Thank you Dr. Vitelli for a much more nuanced look at MUS than I am used to seeing in Psychology Today. As you have no doubt noticed from the above comments, there is a good deal of bad blood between patients with MUS and the psychological profession.
I imagine that a psychologist reading the comments might feel many of them are unjustified—and perhaps rightly so. Didn't the article explicitly state that psychological treatment is undertaken because of its proven track record of improving physiology and NOT because the disease is psychological? If no treatment exists for a disease, surely psychology is worth trying, and at the very least could not hurt?
Unfortunately, psychology has hurt patients with MUS. Here is a short list of the reasons some patients with MUS have become quite hostile towards any psychological treatment for their disease. Most of my examples will come from Chronic Fatigue Syndrome, as this is what I am most familiar with.
1. Bad Blood: Patients with Chronic Fatigue Syndrome have, under the care of psychologists, been encouraged to gradually increase their exercise until * presto * they are not longer fatigued. The PACE trial purported to support the use of this therapy, however after a long and nasty court battle forced the authors to release their data for independent reanalysis it was found that the results were not statistically relevant. Nonetheless, patients have been and continue to be institutionalized against their will and subjected to harmful psychological “cures” based on faulty research (see Karina Hansen).
2. Wasted Money: Treating MUS with psychology naturally leads to research into the efficacy of said intervention—much of which has been of dubious quality. For most medically unexplained diseases, this pulls already-scarce funds away from desperately needed biomedical research. Compounding this problem, diseases regarded as “psychosomatic” (no matter how considerately you define that word) receive very little research funding because why research a made-up disease? In the case of CFS this happened so completely that thirty years went by where almost nothing new was discovered. The importance of this grievance cannot be understated.
3. Faulty Logic: Although patients with MUS might improve a little from the biological benefits of psychotherapy, the argument would be better made to all of medicine. If you believe in the ability of psychotherapy to improve all sorts of bodily systems, why are you not pressing equally for patients with AIDS, MS, Yeast Infections or frequent colds to go to psychotherapy? I believe the argument is not made because, like with MUS, the benefits of psychology are unproven and underwhelming at best. This is not to dispute the inherent value in coming to terms with one's life in the way that psychology helps people do; I am simply suggesting that this change in perspective is mostly just that. Although it might make discomfort more bearable for its adherents it does very little to change or eliminate the symptoms themselves, and as such is not an appropriate substitute for biomedicine.
To those psychologists who want to be helpful: Stop suggesting that the only problem is that we don't think we're “crazy” or “malingering”--it's insulting given the clear history of abuse and bad science. Educate yourself about what good research is, advocate for higher standards in your field, and hold bad scientists accountable. Don't assume that psychotherapy, like butter, makes everything a little better--it does not. And finally, please stop making us a special case in need of your help; this is what perpetuates the “psychosomatic” label that chokes biomedical research funding. Like everyone else if we want your help, we know where to find you! Until then, I respectfully ask that you leave us alone.
