Why psychiatry should not get involved...by a psychiatrist

[alex3619]

On the SSD article:

In the absence of abnormal thoughts, feelings, and behaviors, patients with irritable bowel syndrome, chronic fatigue, or fibromyalgia would not qualify for a diagnosis of somatic symptom disorder.

This claim is problematic. How do you assess that? Pacing might be considered an abnormal behavior. So might resting during the day. So might falling over or passing out from OI. So might taking supplements, or restricting the diet. In cases of CFS for example, with strong anxiety, then a diagnosis of CFS with anxiety might be appropriate, but SSD? The devil is in the details. Basically the only person who is safe under this is a mild CFS patient who is still struggling with full time work, and does not take any drugs or supplements and has not made any dietary or other changes.

It doesn't help that there is no objective evidence that SSD or anything similar is a valid diagnosis, nor that like most such disorders it relies on subjective interpretation and the formal fallacy, the psychogenic fallacy.

Until the psychiatric profession wakes up to the advances in biomedical testing for ME, any such disorder is dangerous because, to paraphrase one researcher (Steven Holgate?) , they are bathing in ignorance.

 

[Cheshire]

This claim is problematic. How do you assess that? Pacing might be considered an abnormal behavior. So might resting during the day. So might falling over or passing out from OI. So might taking supplements, or restricting the diet. In cases of CFS for example, with strong anxiety, then a diagnosis of CFS with anxiety might be appropriate, but SSD? The devil is in the details. Basically the only person who is safe under this is a mild CFS patient who is still struggling with full time work, and does not take any drugs or supplements and has not made any dietary or other changes.

It doesn't help that there is no objective evidence that SSD or anything similar is a valid diagnosis, nor that like most such disorders it relies on subjective interpretation and the formal fallacy, the psychogenic fallacy.

Until the psychiatric profession wakes up to the advances in biomedical testing for ME, any such disorder is dangerous because, to paraphrase one researcher (Steven Holgate?) , they are bathing in ignorance.

And in those cases where "abnormal" thoughts, feelings, or behaviors are found, they will be considered (unlike in cancer and any "real" pathology) in ME/CFS, IBS and FM as being the etiology of the disease. So that would mean that there are "psychiatric" ME/CFS, IBS and FM, and "physiologic" ME/CFS, IBS and FM. Just nuts...

 

[IreneF]

I just had a look at what I said and I'm not sure that I was altogether clear. I'm having trouble organising my thoughts.
Or perhaps I'm not understanding what you're saying.

Can't argue with our having insight and understanding that kitty has no access to and that we can, using metacognition, alter a rising response by being aware of it.

Are you saying kitty's non ability to alter her response with insight is the hallmark of what makes it psychogenic? Or the outside stressor?

My thoughts are that even though we might be able to alter our response that doesn't alter the fact of it being physical.

I think this is where the waters get muddy. What is the nature of mind. If something arises from the mind does that mean that It's 'all in our head'? Again, I think of mental phenomena as arising from some physical stimulus to our environment. Depending on our personal physical makeup that stimulus may lead us to ignore cranky kitty or become upset. Again, the difference being that we can think about that stimulus and (sometimes for some things) alter that response.

Brigid's problem was not due to an infection, cancer, or other problem within her urinary tract. It cleared up when the old cat died. The third cat (Orlando) was dominant and never had a problem. So this is an example of a serious problem that was due to how the individual (Brigid) reacted to a stressor in her environment. So it's clear that problems in a living situation can cause disease, at least in cats. It's called feline idiopathic cystitis and shows similarities to interstitial cystitis in humans.

I'd say the outside stressor makes it psychogenic, although I don't like the term. "Stress-induced" is too vague. It wasn't something she "imagined" (I don't know how you would determine imagination in a cat) and the physical effects were observable. I wouldn't call it a mental phenomenon, because it was caused by something in the outside world.

Where we differ from animals is self-awareness, so we can recognize stressors in our lives and take steps to reduce their effects. Interestingly, certain "psychosomatic" disorders are supposedly more prevalent among children or less sophisticated people--those who lack insight or self-awareness.

 

[Snowdrop]

Brigid's problem was not due to an infection, cancer, or other problem within her urinary tract. It cleared up when the old cat died. The third cat (Orlando) was dominant and never had a problem. So this is an example of a serious problem that was due to how the individual (Brigid) reacted to a stressor in her environment. So it's clear that problems in a living situation can cause disease, at least in cats. It's called feline idiopathic cystitis and shows similarities to interstitial cystitis in humans.

I'd say the outside stressor makes it psychogenic, although I don't like the term. "Stress-induced" is too vague. It wasn't something she "imagined" (I don't know how you would determine imagination in a cat) and the physical effects were observable. I wouldn't call it a mental phenomenon, because it was caused by something in the outside world.

Where we differ from animals is self-awareness, so we can recognize stressors in our lives and take steps to reduce their effects. Interestingly, certain "psychosomatic" disorders are supposedly more prevalent among children or less sophisticated people--those who lack insight or self-awareness.

Hi Irene

I was thinking from my point of view that the environmental stressor caused an actual physical response in the cat's anxiety pathway. In other words that cat had a lower threshold to responding with anxiety to the stressor than did the alpha cat.

The anxiety, again to me, would be based an physiologic reasons. The cat physical profile in terms of it's chemical functioning and genetic susceptibilities cause the anxiety to manifest and then the anxiety causes the peeing.

Many, many years ago I was diagnosed with idiopathic epilepsy. Idiopathic just means that they have no idea of the cause.
I my case, back then it suggested that while some epilepsies were 'organic' and a cause could be found epilepsies of an idiopathic nature were likely 'all in your head' manifestations of a psychological nature.

Needless to say new understanding and technologies have come to light regarding epilepsy and mine would no longer be idiopathic.

 

[IreneF]

Hi Irene

I was thinking from my point of view that the environmental stressor caused an actual physical response in the cat's anxiety pathway. In other words that cat had a lower threshold to responding with anxiety to the stressor than did the alpha cat.

The anxiety, again to me, would be based an physiologic reasons. The cat physical profile in terms of it's chemical functioning and genetic susceptibilities cause the anxiety to manifest and then the anxiety causes the peeing.

Many, many years ago I was diagnosed with idiopathic epilepsy. Idiopathic just means that they have no idea of the cause.
I my case, back then it suggested that while some epilepsies were 'organic' and a cause could be found epilepsies of an idiopathic nature were likely 'all in your head' manifestations of a psychological nature.

Needless to say new understanding and technologies have come to light regarding epilepsy and mine would no longer be idiopathic.

I don't like the idea of a split between the mind and the body.

I hope you got effective treatment for your epilepsy. That must have been quite a while ago! Both you and Miss B highlight the difficulty with an idiopathic diagnosis--equating absence of evidence with evidence of absence. I don't think there's such a beast as cat psychology, since cats don't have a psyche.

 

[Snowdrop]

@IreneF Hi Irene

It's interesting that you take what I said about the physicality as meaning a mind body split. I find that thought appalling.
I had not thought of what I was writing in light of that particular mindset.
I don't like Cartesian dualism either. At all. I see what I'm saying quite differently.
The mind isn't a separate thing but arises from the physical. I see it as a reconnection of the two.

 

[stridor]

One of the problems, I believe, is that there is a form of CFS that forms part of Major Depressive Disorder - MDD. Also, a percentage of those with Bipolar have vegetative depressions very similar to ME. I know because I have been frequented by this.
When someone with a Major Depressive Disorder responds to antidepressants and the pseudo-ME clears, it only encourages them to seek out those with symptoms in the same ballpark.

Before I go further. The depression that I had with Bipolar was a dark and dirty, throw myself in front of the bus type and distinctly different from the "all-low-monoamine depression" of ME. The latter was characterized by a loss of interest in my colourless, pointless world and the people in it.

I can understand the mistake. I am sure that to an observer that there are similarities. This is where the Dr really needs to listen. I am an expert in how depression manifests itself in me. I could drop my temperature 2 degrees just doing 3 or 4 flights of stairs and it would stay down for hours. I offered to demonstrate for 3 different Drs and none were interested. They were satisfied with their diagnosis...or I should say, my diagnosis.

While Bipolar, FM, ME, MDD are all likely related in terms of cause and eventually will share similar metabolic interventions, The best thing in terms of moving forward with all of this is to clearly differentiate ME and the CFS associated with MDD. I applaud those that have been working hard towards this goal. brad