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Psychogenic explanation of physical illness: time to examine the evidence

Sean

Senior Member
Messages
7,378
Secondary gain is a huge pile of nonsense.

I think it is obvious who gains the most from such diagnoses.
One of the most bizarre aspects of this whole farce is the accusation that patients are gaining some special and illegitimate advantage out of this disease. Nowhere do the accusers seriously consider the actual and often extreme losses against the alleged (but unproven) gains.

It is so blatantly false an accusation and smear, with appalling consequences, yet they get away with it for decades.

Then they cry and whine and play the victim card against us ungrateful bastard patients for not showering them with acclaim and roses.

And they wonder why we despise them?

You can't make this shit up.
 
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chipmunk1

Senior Member
Messages
765
Somatization is based on Freud and Freud has been said to be heavily influenced by cocaine. So can we say that the belief of psychogenic illness is at least partially based on cocaine?

It is believed by many scholars that Freud compulsively abused cocaine over a period of 12 years. During that time many fundamental theories upon which Psychoanalysis is based were developed.

A brief timeline:

1865 Freud enters Leopoldstadter Gymnasium School.
1873 Freud decides to study medicine at the University of Vienna. Reads Oedipus Rex for final school examinations.
1881 Freud graduates as doctor of medicine.

1884 Freud starts researching clinical uses of cocaine.

In his first publication he wrote:

Coca is a far more potent and far less harmful stimulant than alcohol, and its widespread utilization is hindered at present only by its high cost.

Long-term use of coca is further strongly recommended and allegedly has been tried with success – in all diseases which involve degeneration of the tissues...

After experimenting with "Coca" he decides to move away from traditional neurology to study the human mind instead.

1885 Freud studies under Charcot at the Salpetriere Hospital, Paris. Charcot provides new insight into hysteria and uses hypnosis.

1886 Freud sets up private practice.

1887 Freud treats nervous diseases in his practice. Introduces hypnotic suggestion.

1895 Freud has to have his nose opened up surgically because it was so congested from cocaine abuse that he was unable to breathe.

1895 Publishes "Studies on Hysteria" with Josef Breuer. Introduces the idea that the symptoms of hysteria were symbolic representations of traumatic memories, often of a sexual nature.

Breuer's work with Bertha Pappenheim provided the founding impetus for psychoanalysis, as Freud himself would acknowledge. In their preliminary (1893) paper, both men agreed that “the hysteric suffers mainly from reminiscences. Freud however would come to lay more stress on the causative role of sexuality in producing hysteria, as well as gradually repudiating Breuer's use of hypnosis as a means of treatment.

1896 Freud claims to have stopped his cocaine consumption.

1896 First use of the term 'psychoanalysis'.

1897 Freud's self-analysis begins, leading to the abandonment of the trauma theory of neurosis (developed with Breuer), recognition of infantile sexuality and the 'Oedipus complex'.

1897 One of his patients, Emma Eckstein nearly dies following a nasal surgery recommended by Freud.
Emma was believed to suffer from nasal reflex neurosis. Either Freud or his friend Wilhelm Fliess had discovered that applying cocaine to the inner parts of the nose would lead to instant relief from neurotic symptoms like depression or anxiety. They theorized that the nose was involved in causing neurosis and removing a part of the nose surgically would lead to permanent improvements of the mental state.

1899 Publishes his important work 'The Interpretation of Dreams'. The book was based on his most important dream where he meets one of his patients, Emma Eckstein at a party in midst of syringes and cocaine.

The two most important paragraphs in the timeline in my opinion:

1895 Freud has to have his nose opened up surgically because it was so congested from cocaine abuse that he was unable to breathe.

1895 Publishes "Studies on Hysteria" with Josef Breuer. Introduces the idea that the symptoms of hysteria were symbolic representations of traumatic memories, often of a sexual nature.

I don't know if the surgery happened before or after "Studies on Hysteria" was published.

another rather interesting claim:

http://www.npr.org/2011/11/25/142782875/a-tale-of-two-addicts-freud-halsted-and-cocaine

DR. HOWARD MARKEL: Freud loved the way cocaine made him feel. And he was very interested in its psychological components. For one, it did make him feel better when he was sad.
He also was amazed at how it made him talk about things endlessly that he thought were locked away in his brain. Sound familiar? That’s talk therapy, but without the toxic side effects of cocaine. But he got to like it a little bit too much.

BETTY ANN BOWSER: Did any of his writings, the dreams, the sense of euphoria, all the things that he got from using cocaine, did any of those lead to anything that we now see in psychiatry today?

DR. HOWARD MARKEL: Well, it did. It did. To begin with, the idea of talk therapy where you talk freely or free associate from one thing to another, may have been inspired by the cocaine unleashing his tongue or his repressed memories. But most importantly, cocaine haunts the pages of “The Interpretation of Dreams.”

MARKEL: Well, it's a complicated answer. It's yes and no. I mean, there are points in Freud's early cocaine abuse where he was amazed at how loquacious it made him, how it freed up ideas that he thought were locked within his mind. Sound familiar?

FLATOW: Yeah.

MARKEL: And of course, that's what - a safer version of that is free association, where you're simply talking about things and going from topic to topic, to try to delve what's in your unconscious or subconscious mind.
 
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Aurator

Senior Member
Messages
625
It is so blatantly false an accusation and smear, with appalling consequences, yet they get away with it for decades.
The notion that ME patients are all "doing" illness for secondary gains can be disposed of in an instant by reference to the activities of at least some PwME on forums like this one; if we were manipulators of others for secondary gain why would we spend not insignificant amounts of time on PR pushing for effective treatment? Why wouldn't we simply get on with the job of enjoying our little "ill-gotten" secondary gains in silence? This leaves aside the fact that some people, like myself, get no money at all that doesn't come from self-employment - no benefits, no insurance payments, nothing.

Yes, the idea that we're in it for secondary gain is one of the cruder bits of generally crude theorising bandied about by people of a particularly narrow mind-set who are projecting the kind of parasitic behaviour (i.e. faking illness) they would no doubt be tempted to engage in themselves if they found themselves at the other end of the economic spectrum, but who are generally too safely assured of their generous salaries and pension schemes for a life at the other end of the economic spectrum ever to be a realistic possibility. The accusation of secondary gains says far more about the accusers than the accused.
 
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Sean

Senior Member
Messages
7,378
Yes, the idea that we're in it for secondary gain is one of the cruder bits of generally crude theorising bandied about...
I don't think it can even dignified with the label 'theorising'. It is just plain malicious propaganda, the sort of stuff that makes it clear they are really not in this game to help us.

The accusation of secondary gains says far more about the accusers than the accused.
Exactly. :grumpy:
 

chipmunk1

Senior Member
Messages
765
I don't think it can even dignified with the label 'theorising'. It is just plain malicious propaganda, the sort of stuff that makes it clear they are really not in this game to help us.


Exactly. :grumpy:

According to this book it is pseudoscientific freudian stuff.

The Corsini Encyclopedia of Psychology and Behavioral Science, Volume 4
By W. Edward Craighead, Charles B. Nemeroff

Gain is a psychoanalytic concept first noted and defined by Freud.

He described two types of gains from illness, primary and secondary.

To Freud, primary gain was a decrease in anxiety brought about through a defensive operation that had resulted in the production of the symptom of the illness. Primary gain was therefore an intrapsychic phenomenon. The right arm the becomes paralyzed via a conversion mechanism. He is therefore punished.

This results in decreased guilt and a reduction in intrapsychic conflict and decreased anxiety(i.e primary gain).

Freud went to define secondary gain as an interpersonal or social advantage, attained by the patient as a consequence of the illness.

Since Freud's time the psychiatric definitions for primary and secondary gain have remained essentially the same.
.

Good to know that evidence based psychiatry is based on the rants of of a cokehead.

How many scientific papers about ME or somatization mention secondary illness gain? Did anyone ever bother to investigate if these theories were true and where they came from?
 
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SilverbladeTE

Senior Member
Messages
3,043
Location
Somewhere near Glasgow, Scotland
Absolutely brilliant. I have been waiting for years to see a good scientific paper critical of psychogenic explanations of physical illness. I like these excerpts:


This is a key point: the fact that psychologists and psychiatrists who deal in psychogenic explanations have far lower standards of evidence compared to medical scientists who study biochemical mechanisms of disease.


Spot on. This in a nutshell is the fundamental flaw in psychogenic explanations: the erroneous and baseless assumption that because current medical technology cannot find very much physically wrong in the patients, their physical symptoms must be caused by psychological factors. This ridiculous assumption needs to be purged from medical science.

hell yes! OI am SOOO sick of the horrendous arrogance in the Medical Profession AND in those who profess to be "scientific", when if they find a problem they cannot explain, they demand it mus tbe "wrong", the patient's making it up or whatever

We know JACK S**T! this needs hammered into people, we know very very little of our Universe
Human bodies are so incredibly complex, that by comparison, a nuclear powered aircraft carrier (largest most complex mobile thing we've ever built) is absolute "Lego" simplistic by comparison!

as I've said before, there are *basically* 70 trillion basic possible variations on a Human from their parents' chromosomes, but the full potential is a number so large as to be meaningless (depending on who's maths it's a number equal to either as many atoms as in our Solar System, or more than the entire universe!)

so, while the basics of our bodies have to operate the same for a person to live (how heart beats for example)
there's so many variations every medical diagnosis has to be extremely cautious
my Dad for example had his heart in the Centre of his chest not the left like normal and my uncle had a peculiar heart racing problem where it could soar up to 300 beats per minute and the poor sod would collapse (turned out he had an extra, oh don't know right name etc, like a nerve centre in his heart, should be 4 but he had 5 so it had to be burned out electrically to stop the heart problems)

then you add the possible synergies of diseases, injuries and poisons to a person's medical history over time
for example, I'ce had several concussions (which can cause serious brain problems as the years go on, including risks of dementia etc increase)
heavy metal poisoning, meningitis...etc
all adds up

so the potential causes and interwoven patterns leading to disease can be mind bogglingly complex

there is NO room for arrogant surety in Science, especially not medical science!

"It's worse than that, he's dead, Jim!" :p
 
There is certainly a lot of bath water to throw away around the Freudian baby, but there is one concept in there I would definitely keep:

"Countertransference"

It was meant to designate the sum of the psychoanalyst's inner reactions to the patient.

Freud had various (and debatable...) concepts pertaining to human experience (e.g. the oedipus complex), and other concepts pertaining to analytic technique, such as countertransference.

The analyst had to observe both the patient AND the manner in which he himself was "observing" the patient and was affected by their interaction.

How many MD's really do that?...

Good analysts know that countertransference is generalizable: How am I relating not just to my patients, but to … my theories? Or to Freud? Or to my field? Or to…anything for that matter. Am I being defensive about something, am I refusing to mourn a certain conception I have held on to, am I idealizing, denying, etc.

(Am I projecting my grandiose sense of self in describing the PACE trial as a superb ocean liner and a "thing of beauty"? Might have asked Wessely… had he been analyzed during his training in mental health...)

That is more than psychoanalytic technique: It should be an ethos all across science.

There are countless brilliant scientists whom I am sure are not aware of this elementary fact: They have emotional bonds to their theories.


p.s. Freud did not spend four decades after the infamous "Studies on Hysteria" writing on hysterical conversion or somatization. He also wrote about "Civilization and its discontents", about religion in "The future of an illusion" (all-too actual…), sculpture and literature and poetry and the list goes on… I would say that this is where the cocaine addiction is most perceptible in his work: He was all over the place!

He sure as hell had bad theories about female sexuality. At first. And then he had none... ("Wass will dass Weib?" - "What do women want?" was his last stance on this question I believe). But, he did take the time to listen to the first "hysterics" who came to him. At least he tried. Not many men back then would have. Moreover he was more than willing to let women become analysts, something his other pompous colleagues were reluctant to accept.

Just as he was willing to let non-MD's become analysts - "lay" analysts - again, contrary to the same pompous colleagues. To him you were just as much, if not more so, qualified for psychoanalysis if you had read Shakespeare instead of neurological studies.

Do cognitive-behaviorists recommend Shakespeare?

Psychology today would be robotic without its Freudian origins.

Without Freud we would not have… Woody Allen movies! That's how important he was to mankind… (And perhaps we would not have Ingmar Bergman movies as well, an even greater loss)

Seriously, countertransference. Please, let all MD's be in on this one…
And, yes, Freud had his own share of major countertransferential issues, - towards his patients, his colleagues, especially the dissidents, but he also gave us the very tool to critically think this issue. Freud against Freud.
Freud against anyone who doesn't look in the mirror.
 

Richard7

Senior Member
Messages
772
Location
Australia
Thanks for posting this!.

The article itself is only 17 pages long, the 40 pages total is when you include the massive list of references.

Just wanted to mention in case folks are scared by the hefty article. :)

It's well worth reading.

thanks, I gave up after I vagued out at page 4. I'll give it another go tonight.
 
Messages
3,263
Without Freud we would not have… Woody Allen movies! That's how important he was to mankind… (And perhaps we would not have Ingmar Bergman movies as well, an even greater loss)
Yea, I tend to think he did a lot of good stuff, and his bigotry needs to be seen in the context of the period he lived in. If we read back on the other crazy ideas that were about at the time, Freud doesn't particularly stand out. The problem here is that subsequent physicians and other persons have enshrined the guy as some sort of oracle of the truth, when in all those other areas, we have revised our views.
I gave up after I vagued out at page 4. I'll give it another go tonight.
Its fairly long and detailed with lots of descriptions of symptoms and scales. If you read the intro, the bit on theoretical and conceptual issues, then skip to the Discussion, you get the main gist of it pretty well (the results are summarised at the beginning of the Discussion).
 
Messages
13,774
I tend to think he did a lot of good stuff, and his bigotry needs to be seen in the context of the period he lived in. If we read back on the other crazy ideas that were about at the time, Freud doesn't particularly stand out.

Maybe too OT: I'm not well informed on Freud, but I've always been pretty disgusted by what I've read from/about him. Was there any real 'good', or just 'a bit less bad than the other terrible stuff going on at the time'?
 

chipmunk1

Senior Member
Messages
765
Spot on. This in a nutshell is the fundamental flaw in psychogenic explanations: the erroneous and baseless assumption that because current medical technology cannot find very much physically wrong in the patients, their physical symptoms must be caused by psychological factors. This ridiculous assumption needs to be purged from medical science.

and if the patients can't find anything wrong with their attitude what does that mean?

Perhaps we should counter that with: It's all in YOUR head.
 
Messages
3,263
Maybe too OT: I'm not well informed on Freud, but I've always been pretty disgusted by what I've read from/about him. Was there any real 'good', or just 'a bit less bad than the other terrible stuff going on at the time'?
Other bad stuff around then: wasn't this about the time when it was being recommended that the "feeble minded" should be sterilised? And by feeble minded, they didn't mean severely intellectually handicapped, it seemed to cover anyone of the lowest classes with no education. It was the heyday of phrenology. It also was a time when blacks were believed in many quarters to have higher pain tolerance than whites, so no need of anaesthetic. Prostitutes were held morally culpable of death for spreading syphilis among men. And only a decade or so later, people were coming up with the idea of lobotomies.

Good: I don't know whether you can entirely attribute this to Freud, but the idea that "holding in" extreme distress and anger is bad for you. That you need to express it, to "let it out". This is kind of common sense now, but before that time, most people thought that you should just exert willpower over your mental pain and unwanted thoughts and be done with it. This idea of mental health as a thing, something you should preserve/maximise, seems to have arisen around then. Okay, I suppose people around then understood things like pain and grief, but even then, you were supposed to get over these things after a respectable time.
 
Messages
13,774
Good: I don't know whether you can entirely attribute this to Freud, but the idea that "holding in" extreme distress and anger is bad for you. That you need to express it, to "let it out".

tbh, I'm not too keen on that. Different people probably do best by responding in different ways, and I think that they should be left to do what they want, without 'experts' telling them waht's good/bad for them unless they really know what they're talking about. Never seemed that Freud really did.

This idea of mental health as a thing, something you should preserve/maximise, seems to have arisen around then. Okay, I suppose people around then understood things like pain and grief, but even then, you were supposed to get over these things after a respectable time.

I think people are still supposed to get over things after a respectable time (didn't they just removing the grieving exclusion for depression in the new DSM? Think it was at least proposed). The good and bad of seeing mental health as 'a thing' seems to really depend on a lot of specifics.

Thanks for the response. After this extensive discussion I feel I can safely conclude that Freud sucked.
 
Messages
3,263
After this extensive discussion I feel I can safely conclude that Freud sucked.
Hell, never thought I'd hear myself supporting Freud's side on any argument! Its just that I put the blame much more on the blind followers. This appeal to Freud's authority, which you still see rampant in the psychogenic literature today.

If your strongest argument in favour of an idea or theory is the identity of the person who proposed it, you got a serious problem. This goes against everything Science stands for.

So much for "nullius in verba" (take no-one's word for it, the motto of the Royal Society of London)
 
Messages
13,774
Its just that I put the blame much more on the blind followers. This appeal to Freud's authority, which you still see rampant in the psychogenic literature today.

If your strongest argument in favour of an idea or theory is the identity of the person who proposed it, you got a serious problem. This goes against everything Science stands for.

Isn't Freud partly to blame for this? I've not read a lot of his work, but I remember thinking that he wrote like he thought he was a prophet. Lots of revealed truth, little evidence of anything.

Hell, never thought I'd hear myself supporting Freud's side on any argument!

Thanks for having a go. I really shouldn't even have an opinion on this when I've done so little reading, and I can't imagine I'm going to find much time for reading Freud in the next few years.
 

Roy S

former DC ME/CFS lobbyist
Messages
1,376
Location
Illinois, USA
A search for "venting fallacy" should find research on the venting fallacy or catharsis theory that I found over 20 years ago. It's not just false, it's backwards. This is one:
 
http://youarenotsosmart.com/2010/08/11/catharsis/
 
 
"Bushman has been doing this research for a while, it keeps turning up the same results.
If you think catharsis is good, you are more likely to seek it out when you get pissed. When you vent, you stay angry and are more likely to keep doing aggressive things so you can keep venting.
It’s drug-like, because there are brain chemicals and other behavioral reinforcements at work. If you get accustomed to blowing off steam, you become dependent on it."
 

chipmunk1

Senior Member
Messages
765
Another interesting finding: Fatigue in liver disease can be biopsychosocial. :eek:

I read some of the medical literature hoping to learn more about the mechanism causing fatigue in liver diseases.

I learned was that it is not well understood and behavioural therapies(GET) would be a possible treatment.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2582971/

Modifying behavioural components to fatigue
Significant central fatigue warrants lifestyle changes, which may include rest periods and reduced workloads (104,105). However, the maintenance of physical activity is of paramount importance. The natural inclination of patients with central fatigue is to decrease physical activity. However, decreased physical activity over time will lead to cardiovascular and muscular deconditioning, which then makes physical activity even more difficult (104,105). Therefore, all patients need to be counselled with regard to maintaining an appropriate level of activity. In addition, an increase in activity should be attempted through the institution of a graded exercise program (106).
In many patients with liver disease and central fatigue, the degree and perpetuation of fatigue may be directly related to and influenced by a complex interaction of physiological, emotional, cognitive, behavioural and social factors (107). A patient’s thoughts and beliefs (ie, cognitions) may contribute significantly to the maintenance of certain illness behaviours, including fatigue (107,108). This concept has received the greatest attention in the setting of central fatigue related to chronic fatigue syndrome (107,108). The idea is that psychological processes not only drive deleterious behavioural patterns, but also directly increase the perception of fatigue (108). Moreover, cognitive behavioural therapy is the only therapy of proven efficacy for patients with chronic fatigue syndrome (109). Therefore, cognitive behaviour therapy needs to be examined as a potential therapeutic modality for fatigue in patients with liver disease. Subjective sleep disturbance is commonly associated with fatigue in patients with liver disease (8,110). Therefore, all fatigued liver disease patients need to be counselled with regard to proper sleep habits.
 
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