea on the biomedical side, especially when inflammation is more often than not misused as simply meaning that the immune system is where it's happening, and that it's likely caused by pathogens, which is far more coherent and plausible than their weird stuff ever was. Even more absurd is that since they don't have any actual evidence for the conversion disorder of psychosocial distress, one popular idea that has been growing, an updated analogue to the 'chemical imbalance' nonsense, is that stress causes inflammation.

Meanwhile they still have nothing. Not one single achievement to biomedicine's billions of lives saved/improved and numerous breakthroughs. But they are still pushing their weird pseudoscience, obsessively, mindlessly, in what can only be described as pathological inflexibility. Exactly what they project onto us. Because everything out of this weird ideology is pure projection. All of it. That's why they will never achieve anything with this. Only suffering and misery.

And there is, throwing rocks from a glass promontory, using a glass slingshot, directly at, uh, women I guess.

 

That’s a bit pot calling kettle black

and to open with a line calling it ‘a new world-view’ says darvo to me from someone who well understands the other views are political (small p at least - and then they try and claims ‘anti-psychiatry’ - and I think those silly activist phrases should be banned from grown-up literature) as much as medical in their implications and origins

maybe it’s been required as an argument style because of psychosomatic, personality-based Freudian - isms being far from nuanced or even proportional in their claims in abstracts and conclusions vs their own results

and if they use the term significant and evidence in a certain way that is less meaningful than laypersons would assume you’ve a tricky situation where it seems too many medics who are gatekeepers to funding and referrals and understanding conditions are persuaded by one paper making claims in their words vs one being measured making it look like the larger effect is in the former rather than the latter. Particularly when it’s the same literature

I agree that things should be presented on a basis of:
- these are the actual findings
- these are the potential flaws of questions we still have to bear in mind when looking at this
- this could be a possible meaning of this… or y.. or maybe something else will fit in future hence why we’ve detailed the more raw stuff
- if this is the case we’d likely see x,y,z detail this is why it fits and this why it mightnt with the experimental data that we can rely on

but they are up against storytelling told in an authorstive tone as if that’s the whole picture and is a truism such as ‘it’s all fight and flight avoidance’ or ‘chemical imbalance’

so I can sort of understand the need to describe another big picture possibility where your findings show enough to say those two don’t fit. And if this one might not be ‘the model’ either but fits better than those then we need to be open-minded and wary of our orthodoxy?

 

The way I read it is mainly his worry at seeing people for whom there's a good chance psychiatric treatments would be helpful being influenced to think "psychiatric" is a dirty word and rejecting something that may actually ease their suffering. As far as I understand - and I could be wrong - there is good evidence of CBT, antidepressants, and other medications and forms of therapy being useful in all manner of conditions.

And on top of that, they are being pulled the other way in the direction of thinking there are biological treatments that are highly evidenced, but really have little evidence and might be dangerous for their health or wallet.

He seems like he would enthusiastically welcome any well-evidenced science that would lead to better treatments, whatever field they come from. He has little doubt biological signals will emerge, but so far, whatever signals there are, aren't clear enough to shift treatment decisions away from standard practice.

He only mentions ME/CFS once to give an example of the "war" between psychiatric and anti-psychiatric. I don't know if he thinks ME/CFS can be benefitted by CBT or antidepressants or exercise, but I can just as easily read this as him just providing an example to illustrate the high animosity between these camps, but saying this is only one of the most obvious examples, and people with conditions that might be helped by something like therapy are also getting caught up in the "war" and being harmed.

 

Well, if the author knows all about biopychosocial factors and how they influence people's beliefs of being ill and knows the way psychiatry can help with that - which would presumably be the justification for his position - surely he has no problem. He just puts the patients right, explains the psychology of their misguided views and they will be well. The new world view is surely providing lots of interesting work for him and his colleagues to do and demonstrate their great skill at curing people.

 

Sounds very existential to me....

I suggest to overcome this existential crisis - is for the author to reconsider his article especially looking at the fact that there is no real acknowledgement of the problem (in relation to ME/CFS) or stepping back to see what has happened and thinking about how to change it.

I doubt that will happen anytime soon.

edit to add: being trained in this area I could also talk about the word seductively in the opening statement but it all gets a bit Freudian.

 

Out of curiosity, looking at one quote from this (my ...):

He appears to have used a non-sequitur to infer that as he 'regularly sees people' on one side of the coin whose autoimmune brain diseases hadn't been picked up... when he then follows with a 'but' and says 'when I consider the time and resources spent' on those who range from perhaps reading some online content to actually having been 'unhelpfully diagnosed with inflammatory brain conditions' it must be hugely more regularly than the first set.

Is this the case? Where from any ear to the ground in the profession people are getting 'more than regularly' some swathe of people who've been misdiagnosed with inflammatory brain conditions on the 'very flimsiest of evidence' ? or the same even for 'people who've been sent down the wrong path by misleading online content [on inflammatory brain conditions I guess / I assume from what is being inferred by the non-sequitur]'?

 

I think he sees both, people will come in for assessment from referrals from GP's and other medical doctors. I am not sure if he gets self referrals.

I find the word "but" and talking about all the time and money, flimsy of evidence etc - the non-sequitur really odd too. Psychiatrists are very used to assessing people with a variety of world views and cultural inputs. It sounds to me like he is moaning to his colleagues about how hard his work day is. But this is normal work for psychiatry, the cultural phenomena going on with social media is not new, nor is people trying to understand their symptoms and reading up on a variety of possibilities.

 

Thanks, I think that maybe makes sense now I've read his staff profile which includes:

and

I'd guess if someone suspects it could be something autoimmune then that would be where you'd send them/you'd look up someone who covers that possibility. And if autoimmune in general is quite thin on the ground as a specialty he might get a lot that are looking for someone who touch on that area at all in case they need to rule it out.

 

Ironically: 'depression', which is likely the most over-diagnosed thing in history, and very likely not one thing but several. Probably with anxiety second, which is also very likely not one thing but several. Most importantly: both things that no one can tell apart from any other thing, unless they have technology showing them that it's another thing. As in the case of this dude: autoantibodies. But of course he doesn't mean that. He means instead to project the flaws of his profession onto us because they cannot possibly be flawed. He is throwing rocks from the glassiest of all houses.

A recent meme out of biopsychosocial ideology has been exactly that: that stress causes inflammation which causes all sorts of mental illness. Or vaguely generically whatever. This has been developed in recent years and did not come out of patient communities but out of the medical profession itself. It's the new updated meme to stick some bio on their 100% psychosocial concept, a direct replacement to the failed 'chemical imbalance' meme, because that concept fails far too often in the form of people whose life was otherwise great, never had trauma in their lives and so on.

The most common meme I see out of random physicians who complain about us is that we all have undiagnosed mental/psychiatric illnesses. Which would say very poorly of how health care is handling those, if it were true. But there is no such evidence, unless you count having symptoms a mental illness, which is literally the biopsychosocial/psychobehavioral ideology in a nutshell. But since they never only ever find loose associations and need to pretend they have some bio in there, inflammation resulting from stress, basically the idea that the conversion disorder biologically could just as well be stress-induced inflammation, has gotten quite popular. Alongside the kitchen cabinet of other failed memes such as central sensitization and other circular nonsense.

But in patient communities I never see this. Some people are fixated on a single mechanism, but the vast majority, in fact the near totality, of patients don't give a damn about the nature of the cause, in fact would be quite happy if it was psychological and easily treated with exercise and other easy stuff. Except that it obviously isn't and the medical profession is behaving in a completely unhinged way in response to it. But it's all very telling that a meme that came out of medicine is being used to depicted us all as irrational for being obsessed with a single cause, when in fact we do no such thing and the very meme this dude is applying onto us literally came from the medical profession.

And that's all before you get to the absurd fact that a psychiatrist is tut-tutting about psychiatric illnesses and included ME/CFS as an example, which only shows that the entire discipline is very confused about what even falls under their responsibility, can't even tell them apart from things that aren't.

 

That’s a lot of words to say the author is worried patients might doubt the efficacy of what he has to offer.

Maybe he should get some support for his catastrophising?

 

Alternatively

“Why psychogenic reductionism by parts of psychiatry and medicine is a threat to real people’s actual health and well being”