Regarding studies that attribute symptoms to psychology

[Andrew]

We are in an unusual position with regard to how research is seen for our illness. To explain, I'll use an analogy I've used before. If a study shows that CBT or exercise helps some cancer patients feel moderately better, nobody assumes cancer is a mental illness. But, if the exact same result is found in a CFS study, people offer it as "proof" that CFS is all in the head. And no amount of explaining the reality of what a study actually studies seems to change this. But I do sometimes find it helpful to offer other studies that illustrate how a psychological evaluation might be mistakenly made with other illnesses.

First, here are some studies where a well-known and widely used standard psychological test scored people with various physical illnesses.

The psychosocial impact of systemic lupus erythematosus and rheumatoid arthritis
http://onlinelibrary.wiley.com/doi/10.1002/art.1780270102/abstract

Elevated MMPI scores for hypochondriasis, depression, and hysteria in patients with rheumatoid arthritis reflect disease rather than psychological status
http://onlinelibrary.wiley.com/doi/10.1002/art.1780291206/abstract

As you can see, people who are physically ill scored high on scales of Hypochondriasis, Depression, and Hysteria. And I can imagine why. If someone is sick they are going to manifest physical symptoms that might concern them. But it doesn't mean they are imagining these symptoms. Also, negative things in ones life can lead to depression, so it's no surprise that illness can too.

Now, one can argue and say "Well, the presence of a physical illness would rule out (or mitigate) the mental diagnosis." But if that were the case, why doesn't CFS rule out a mental diagnosis. It's categorized as a neurological illness by the WHO, and many studies have found physical manifestations.

Next, there is the assertion that CFS patients had higher levels of abuse in their lives, and this demonstrates that CFS is based on an emotional response. To begin with, I should point out that some studies suggest that emotional abuse can lead to problems in the endocrine and immune systems. IOW, emotional abuse can lead to measurable physical problems.

For example:

Thymus of abused/neglected children: http://www.ncbi.nlm.nih.gov/pubmed/1568682

Psychobiological Effects of Sexual Abuse: A Longitudinal Study http://onlinelibrary.wiley.com/doi/10.1111/j.1749-6632.1997.tb48276.x/full

Next, it's not necessarily the case that CFS patients did have higher levels of childhood sex abuse.

Sexual Abuse, Physical Abuse, Chronic Fatigue, and Chronic Fatigue Syndrome: A Community-Based Study - http://journals.lww.com/jonmd/Abstr...,_Physical_Abuse,_Chronic_Fatigue,_and.8.aspx

Before I conclude I want to make something clear. My point here is not to prove the phenomenon of psychobiology one way or another, nor is it to argue the merits of the MMPI. I am simply pointing out that the picture is not as simple as some sources would have us believe. And because these sources only present research that supports one side of the argument, I thought it would be helpful to realize that there is other research as well.

 

[Enid]

Andrew - I cannot read much of the above - it's for whimps. And I abhor the psychos who suggest type, age, (try the size of my head), was I abused - no, etc. Bunk! Ignore it. 2011 type eugenics is now the Psychos if we let them grasping at straws.

 

[Andrew]

Andrew - I cannot read much of the above - it's for whimps. And I abhor the psychos who suggest type, age, (try the size of my head), was I abused - no, etc. Bunk! Ignore it. 2011 type eugenics is now the Psychos if we let them grasping at straws.

As I said above:

I want to make something clear. My point here is not to prove the phenomenon of psychobiology one way or another, nor is it to argue the merits of the MMPI. I am simply pointing out that the picture is not as simple as some sources would have us believe. And because these sources only present research that supports one side of the argument, I thought it would be helpful to realize that there is other research as well.

 

[Enid]

But such research leads us nowhere. With enormous cognitive (perceptual only problems) it dawned on me my intelligence greater than theirs the psychos best avoided (no intelligence whatsoever it takes too much to change their superficialities - probably Freud and all offspring)

 

[Andrew]

It leads whoever needs it to information that proposes an alternative possibility to the psychological theories for why PWC are upset about being sick and/or have stress in their pasts. And with this information, those who wish to can balance out the impact of people who use their psych theories to argue against CFS having a physical cause.

 

[Enid]

History of medicine when "something" is not quite understood - the lovely jubbley psychiatrists step in. Nothing better or more constructive to do. Rant over Andrew.

 

[Angela Kennedy]

You know my position on this research you've cited Andrew- some of which, at least, I'm afraid do posit psychogenic explanations for somatic conditions. This is a key problem around all discussion of 'psychology' and somatic conditions.

But for the benefit of people reading this thread, these are my problems with the research you've cited about 'childhood abuse' allegedly having biological effects on anatomy:


Firstly you have to be able to establish accurate range of anatomical (or physiological) dimensions among a whole population, taking age, gender, race, genetic differences, nutritional status, physical environmental effects into account. Research on this subject in most bodily systems is not advanced at all. They've only recently found out the female human clitoris is a lot longer than people thought, for example!

And- the whole shebang of objections to the 'abuse causes CFS' research applies: the problems of defining 'abuse', 'neglect' 'trauma' etc. which are a major confounder inadequately addressed in the Heim et al research, for example. This is a real methodological problem, conveniently forgotten. Also - the ubiquity of childhood 'stress', the problem of self-reporting etc.

I'm guessing they've taken averages out of measurements, found a slightly higher mean (or median) of the range on a mixed population and made a 'correlation equals causation' error.

There are too many potential confounders and, if the Heim et al research is anything to go by, these have not been adequately controlled for, and some ontological gerrymandering may have taken place.

These are just common problems that I, personally, know, off the top of my head, plague this sort of research. There are bound to be more that other readers of this thread might remember.

 

[SilverbladeTE]

Any of you ever had the bad luck/necessity/gumption to read the crap about ethnic minorities. women etc, the "studies" put out between oh 1880 and 1936 by Eugenicists?
Yeah...*pukes!*

 

[Andrew]

I prefer to evaluate the pros and cons of research, not just the cons. And not just the pros either, btw.

 

[Angela Kennedy]

I prefer to evaluate the pros and cons of research, not just the cons. And not just the pros either, btw.

Well that's great. But the 'child abuse' research you cited here is likely to have an awful lot of cons- people need to be aware of that. The vast majority of research 'supporting' psychogenic explanations for somatic illness (that research you cited do posit at least one of the various different forms of psychogenic explanations) have very few (often no) 'pros'. The premises are unsafe throughout.

This is why people object to them!

 

[Andrew]

I'd like to share an illustration with everyone that I made elsewhere. And then I'm going to put this thread on my ignore list. This whole topic has become so stressful to me elsewhere, that I feel I can no longer respond to it in an unencumbered way.

Here's my illustration:

I was speaking with a doctor who pointed out to me in a very diplomatic way that people with CFS are suffering from a psychological illness, and he knows this because SSRIs cure CFS. I was pretty fogged up at the time was having trouble articulating. So I simply threw a couple more studies into the pot, that pointed in different directions. I knew that just about all research in CFS is weak, even if it is for no other reason than lack of funding. But his change in his attitude after I did that showed me the playing field was now equal.

But then I added that we really need more research, because all the studies we were talking about were not very big, and so we can't say that we have a clear picture yet. And he agreed.

Now, one can say that all I had to do was tell him SSRI research is not conclusive. But that kind of discussion seemed daunting to me. And I've never found that kind of discussion helpful in real world situations.

And btw, I'm not commenting pro or con on whether SSRIs help. I was not saying one medication is better than another. I was only offering a style of presentation and some tools that go with it. And I hope my qualifier is taken at face value.

Anyway, I apologize for not being able answer any more questions.

 

[Angela Kennedy]

If people study the sociology of doctor-patient relationships within social systems of stratification (a subject within my field of study), sadly there is most often conflict between a powerful doctor and usually powerless patient. There is never a 'level playing field' as such. The literature shows there to be much conflict of interests between the two.

Acquiesing to psychogenic explanations for their somatic (that is, bodily) illness is not the answer to people not suffering from psychogenic illnesses, however one manages their personal interactions with their doctors (which will be different depending on many factors).

My daughter has benefitted enormously from my own critical analysis of pyschogenic explanations over the years, thankfully. She remains extremely ill, but some of the abuses she initially suffered, due to psychogenic dismissal and construction as deviant, have been reduced, because of her increasing ability not to accept absurd behaviour and misinformation from others, including medics.

On these informal forums and the public domain, of course, we are all at liberty to critically analyse the flaws in psychogenic explanations of this illness (ME/CFS), thank goodness.

If anyone is interested in literature I have on conflicts in doctor-patient relationships, pm and I will send PDFs.

 

[SilverbladeTE]

And since when the flying HELL can SSRIs cure a *lethal* illness, hm? Jeesh.
yes, ME/CFS kills in severe cases or it would not be on death certificates (and also reduces life expectancy severely)