White says FSSs "are probably the most useful description of a group of conditions presenting with physical symptoms and disability for which medicine cannot find presently a convincing explanation". White wants to merge neurology and psychiatry together as a single discipline. IIRC it is often implied that the word functional is neutral on cause, but most neurologists and psychiatrists would define functional as non-organic, which is not in fact a neutral placeholder. So what happens when biomedical science does eventually find a convincing explanation for so-called FSSs?
As Alex said, medicine started out with almost everything being medically unexplained. The etiology of MS itself is still not established, but symptoms are explained (demyelination, white matter lesions, immune-mediated). We need an accepted equivalent for CFS, in which the symptoms can be explained even if the etiology cannot. There must be biological abnormalities in CFS which correlate with or even explain symptoms. AFAIK, a picture is already emerging from the research despite the heterogeneity, although I am not in good enough shape right now to properly outline what that is.
Whether or not the biological abnormalities in CFS are "organic" or "psycho>somatic" or "functional" or somewhere inbetween is another story, sooner or later this will become more obvious when the nature of the abnormalities is better established. I doubt there is a strict division between organic damage and functional disturbances in biological function, but I know where I am placing my bets on the spectrum, and those bets are not on many of White's views.
Biopsychosocial Medicine: An Integrated Approach to Understanding Illness[6] is the product of a two-day conference held under the auspices of One Health—an organization that seeks to promote a system of healthcare based on this approach—and the Novartis Foundation.
In his preface the convenor, Peter White tells us that his rationale for organizing the conference was a concern that medicine is travelling up a blind alley in its attempt to help patients improve their health and reduce their disability. ‘This blind alley is the biomedical approach...’ The twenty-eight participants, who represented psychiatry, medical history, general practice, epidemiology, and psychology, were asked to deliberate on whether the model is a luxury or a necessity, and a key reference point was George Engel's famous 1977 paper in which the term biopsychosocial medicine first appeared.[7] But it was Engel's follow-on paper, looking at clinical applications of the model,[8] that generated special passion among the contributors.[8] So far as my own discipline is concerned, I confess to puzzlement about this whole enterprise: primary care, in its quest to deliver holistic patient-centred care, has long since embraced the biopsychosocial approach—as was indeed made clear at the conference.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1199645
I can appreciate the consideration of psychosocial factors outside or in integrative addition to a reductionist biomedical model eg BIO-psycho-social, but biomedical science still has so much promise to improve the health of humanity. I believe that in this century we are going to start seeing many major chronic diseases (including psychiatric diagnoses) being much better treated or even cured while the FSS/MUPS issue will be elucidated enough to make the current ideas look as crude as Freud's era does now. The progress is mostly going to come more from advanced biological research than increased consideration of psychosocial factors (which to be fair can still have significant importance).
Has anyone even seen White write a single paper on CFS which incorporates the findings of researchers with a more biomedical perspective of CFS, such as the Lights, Pacific Labs, and Klimas etc? White mentions "sleep–wake circadian rhythms, nocturnal sleep architecture, autonomic nervous system, hypothalamic–pituitary–adrenal axis, cytokine distributions, and central nervous system sensitisation", but these are usually framed by White and colleagues as functional and arising from or mainly perpetuated by cognitive and behavioural factors. If anyone can currently get White to state that FSSs are probably caused and perpetuated top-down by unknown biomedical factors more than top-down cognitive-behavioural factors, then I will eat a corked hat on Youtube (figuratively speaking).
Moving the FSS debate beyond "all in the mind" is about as impressive as moving 21st century medicine beyond the four humours and vitalism: so what? Deconditioning (White's seemingly favourite explanation for PEM in CFS), and the physiological effects of mental states etc are not "all in the mind" either. I would like to see White and others move beyond the assumption that the critical reaction to their work is based on misinterpretations of it as "all in the mind". LOL Alex for comparing psychosomatic medicine to alchemy and astrology; if alchemy and astrology helped give birth to chemistry and astronomy respectively, it will be interesting to see what psychosomatic medicine will become?
Since the 1970, the concept of psychosomatic diseases has gradually fallen into disuse because research has shown that stress can contribute to the development of a diverse array of other diseases previously believed to be purely physiological in origin. Although there is room for debate on some specific diseases, stress may influence the onset and course of heart disease, stroke, gastrointestinal disorders, tuberculosis, multiple sclerosis, arthritis, diabetes, leukemia, cancer, various types of infectious disease, and probably many other types of illnesses (Brummett et al,. 2004; Critelli & Ee, 1996; Dougall & Baum, 2001; Murison & Milde, 2007). Thus, it has become apparent that there is nothing unique about the psychosomatic diseases that requires a special category. Chapter 5 goes into greater detail, but suffice it to say that modern evidence continues to demonstrate that the classic psychosomatic diseases are influenced by stress, but so are numerous other diseases (Jones & Bright, 2007; Levenson et al., 1999).
Psychology Applied to Modern Life: Adjustment in the 21st Century
Wayne Weiten (Author), Dana S Dunn (Author), Elizabeth Yost Hammer (Author)