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Psychogenic explanation of physical illness: time to examine the evidence

Discussion in 'Other Health News and Research' started by Kati, Nov 29, 2015.

  1. Kati

    Kati Patient in training

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    Carolyn Wilshire is a psychologist and also a university senior lecturer who wrote a polished response to a PACE trial paper earlier this year, which can be found here

    She wrote a new paper (which I haven't read, but I am sure it is good) 40 pages long, available here:

    http://www.researchgate.net/publica...physical_illness_Time_to_examine_the_evidence

    She is seemingly on the same side as James Coyne is which is very good news for us.
     
    Last edited: Nov 29, 2015
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  2. Never Give Up

    Never Give Up Collecting improvements, until there's a cure.

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    Wow!
     
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  3. Hip

    Hip Senior Member

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    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.
     
  4. barbc56

    barbc56 Senior Member

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    Thanks!
     
  5. Cheshire

    Cheshire Senior Member

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    Yes, this paper is a very solid critique of the psychogenic theory. There are several points that deserve to be highlighted, it's a very long and complex article.

    It tackles the lack of science to back up this theory, the flaws and limitations of the research upon which it is built, the arbitrary choices that are made (this disorder is psychogenic, this one isn't), the harm it does to patients.

    Complete, dense and empathetic!

    Some quotes (not the best ones, but I must read the whole text again):

     
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  6. Kati

    Kati Patient in training

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    Thank you so much @Cheshire, the last quote is very powerful and resonnate with me a whole lot.
     
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  7. Hutan

    Hutan Senior Member

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    It is very good.

    The points made are common sense and are issues we often talk about here (e.g. sample size; suitable controls; recall bias; problems with self reporting; researcher bias with lack of blinding). They are nicely supported with data and references. And while the points are common sense, clearly medical professionals who are applying, promoting and researching psychogenic diagnoses need much more exposure to them.

    There are quite a few typos in the paper though. This may make it easier for the people who most need to hear its messages to dismiss it. (ie 'the sentence doesn't make sense, maybe the analysis was sloppy too')

    It is odd as clearly a lot of time has been spent doing all the data gathering and analysis and the content is great; it just needed an hour of editing to finish it.

    Hopefully there will be a more polished version of the paper later as it is one I would like to have in my armoury when dealing with doctors who are still stuck on the idea that behavioural and personality issues are the cause of ME/CFS.

    (Fingers crossed my typos in this post aren't numerous. Always a risk when pointing out others' typos.)
     
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  8. Cheshire

    Cheshire Senior Member

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    From what I get, it's a pre-publication paper. The article has not yet been published. So the typos may be corrected. Let's hope it will be released soon, and then reach a wider audience.
     
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  9. A.B.

    A.B. Senior Member

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    Beautiful article. Finally some sense and critical thought.

    It's unfortunate that the article is based on just movement disorders and seizures.

    And it could have been even more critical when it comes to the catastrophic consequences of labelling a health problem as psychogenic. In ME/CFS, they have been witholding help, research, treatment for decades now, in the belief that ME/CFS is merely a fashionable social construct for depressed somatisers that will go out of fashion if health practitioners avoid legitimising it.
     
    Last edited: Nov 30, 2015
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  10. Snow Leopard

    Snow Leopard Hibernating

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    Excellent paper!
     
  11. Jonathan Edwards

    Jonathan Edwards Senior Member

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    A very nicely argued review. It will be good to see it as a formal publication. I doubt a few typos would detract from the clear writing style and they ought to get dealt with by a journal subeditor.
     
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  12. A.B.

    A.B. Senior Member

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    And I suspect that if we search for the origin of this belief, we will find Freud, who was later shown to have fabricated the evidence to support his theories. It's all based on the lies of a quack.
     
    Last edited: Nov 30, 2015
  13. Kati

    Kati Patient in training

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    I have exchanged a few tweets with Carolyn and she says more is coming. :cool::thumbsup:
     
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  14. chipmunk1

    chipmunk1 Senior Member

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    Nice publication. We can only hope more of this type gets published.

    I would say the current bio-psycho-social model of somatization will effectively maximize biological, psychological and social damage done to an individual.

    Secondary gain is a huge pile of nonsense.

    I think it is obvious who gains the most from such diagnoses.

    It's not just secondary gains that can be found in organic illness, almost any diagnostic criteria that they have used were found in organic neurological illness as well. (e.g response to suggestion, worsening with emotional stress, rapidly fluctuating symptoms, apathy towards symptoms, exaggerated concern with illness etc.)

    Basically most diagnostic criteria they used turned be invalid but many are still using them.

    It's been over 100 years and there are still very few long term follow-up studies in the medical literature! I wonder why?

    Many types of conversion disorder have not more than a handful of case studies in the entire medical literature despite being known for known for a long time. You don't even have to look for studies done with a small group of people. They often don't exist.

    That would still be a good outcome. Seriously disabled individuals may end up homeless and denied any financial support or medical treatment. Some could be driven into suicide after being stigmatised and isolated from friends and family. The rate of misdiagnosis should be expected to be significant and the outcome in such a case could be devastating.
     
    Last edited: Nov 30, 2015
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  15. chipmunk1

    chipmunk1 Senior Member

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    I would say it's based on cocaine binges. In this book from 1983 it is suggested that Freud's discoveries would coincide with the resumption of his cocaine consumption.

    https://en.wikipedia.org/wiki/The_Freudian_Fallacy

    It was not well received by medical scholars and the author had even been ridiculed for her theories.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1439796/?page=1

    10 years later the field had mostly abandoned freudian philosophy. It continues it to be used to explain conversion disorders even when Freud's name is often not mentioned directly.
     
    Last edited: Nov 30, 2015
  16. PeterPositive

    PeterPositive Senior Member

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    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.
     
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  17. chipmunk1

    chipmunk1 Senior Member

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    It's interesting that "psychogenic" means no disability aids. Would it be acceptable to deny sufferers of severe depression disability aids because it is a "psychological" disease? You really get to wonder what this is all about.

    She does not mention Diabetes, Cancer, AIDS, Asthma, Graves Disease, Dystonia ....

     
    Last edited: Nov 30, 2015
  18. PeterPositive

    PeterPositive Senior Member

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    Good point, I've wondered about this issue many times.

    There is a monumental difference between something "psychological" and something faked, on purpose. Our psychology is not necessarily under our direct control. We don't "decide" our psychological traits, or how we can or cannot cope with psychological trauma etc...

    On the other hand fakers are just making symptoms up.

    Why someone with an alleged psychogenic disorder is to blame more than - say - someone with a disabling liver cirrhosis caused by a bad life style? ( and isn't life style psychogenic too?! :D:rolleyes: )
     
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  19. ScottTriGuy

    ScottTriGuy Stop the harm. Start the research and treatment.

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    @Kati

    Thanks Kati - excellent info for our side.
     
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  20. Aurator

    Aurator Senior Member

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    I've read about half of it and found only one typo: a capital where there should have been a lowercase letter. Can you tell us some others you've found?
     

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