Disappointing article in NEJM on anxiety

[Hip]

I think we all agree here, @Hip. If you read back over the posts, that is exactly what I and the others were saying.

It did not seem to me that you were, from your comment here:

The core idea underlying depression, anxiety etc., is that these are about certain patterns of thinking and/or kinds of feelings. That's what makes them psychological. Somatic complaints are often included in diagnoses or in self-report scales because they seem to frequently accompany those thoughts and feelings. But by including them in definitions and scales, we risk losing the integrity of the original concept - which was psychological - and contaminating them with a measure of something very different.

You seem to be saying that by mixing mental and physical symptoms in the description of a disease, we are contaminating the psychological essence of the mental symptoms.


Similarly, @MeSci says after listing all the physical symptoms of GAD:

Er, where are the mental illnesses in that lot?

 

[Woolie]

You seem to be saying that by mixing mental and physical symptoms in the description of a disease, we are contaminating the psychological essence of the mental symptoms.

Yes. Still got to keep them separate conceptually. Else, you end up with a meaningless construct that is neither psychological nor physiological but some weird confusing mix of both. Then you can't even go about establishing whether this mess is associated with any other illness factors, let alone what the direction of any causal relation is.

Edit: What I'm saying is that by mixing mental and physiological symptoms in the description of a psychological construct (like anxiety), we are getting into troubled waters. A disease may very well have both psychological and physiological components.

 

[Hip]

Edit: What I'm saying is that by mixing mental and physiological symptoms in the description of a psychological construct (like anxiety), we are getting into troubled waters. A disease may very well have both psychological and physiological components.

I don't think the disease description mixes in physical symptoms when describing the actual nature of mental symptoms. In the case of generalized anxiety disorder, the mental symptoms are typically described as: mental tension and/or excessive worry, sense of dread, constantly on edge, inability to relax, difficulty concentrating. It goes into a little more depth than that, but that's the basics.

But then since there are often physical symptoms also present in GAD, these are also detailed.

 

[MeSci]

Similarly, @MeSci says after listing all the physical symptoms of GAD:

No, I was saying that this was a list of supposed mental and physical illnesses, but I could not see a single mental illness in the list.

I too am arguing that 'psychological' illnesses probably have physical causes.

 

[Brain Fog]

No, I was saying that this was a list of supposed mental and physical illnesses, but I could not see a single mental illness in the list.

I too am arguing that 'psychological' illnesses probably have physical causes.

No no no - you are just imagining that gluten is a problem. You are clearly worrying too much. Non-coeliac gluten sensitivity is just a fad...

Giving up Gluten was the best thing I ever did. It felt like waking up after being partly under anesthetic all my life!

 

[MeSci]

Giving up Gluten was the best thing I ever did. It felt like waking up after being partly under anesthetic all my life!

Yes - it helps a lot of us. I hope you realise that I was being tongue-in-cheek above.

 

[Brain Fog]

Of course

 

[Hip]

I too am arguing that 'psychological' illnesses probably have physical causes.

Well then we are all in agreement.

As a general point: people may not have it clear in their minds the difference in the concepts of mental/psychological symptoms, and mental/psychological causes.

In fact, there are four such concepts:

mental (psychological) symptoms
mental (psychological) causes

physical symptoms
physical causes

Any given disease may involve physical symptoms and/or mental symptoms. But the causes of those physical and/or mental symptoms is a distinct issue, and these causes may be:

Purely physical causes (even for purely mental diseases)
Purely mental causes
A mixture of physical and mental causes



My view is that too much of psychology assumes that mental symptoms most likely must have mental causes (a sort of "like causes like" philosophy). And that too few psychologists work from the basis that mental symptoms may well be due to physical causes.

Sure, in mental disorders, there can be dual causal factors: as per the GAD example I gave above: if you develop GAD from a physical cause, you then become extra sensitive to stress, tension and uncertainty in the world around you. Thus if your world is full of stress and uncertainty, compounded with your physically-caused GAD, this may make the symptoms of your GAD condition much worse.

Similarly, ME/CFS patients have a disease that most likely has a physical cause, but this disease make you extra sensitive to stress and social discord, such that when you are exposed to these (they are to be considered mental causes), your ME/CFS symptoms may actually get worse (in a PEM-type response).


So while there is no denying that mental causes (such as a stressful environment) may exacerbate a mental disorder, the primary etiology of many mental disorders is most likely to be underpinned by a physical cause, in my opinion.