We would love it if we could reduce all of these things to a simple pathway. You know, science has had all of its greatest successes in reducing problems to a single pathway, a single place and all the, you know, if you take diabetes, understanding the key role of insulin in diabetes, once that was understood, it transformed the whole illness and allowed for people to become better. The problem with things like fibromyalgia and other disorders that are of the neurologic systems of the brain is that the brain seems to have a duel existence. It exists both as a biological construct, but it also exists as sort of a psychological construct and we don’t really understand how the two go together yet, how they play together, how they sing together, how they work together–and so our attempts to alter biology without understanding the emotional overlay probably leads to a lot of failure. It speaks to our lack of understanding of how it really works."
I do not know how that could not be more clear that he see it as a biological disorder.
This IS very clear. He is indulging in a psychobabble explanation. He is a dualist on theory of mind. This unfounded hypothesis is where bad psychiatry likes to hide, but also bad neurology. Charcot was the founding father of both professions, and he definitely was into some weird things, like mesmerism. Freud was the most famous student of Charcot.
I do not doubt most psychiatric illnesses are physical, though not always in the brain, just affecting the brain (such as infections that interact with the brain and can cause depression). I also think some abnormal behavior is due to false belief systems. I note this is behaviour, not illness. I find it weird that people will barrack for their favourite sports team based on geography and who their friends support. That is not a disease however, nor even an illness. This is when calling something a cultural phenomenon has some merit. I suspect its a form of modern tribalism.
The reason that I think this kind of explanation has appeal is that its a mismash of half-truths. The bits, isolated and considered separately, kind of look OK. Yet when added up its more like a religious statement than a scientific one, and without the moral imperative many religious statements have.
These statements need serious disambiguation between what is neurological, and what is psychological, and what is hypothetical psychiatric claims.
I repeat again, something I have probably said more than a hundred times, the list of diseases claimed as psychiatric and disproved is HUGE. Starting with tuberculosis. The number of diseases where these claims have been proved is .... [crickets chirping].
That does not mean that I can guarantee that some such disease claim will never be proven. It might. Its just never happened and the evidence for it is terrible, and the reasoning is irrational. It basically amounts to what I consider one of the worst forms of reasoning I see generally, in various guises. It
might be true, therefore it is.
It might be demonic possession. We need an exorcism.
It might be witchcraft. Burn the consort of Satan.
It might be aliens. Blame everything on those beings from some place far away. There is nothing you can do though, go home and get drunk.
It might be drugs in the water supply. We need to expose the conspiracy.
MIght be can be a place to start rational inquiry, and this can be good. When accepted as truth its dangerous. A point of science is to investigate and remove falsehoods. A point of psychobabble seems to be to justify their claims without proof.
In case anyone is of any doubt I am a monist on theory of mind. The words "psychosomatic" and "mental" and "mind" are deceptive. Just because you put a label on something does not mean you understand it. Indulging in such thinking confuses the debate - its a huge failing in psychiatry.