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

Tom Molmans' letter to the editor:

Link | PDF

 

Title:
Why the threat of psychosocial reductionism to patients in psychiatry and medicine is rather ignored

 

Very good letter. Makes some very solid (although all of them old from our perspective) points:

Really just dishing out wisdom to fools, but the fools are wedded to their folly and so it will fall on deaf ears:

It's so obvious that the obsession with psychosomatic explanations is simply a matter of preference, of wanting reality to work one way that is perceived as more desirable. They're considered more desirable models because they are perceived as easier to deal with. Which is delusional, neither medicine nor psychology has managed to produce a single useful bit of information that improves outcomes, but it's what the perception is, that psychological problems can be conquered with the smart application of magic rituals, uh, I mean using the right words and gestures. Same difference.

I will never understand why that is, why this delusional fantasy is considered easier to deal with than reality, even after decades of failure have proved otherwise. Escapism is really its own goal, it's just not supposed to apply in professional settings. And yet here it doesn't just dominate, it's all there is. It is supreme. And being in a state of permanent failure, it is supreme failure, the highest, or lowest, possible level of failure. No other group of professionals have ever failed worse than this in all of human history. Just as hard, likely. Harder? Not possible. This is truly the maximum level of failure.

 

There are so many professions that have failed at so many things throughout history. We simply have no basis to claim that psychosomatic medicine is the (shared) worst failure. And I’m hesitant to compare levels of suffering or failure at all.

I don’t think it’s productive either, because the claim will become an easy target for the opposition.

Nor is it necessary. The level of suffering caused by psychosomatic reductionism is way past any reasonable ethical or moral thresholds to warrant a substantial response.

As for why barely anyone tries to do something about it - I believe two factors are important, although there obviously are many more:

1. It doesn’t concern them directly
2. It’s too uncomfortable to face the reality

 

... and Pollak's reply. Thoughtful in places, and quite right about the proliferation of unevidenced & potentially harmful treatments, but still clings to "holistic" biopsychosocialism:

https://academic.oup.com/brain/advance-article-abstract/doi/10.1093/brain/awaf092/8068919

 

Good letter pointing out important problems such as straw man and inversion of issues and claiming things in the name of ‘reducing stigma’ when they were the creator of said stigma

but I guess in the language needed to get through to others in said area?

importantly there is the question towards the end of why did you drag me/cfs into this at all ? If it was apparently about inflamed brain
Ie the switch and bait of another Trojan horse for propaganda against an already very badly bombarded and iatrogenicslly harmed group (that they can’t help kicking for the sake of it in psychosomatic medicine, just cos they can/are allowed to)

it’s interesting to see someone else sees through all of this as being as transparent as it is (the untackled misbehaviour of a certain group just because everyone thinks it’s too difficult to bother and as long as they stay in their corner of ‘just’ making me/cfs lives trashed and miserable it seems people think it’s best to leave ‘em where they are because at least they are identifiable?)

 

3. The people behind it and their likely reaction not being at a similar level to the norm in the profession so people I guess at all levels, not just patients, are warned that anything other than agreement that effectively sponsors them to carry on is seen as a personal attack to be remembered forever/making someone an enemy. You get this in normal life of course in personality type but there is more variation in the power they have (and if they can be dealt with eg by HR or big boss or police or lawyer etc if it’s a non work or whatnot)

I think the important part of course is the speaking to hangers on/their audience to at least limit the ear their propaganda gets and how persuaded it is without pointing out the issues and fallacies.

which I can see has to be done carefully without stepping on landlines where they retort withbsophism by picking out one line they don’t like or claiming dualism - so this seems well done in being aware of all that, but it must have been exhausting due to all the tip toeing bps make us do due to all those tricks