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Dimensions of pure chronic fatigue: psychophysical, cognitive and biological correlates in the CFS

Discussion in 'Latest ME/CFS Research' started by Firestormm, Jun 2, 2014.

  1. Firestormm

    Firestormm Guest

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    Cornwall England
     
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  2. Valentijn

    Valentijn Activity Level: 3

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    FFS - psychosomatic cytokines? How stupid and stubborn do these morons have to be to get straightforward biological and cognitive results, completely ignore them, and reach a psychological conclusion?
     
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  3. SilverbladeTE

    SilverbladeTE Senior Member

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    Somewhere near Glasgow, Scotland
    Valentjin,
    there is a old, highly respected and well known scientific term for people such as these Belgians:

    FUTARD!

    :p
     
  4. A.B.

    A.B. Senior Member

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    I suspect careers being built on psychosomatic explanations have something to do with that. In any case, what matters is the data and not the interpretation. From the abstract, the data looks interesting and could contribute to our understanding of CFS.
     
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  5. Bob

    Bob

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    >start sarcasm< CFS patients are so clever that, purely by the power of their minds, they are able to increase their levels of energy depletion in correlation with levels of the immune messenger protein IL-8. >end sarcasm<

    Having said that, using the term 'psychosomatic' might be a case of them using terminology that is acceptable to their colleagues and peers, and perhaps they are pushing the boundaries of what's acceptable for their pitiful peer group. A slow shift in their world-view would be better than no shift.

    And, as A.B. says, there may be something useful in the paper.

    BTW, in case helpful, here's the abstract as published in the journal rather than PubMed:
    http://link.springer.com/article/10.1007/s00421-014-2910-1

    Out of interest, these are the author affiliations (my bolding):
    • 1. Sleep Laboratory and Unit for Chronobiology U78, Department of Psychiatry, Brugmann University Hospital, Université Libre de Bruxelles (U.L.B), Arthur Van Gehuchten Square, 1020, Brussels, Belgium
    • 2. Laboratory for Medical Psychology ULB312, Faculty of Medicine, Neuroscience Institute, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
    • 3. Department of Experimental and Applied Psychology (EXTO), Vrije Universiteit Brussel (V.U.B.), Brussels, Belgium
    • 9. Vital Signs and Performance-Department LIFE, Royal Military Academy, Brussels, Belgium
    • 4. Sleep Laboratory, Department of Psychiatry, Erasme Hospital, University Clinics of Brussels, U.L.B, Brussels, Belgium
    • 5. UR2NF-Neuropsychology and Functional Neuroimaging Research Group at CRCN-Center for Research in Cognition and Neurosciences, and UNI-ULB Neurosciences Institute, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
    • 6. Laboratory of Immunology, Department of Clinical Biology, Queen Elisabeth Foundation, Brugmann University Hospital, U.L.B, Brussels, Belgium
    • 8. Department of Pulmonology, Allergology and Cystic Fibrosis, Queen Fabiola Childrens’ University Hospital (Hôpital Universitaire des Enfants Reine Fabiola, HUDERF), U.L.B, Brussels, Belgium
    • 7. Department of Psychiatry, Tivoli University Hospital, U.L.B, La Louvière, Belgium
     
    Last edited: Jun 2, 2014
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  6. SDSue

    SDSue Florida

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    Under Conclusions, and I quote, "To obtain objective information....." (bolding mine) :lol::lol::lol::lol::lol::lol::lol::lol::lol:

    Objectivity Philosophy
    Objectivity is a central philosophical concept, related to reality and truth, which has been variously defined by sources. Generally, objectivity means the state or quality of being true even outside of a subject's individual biases, interpretations, feelings, and imaginings. A proposition is generally considered objectively true when its truth conditions are met and are "mind-independent"—that is, existing freely or independently from a mind. A second, broader meaning of the term refers to the ability in any context to judge fairly, without bias or external influence; this second meaning of objectivity is sometimes used synonymously with neutrality.
     
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  7. Esther12

    Esther12 Senior Member

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    'psychsomatic' can mean a range of different things. I still think it's bad to use it like this, but it's hard to know exactly what they mean by it without reading the full paper.
     
  8. alex3619

    alex3619 Senior Member

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    Its really hard to judge, though I disagree with most uses of the term psychosomatic, given that the more modern use of the term is not grounded in any realistic research. In this case we do not know the study inclusion criteria based on the abstract. Results from an Oxford defined cohort are likely to be irrelevant to anything, even Oxford defined patients, whereas CCC or ICC defined will be more stringent, though one would expect they would cite ME not CFS if they were using ICC. My guess is Fukuda criteria, which is currently thought to be less than useful., though not nearly as bad as Oxford.

    In any case without checking the details we can't even be properly critical of the paper - it might be worse than we think, or much better. I suspect worse, but the devil is in the details.

    Also, and I am speculating here, the usage of some terms might differ in Belgium. We need to know more.
     
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  9. Bob

    Bob

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    And there might be a complication due to translation.
     
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  10. Bob

    Bob

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    I think the meaning of 'psychosomatic' is actually quite clear-cut, depending on how formally the term is being used, but its meaning sits across a spectrum.

    At one end of the spectrum, 'psychosomatic' refers to an illness (with physical manifestations) that is caused purely by mental factors. (The mental factors are commonly stress, or mental conflict, sometimes associated with personality traits - hence the constant research into personality traits of CFS patients.)
    At the other end of the spectrum it can refer to an illness (with physical manifestations, but without a scientifically proven physical cause) that is aggravated or perpetuated by psychological factors.

    But it all boils down to the same thing - that the illness is caused, aggravated or perpetuated by maladaptive mental stress or mental conflict (which can be related to personality traits) - and so it can therefore be claimed that it is treatable with psychological interventions.

    Whether an illness is said to be either caused, perpetuated or simply aggravated by psychological factors probably doesn't matter too much to those who attempt to classify it as a psychosomatic or functional disorder (except that their theory needs to seem convincing to non-specialist medical staff, and to bureaucratic decision makers.) What matters most is that it can be said that the illness is treatable with psychological interventions.

    "The word psychosomatic has had several meanings, including psychogenic, ‘all in the mind’, imaginary and malingering. The modern meaning is that psychosomatic disorders are syndromes in which both physical and psychological factors are likely to be causative."
    https://www.inkling.com/read/kumar-...ne-8th/chapter-23/functional-or-psychosomatic

    This concept (of a supposed interplay between mind and body) is perpetuated solely by the field of psychiatry, in an attempt to 'own' a number of illnesses (for which the cause is currently unknown) that would otherwise be described as somatic.
    Obviously, if the field of psychiatry can 'own' a physical illness (i.e. convince decision makers and the public that psychological interventions - for an apparently physical illness - will successfully treat the illness) then this widens the scope of psychiatry to have more patients, thus increasing the sources revenue. (In the USA, more patients = more money.)

    Fundamentally, it's a modern, and more sophisticated (superficially), term for 'hysteria' whereby mental stress, or personality traits, are said to manifest physically.
    (The evidence for the lack of actual progress in their thinking is in their assertion that the mind-body dualistic dichotomy is outdated. i.e. This implies that they believe that the power of thought can provoke physical manifestations. And that this happens even in previously healthy individuals. It seems like very old-fashioned witch-doctor type stuff. Even research in depression and other psychiatric disorders is moving away from this paradigm, towards research seeking the biomedical causes. Yes, of course we know there is an interplay between cognition, the brain and the body, but to stretch this to say that individuals suddenly get serious long-term illnesses such as IBS, Fibromyalgia, CFS etc., because of mental conflict, is fantasy. Notice that they never say this for illnesses that have an obvious measurable physical manifestation - it's only the illnesses that have relatively invisible symptoms - They target the illnesses for which they can just about make their make-believe theories seem plausible.)

    In the UK, the term 'psychosomatic' seems to be outdated now, esp in relation to CFS. They prefer to use a range of other terms (e.g. functional disorder, or functional somatic disorder) which are not so well known to the public and which are not so obviously linked to meaning 'all in the mind' etc.

    They know exactly what they mean in psychiatry, and what they are doing. They've been working on their theories and classifications for decades, spending a lot of time perfecting them and keeping them up-to-date.

    In psychiatry, CFS is nicely wrapped up in very specific category (a functional illness) whereby it conveniently is neither a mental illness or a physical illness, but somewhere in between, whereby the symptoms are said to be both mind and body. (i.e. an unexplained and complex mind-body interplay.) (Note that without the mental aspect of the illness, there would be no interplay, and presumably no illness.) But it all boils down to the same thing - the claim that these illnesses can be treated with psychological or cognitive-behavioural interventions.

    "So-called functional (in contrast to ‘organic’) disorders are illnesses in which there is no obvious pathology or anatomical change in an organ and there is a presumed dysfunction of an organ or system."
    "...they do not fit easily within either medical or psychiatric classification systems, since they occupy the borderland between them."
    https://www.inkling.com/read/kumar-...ne-8th/chapter-23/functional-or-psychosomatic
     
    Last edited: Jun 2, 2014
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  11. alex3619

    alex3619 Senior Member

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    From what I am hearing the current buzzphrase in the UK is Functional Neurological Disorder, which is still code for psychosomatic.

    Its very much like once patients figure out that a term really means "you're nuts" they change the terminology so they can deceive a whole new generation of patients.
     
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  12. WillowJ

    WillowJ Senior Member

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    and deceive the more well-meaning doctors. It's very difficult for a doctor with a good heart and no experience with these diseases to understand the politics and stigma surrounding them.
     
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  13. alex3619

    alex3619 Senior Member

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    Quite. Patients are not the only targets. So are other doctors, politicians, bureaucrats etc.
     
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  14. A.B.

    A.B. Senior Member

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    If both physical and psychological factors are causative, why are only the mental factors treated? This definition contradicts what is actually done in practice. It reminds me of the web site of the King's College CFS department. It also has references to physical processes sprinkled throughout and avoids ever saying CBT and GET, but in the end the treatment is about "challenging false illness beliefs".
     
    Last edited: Jun 3, 2014
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  15. Valentijn

    Valentijn Activity Level: 3

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    "Somatic" and "functional" are open to interpretation. "Psychosomatic", on the other hand, has a very clear-cut definition.
     
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  16. alex3619

    alex3619 Senior Member

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    [Sarcasm/Satire] What, how can you refute that disease has both mental and physical components! And therefore can be treated by treating mental components. And therefore the physical can be ignored? And we are not mind-body dualists, so mind is body and body is mind. So really when we say we treat the mental, we mean we treat the physical. So how can you complain about treating both the mental and the physical? Some people just do not appreciate the work we put into dreaming this stuff up!!!! [End Sarcasm/Satire]
     
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  17. SilverbladeTE

    SilverbladeTE Senior Member

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    Biosocial, Psychosomatic etc should be regarded as heinous, evil, stupid, and unscientific as "Eugenics"!
    End of bloody story
     
  18. biophile

    biophile Places I'd rather be.

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    In most cases, "psychosomatic" is used to denote the effects of the mind over the body. As Bob already mentions, there are two main variations: bodily symptoms or disease caused and/or worsened by psychological factors. Even if psychological factors contributed to a disease, it does not automatically mean that psychological interventions can treat it.

    In a best case scenario, I have noticed that sometimes "psychosomatic" is used to denote psychological and somatic (bodily) symptoms in CFS without necessarily assuming a particular direction.

    Somatopsychic means the effects of the body over the mind. As privileging the mind over the body, optimism bias, and just world theory, are all common in our society, "psychosomatic" is a more prevalent assumption.

    Psychosomatic medicine has evolved since the 19th century, but I fear that many of the simplistic assumptions from that era are essentially still alive and well today. The trend of progress appears to suggest that models of psycho>somatic mechanisms tend to exaggerate the strength of the effect or association, over-emphasize some aspects of the illness, oversimplify the mechanisms involved, confuse correlation with causation, and underestimate the role of biology.

    This appears to be the case with biopsychosocial models of CFS, and especially the cognitive behavioural model of CFS which is guilty of all these sins. Our increasing understanding of how the body works should be used to develop new models rather than trying to squeeze new understanding into old assumptions or using "psychosomatic" to fill gaps in knowledge.

    The existence of post-exertional vulnerabilities opens up the possibility of psychological factors affecting symptoms, but none of the research purporting to show that psychological factors trigger or cause ME/CFS have ever been well conducted prospective studies using medically diagnosed patients. I suspect that for some patients, premorbid psychological factors may be to the early stages of ME/CFS as increased rates of premorbid depressive disorder is to the onset of Parkinson's disease: more an early sign of a developing disease process rather than causal factor. Perhaps post-exertional vulnerabilities is the first symptom to manifest and misinterpreted as psychological stress.

    Many ME/CFS patients are clearly affected by significant psychological stress, even if the mechanism is organic. I don't think it is fair or adequate to call this phenomenon "psychosomatic" if the main or only reason psychological stress impacts them in the first place is because of a biological state which is sensitive to disruption from psychological stress.
     
    Last edited: Jun 4, 2014
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  19. Sidereal

    Sidereal Senior Member

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    They used the Fukuda criteria. I am too brain fogged today to wade through the full text but if someone else wants to, let me know and I can send on the PDF.

    From the discussion:

    [​IMG]

    That's a psychosomatic illness right there. :rolleyes:
     
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  20. Bob

    Bob

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    'Somatic' categorically refers to biomedical/organic illness doesn't it?
    Are you getting your terminology muddled, Val, or am I more confused than usual?
     

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