alex3619. My copy arrived about a week ago but I have been too busy or brain foggish to start reading it properly for note taking. I did however have a quick scan through a few times to see what was being covered. One page which made me laugh was her account of being told by a doctor that her suspected pregnancy (symptoms and supposedly-unreliable home test) was probably a "hysterical pregnancy", only for the reliable test to later confirm a genuine pregnancy. Such speculations seem inappropriate when stated before the reliable test result even comes back! It sounded to me this was one of the key moments which encouraged her to start questioning deeper the profession's tendency of defaulting to psychogenic explanations for unexplained physical symptoms.
The days of psychobabble are indeed numbered. There have been numerous systematic reviews over the last decade which have sobered up a lot of the hyperbole surrounding psychological factors in illness/disease and the placebo effect. Also, unsurprisingly, prospective research generally finds less associations than retrospective research. I was satisfied to accept whatever remained as genuine, but one challenge which Angela (and others) has indirectly encouraged me a while ago to explore further, was the issues involving psychometrics and response bias etc, which may further reduce the strength of the remaining associations.
I take the approach that the mind-body connection exists, but has been overstated, oversimplified, and overgeneralized, for ideological, political, and academic purposes. I think well-conducted studies into epidemiology and neuro-endrocine-immune interactions will elucidate something significant in certain situations. I have explored the evidence for psychosocial factors in other diseases, and ME/CFS does not necessarily stand out, such associations are claimed in many conditions. In fact, contrary to the oceans of psychobabble waving across us, the evidence is weak at best; after decades of claims there has been no well-conducted prospective study on this issue for medically diagnosed ME/CFS patients.
Another angle I've also been considering is the early stage disease processes in patients before symptoms becomes apparent enough for traditional diagnosis. There are diseases which can cause changes to mental functioning before the classic physical symptoms emerge. An example I often use is premorbid depression and Parkinson's disease. This association is usually attributed to the beginnings of dopaminergic neuronal death, giving the illusion that depression contributes to the development of PD, when it is probably an epiphenomenon (although I cannot rule out with absolutely certainty that severe depression could not contribute at all to the underlying process). Assuming that pre-morbid psychosocial stress and pre-morbid psychiatric symptoms are indeed associated with ME/CFS (the evidence is poor and conflicted), I have therefore wondered if something similar is happening for ME/CFS.
This line of thinking has me also wondering about other potential biomedical factors which have never been explored much, such as low levels of toxins in the womb and childhood, leading to very subtle developmental alterations which may increase susceptibility to some diseases. In animal studies at least, some of these toxins have at been shown to affect immunity and the stress response, and affects future generations.