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

SNT Gatchaman

SNT Gatchaman

Senior Member (Voting Rights)
Staff member
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.

Link | PDF (Brain) [Open Access]
 
Thomas A. Pollak King’s College London, London, UK

For some disorders in medicine, the conversation between inflammation oriented biological and psychological narratives has become so acrimoniously dichotomized that there appears to be little possibility of a rapprochement between opposing sides. The toxicity around the myalgic encephalomyelitis-chronic fatigue syndrome (ME-CFS) debate is one such example, and much public narrative around long Covid has taken on a similar tenor.
Click to expand...

There appears to be something peculiarly seductive about inflammatory reductionist explanations. So what drives them? Perhaps it is because inflammation represents a final biological end point, which is converged upon by the downstream effects of all manner of potential environmental threats, which at times have loomed large in the public imagination—from mould to antibiotics in our food and meat, to microplastics and harmful fertilizers making their way into the food chain, to ever-increasing levels of pollution. Perhaps it is driven by the genuinely exciting research that suggests a role of inflammation in the aetiopathology of mental health problems. The inflammatory turn in psychiatry has re-energized research communities and ushered in a new era of interdisciplinary crosstalk between psychiatrists and scientists working in inflammation biology or immunology.
Click to expand...

There is a political aspect here, too: we have begun to move beyond traditional distinctions like left and right, and into a political ecosystem in which one of the most salient axes of belief is between trust in institutions, on the one hand, and a deep distrust of those on the other.
Click to expand...

There is clearly something appealing about inflammation as a simple explanation, one that in its simplicity can cut through the legacy and ongoing currents of medical misogyny and other systemic injustices, and provides an answer where previously the medical establishment has failed to provide one. Some of the first articulations of inflammatory reductionism emerged in public discussion of chronic complex diseases. Historically, many of these illnesses are diseases that predominantly affect women. Much of medicine has been characterized by the dismissal and setting aside of women’s concerns, particularly when suffering from these chronically painful or distressing conditions for which no aetiology was identifiable.
Click to expand...

While the ‘inflammatory turn’ in psychiatry is a welcome shift in principle in that it expands the repertoire of explanatory models, in practice it increasingly entails an unwillingness to consider more biopsychosocial explanations or treatments, which are increasingly dismissed as ‘medical gaslighting’. Whereas antipsychiatry once came from critics who argued that psychiatrists are complicit in the inappropriate medicalization of everyday suffering, today some of the most hostile criticisms come from voices arguing that psychiatrists do not medicalize enough, that we are so ideologically committed to ‘psychologizing’ everything we see that we fail to recognize the biological (= inflammatory) realities staring us in the face.
Click to expand...
 
There appears to be something peculiarly seductive about inflammatory reductionist explanations. So what drives them? Perhaps it is because inflammation represents a final biological end point, which is converged upon by the downstream effects of all manner of potential environmental threats, which at times have loomed large in the public imagination—
Click to expand...
It's funny reading that and just substituting a couple of words:
There appears to be something peculiarly seductive about psychosomatic reductionist explanations. So what drives them? Perhaps it is because BPS represents a final end point, which is converged upon by the downstream effects of all manner of potential psychosocial threats, which at times have loomed large in the public imagination—
Click to expand...
Pot. Kettle.
 
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.
in practice it increasingly entails an unwillingness to consider more biopsychosocial explanations or treatments, which are increasingly dismissed as ‘medical gaslighting’
Click to expand...
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.
Much of medicine has been characterized by the dismissal and setting aside of women’s concerns, particularly when suffering from these chronically painful or distressing conditions for which no aetiology was identifiable.
Click to expand...
And there is, throwing rocks from a glass promontory, using a glass slingshot, directly at, uh, women I guess.
 
:jawdrop::jawdrop::jawdrop::jawdrop:
SNT Gatchaman said:
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.

Link | PDF (Brain) [Open Access]
Click to expand...
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?
 
Last edited:
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.
In my practice non-compliance with psychiatric treatment is a big problem, as it can be everywhere. But here the resistance now frequently comes not from the cohort of patients whose lives are so chaotic that they forget their medications or can’t attend therapy, or who are ideologically opposed to drugs of any sort, but from well-educated patients carrying articles about brain inflammation from broadsheet newspapers, eager to try intravenous immunoglobulins. The tragedy is that the mainstream psychiatric treatments that they reject can be lifesaving.
Click to expand...

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.
With sufficient cash and a willingness to travel, one can access any number of treatments for indications including autism, attention deficit hyperactivity disorder (ADHD), psychosis, paediatric acute-onset neuropsychiatric syndrome/ paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANS/PANDAS), seronegative autoimmune encephalitis and Lyme disease, plus a dizzying list of supposed coinfections. These treatments include, but are certainly not limited to, extracorporeal membrane blood ozonation, antisense oligonucleotide therapy, intravenous immunoglobulins, rituximab, intravenous nicotinamide adenine dinucleotide and many more.
Click to expand...

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.
I am absolutely not suggesting we do not need more well funded research into the relationship between brain inflammation and mental health—I am in no doubt that there is a signal here, in amongst all the noise. I will continue to pursue this research myself, and I look forward to seeing a thriving and diverse research community working to answer important questions for the benefit of patients and their carers. But the research has to be done, and it has to be done properly, before our diagnostic and therapeutic behaviours are substantially changed.

The rate of change is frustrating and incremental. There are times when it takes weeks to get even the simplest investigations on psychiatric patients and this is a great inequity that exists in modern medicine.10 I regularly see patients who have turned out to have autoimmune brain diseases but who went undiagnosed, unhospitalized or untreated for scandalously long periods of time, and I consider it part of my mission as a clinician to make sure that these patients are given the help that they need as early as possible. But when I consider the resources and time spent in addressing the concerns and distress of patients and their families who have been unhelpfully misdiagnosed with inflammatory brain conditions on the very flimsiest of evidence, if any, or yet again sent down the wrong path by misleading online content, I am quite sure that this new brand of uncritical biological reductionism is one that we can do without.
Click to expand...

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.
For some disorders in medicine, the conversation between inflammation-oriented biological and psychological narratives has become so acrimoniously dichotomized that there appears to be little possibility of a rapprochement between opposing sides. The toxicity around the myalgic encephalomyelitis-chronic fatigue syndrome (ME-CFS) debate is one such example, and much public narrative around long Covid has taken on a similar tenor.3
Click to expand...
 
Last edited:
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.
 
an unwillingness to consider more biopsychosocial explanations or treatments, which are increasingly dismissed as ‘medical gaslighting’.​

Bullshit. It is because the psychosomatic heavy BPS model that has ruled the roost for decades has clearly not delivered, quite the contrary, and its proponents are using increasingly dodgy tactics and strategies to stake out their illegitimate claim.

It is being dismissed because it Does. Not. Work. And causes very serious harm. Yet its proponents will not admit that, and just keep doubling down on blaming everybody and everything except themselves and their shitty model and methodology. Which is gaslighting in my book. Fraud even.

But don't let any of that inconvenient truth get in the way of your ideological rant.

Besides, I don't see any general infatuation with the inflammation angle in the ME/CFS patient community, or even researchers. It is a possibility, that needs adequate assessment, but nothing more.

This guy better stay away from mirrors. Might not like what he sees.
 
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.
 
hibiscuswahine said:
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.
Click to expand...
Out of curiosity, looking at one quote from this (my ...):

I regularly see patients who have turned out to have autoimmune brain diseases but who went undiagnosed, unhospitalized or untreated for scandalously long periods of time, and I consider it part of my mission as a clinician to make sure that these patients are given the help that they need as early as possible.
..... But when I consider the resources and time spent in addressing the concerns and distress of patients and their families who have been unhelpfully misdiagnosed with inflammatory brain conditions on the very flimsiest of evidence, if any, or yet again sent down the wrong path by misleading online content, I am quite sure that this new brand of uncritical biological reductionism is one that we can do without.
Click to expand...

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]'?
 
bobbler said:
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]'?
Click to expand...
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.
 
hibiscuswahine said:
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.
Click to expand...

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

I have set up and co-run a joint multidisciplinary clinic at King’s College Hospital dedicated to the assessment and management of patients with confirmed or suspected autoimmune encephalitis and other central nervous system autoimmune disorders. I also jointly ran a neuropsychiatry-led long COVID clinic.
Click to expand...

and
Research Interests
  • Immunopsychiatry
  • Autoimmune encephalitis
  • Neuropsychiatry
  • Psychosis studies
  • Organic psychosis
  • Psychiatry of infectious disease
  • Neuroimmunology
Click to expand...

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.
 
bobbler said:
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]'?
Click to expand...
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.
 
Sean said:
an unwillingness to consider more biopsychosocial explanations or treatments, which are increasingly dismissed as ‘medical gaslighting’.​

Bullshit. It is because the psychosomatic heavy BPS model that has ruled the roost for decades has clearly not delivered, quite the contrary, and its proponents are using increasingly dodgy tactics and strategies to stake out their illegitimate claim.

It is being dismissed because it Does. Not. Work. And causes very serious harm. Yet its proponents will not admit that, and just keep doubling down on blaming everybody and everything except themselves and their shitty model and methodology. Which is gaslighting in my book. Fraud even.

But don't let any of that inconvenient truth get in the way of your ideological rant.

Besides, I don't see any general infatuation with the inflammation angle in the ME/CFS patient community, or even researchers. It is a possibility, that needs adequate assessment, but nothing more.

This guy better stay away from mirrors. Might not like what he sees.
Click to expand...
That quote is fascinating

it is gaslighting , not ‘dismissed as gaslighting’ . and the para is arguing for those who dare to object to being gaslighted (injurious/harmful in itself before you even start to use it as an excuse to cut off access to basics of medical care by calling it an ‘instead’) is poor sophism trying to suggest those victims of something which is an assault [gaslighting] just have ‘an attitude problem’ for not being ok with being treated that way


It’s disgusting justification if bullying and a narcissism worldview where the victim is to blame for and deserving of their own abuse

it is shocking and should be taken as a serious disregard of harm if one’s own consequences ie irresponsible to a dangerous level for someone to use the term gaslighting as if it’s nothing to whinge about ‘fir others’

we have seen how the same people in return can’t react normally (on an emotion scale and proportionate behaviour with their mock or real outrage at being called out) when things that are actually wrong they do are merely critiqued or highlighted by the same people who they expect to live under a state of imposed injustice, silencing and untruth. Hypocrisy underplays that.

No wonder they don’t measure reaction in context ie in anything they do because rather than it being internal emotional regulation they are measuring (as they claim) they wish to distort normal reactions to foot on neck abusive or unjust situations as ‘the fault of the victim’ who normally had nothing to do with what was thrown at them other than the misfortune of crossing paths with certain people who can’t act appropriately
 
Last edited:
You must log in or register to reply here.
Back
Top Bottom