Oh I expect they will argue with you Alex that FSSs are real diseases especially if the resultant research unearths evidence that they agree with. This 'mediating chemistry' you mention is to me the same thing as 'biomedical' evidence. And even if the categorisation of FSSs is considered to be mental; then if the treatment works - who cares? Yeah ok they might be fairly accused of trying to cram too many syndromes into too small a box - but if the research results in evidence and more effective treatment - again - who cares? All this faffing around with names is what gets on my tits. And anyway, I thought the DSM thingy wasn't including CFS as a somatic condition? Pretty sure they weren't anyway.
I have been debating on this issue for many months now. Its spread all over my posts and blogs. CBT/GET doesn't work for ME nor CFS. They have never been able to prove these FSSs exist,
ever. They argue for an FSS interpretation but the theory is too nebulous to be tested.
Biomedical evidence, biomarkers,
must exist. You have one alternative to this: magic. Are they invoking magic?
So they have to find those biomarkers. Then they have to show that there is no other alternative to mental causation. They have to track the biological abnormalities, which are massively documented in the literature, back to the brain and thought patterns within the brain. I say to them: good luck, you are going to need it by the supertanker.
What will most likely happen, what
is happening, is that the biochemistry will fold together and an entirely physical explanation will emerge. Sure in some this might involve a brain disorder, I cannot rule that out.
There is a word for mind over matter: magic. There is a word for magic: superstition. There are words for superstition, including "myth" and even "fetish" (look it up). They spin a nice story, they just don't have any evidence that is more than vaguely suggestive. Sure they amass mountains of vaguely suggestive data ... all of which can have other interpretations. Then they assert there are no alternative explanations. My reply: MS, diabetes, RA, peptic ulcers, Lupus, etc.
A belief in FSS can be one of two things given the data. For those who think its an hypothetical unproven diagnostic category with dubious value and needs lots more research, ok, they may claim an appropriate medical or scientific view. For those who act as though it is real, sell it as real, create public intervention on the basis it is real: this is cult-like thinking, and its trying to spread through government and pursuasive rhetoric. Show me the data! There is only rhetoric and data that can have many interpretations. There is no science that I can see, only what Karl Popper and others call nonscience.
Now the use of CBT/GET does have many trappings of modern science. Yet they know the pitfalls. They continue to prefer to use subjective and potentially very biased measures rather than objective ones - though I am hoping adopting biomarkers might change that. Some adherents make unsubstantiated hyperbolic claims, even in medical journals. There is a name for science that has no hard data supporting it, has no validated theory, is untestable, is spread by rhetoric and unproven assertions of sweeping recoveries that the science cannot substantiate despite unblinded RCTs, looks vaguely like good science but misses the mark, and is propagated by spin and politics. The most favourable interpretation of that is pseudoscience, but there is another one I am looking at too.
Please keep in mind that pseudosciences like alchemy and astrology were once considered hard science. Many credible scientists pursued them. Then things changed, and now no scientist worthy of the name gives credibility to either alchemy or astrology. I think this is happening to psychosomatic medicine, where "think" in this sense really means its how I interpret the accumulation of evidence. Whereas once they had a good premise, and there are still threads of good ideas here or there, most of it is a web of superstition. I don't know what the shelf life of pseudoscience is, but psychosomatic medicine as its currently practiced is definitely past its best before date, and getting closer to its use by date.
Bye, Alex