The belief that physical illness can be psychosomatic, or caused by the mind, has long been seductive, capturing the imagination of doctors and writers alike.
Does this sound familiar? All the latest non-drug bio-psycho-social treatments of chronic pain are based on this flawed concept.
Contemporary, ad hoc resurrections of the concept of hysteria, now called conversion disorder, are commonly diagnosed by doctors and accepted by patients.
I’m still shocked every time I learn how incredibly irrational the medical field is. Especially in current research, pain is too often assumed to have bio-psycho-social causes, but without the “bio” part.
This is probably because pain is so resistant to purely biochemical explanations, which cannot account for the wide variation in pain perception.
When they can’t explain something biologically, even doctors turn to “magical thinking”.
But my research suggests that psychogenic explanations for physical conditions can be dangerous.
Because my EDS was undiagnosed for the first 2 decades I suffered from its chronic pain, I continued doing highly recommended activities like “stretching” and “yoga”.
I had no idea such “healthy” exercises would further damage the connective tissue around my joints and exacerbate my pain, which is permanent.
They contain numerous confused ideas, flaws in reasoning, and fundamental problems in methodology, often making a mockery of claims to be ‘scientific’
Such explanations constitute a ‘God of the gaps’ theory, whereby fictional, sometimes magical narratives slip into medical reasoning whenever there is a vacuum of knowledge.
They contain prejudicial assumptions about people and how they experience their ill-health.
Yet the assertion that physical illness is due to psychosocial stress is absurdly common, in both the popular media and the medical literature.
Yes, I’ve also found that even medical articles go along with the popular myth.
These days, scientific research is riddled with vague, flawed, and misleading “studies” on all kinds of “alternative” treatments which have normalized this fantasy.
The abundance of conditions supposedly caused by psychosocial stress is enough to raise alarm bells in a critical, scientific enquirer.
One logical flaw in such reasoning is that stressful life events and circumstances are themselves ubiquitous.
This is the problem of retrospective studies: they may find statistically significant past behavior, medication, or actions in the studied group, but they cannot determine if these past traits are unique to this group of selected patients or whether they are common in everyone.
The British psychiatrist Eliot Slater understood this in 1965, when he said that: ‘Unfortunately we have to recognise that trouble, discord, anxiety and frustration are so prevalent at all stages of life, that their mere occurrence near to the time of onset of an illness does not mean very much.’
What’s more, memories of stressful events can be unreliable, especially if the recounting of such self-reported events is influenced by the expectations of researchers.
A study in 1960, for example, found that parents of children with Down’s syndrome reported more ‘shocks’ during pregnancy than control subjects did. However, Down’s is a genetic disease that occurs at conception.
Ironically, ‘healthy’ control subjects might tend to under-report adverse life experiences, and over-estimate their ability to control their circumstances. Sick people, on the other hand, are more likely to report adverse events, which are then incorrectly assumed by researchers to be directly relevant to the illness itself.
Conflating psychological adversity with illness is now the topic of many books.
I’ve often wondered about this when I read biographies of highly accomplished people. They overcome all kinds of difficulties and torturous circumstances that would leave me in crippling pain.
But these heroes live through such disasters without suffering the bio-psycho-social disorder of pain that I live with.
the United States Centers for Disease Control and Prevention and its partners in their massive, long-term Adverse Childhood Experiences study … might have good intentions, but is subject to the same problems of confounding, and is as likely to be used in victim-blaming.
The tendency to accept without question the vague mechanisms by which the mind allegedly manufactures disease is reflected in the very language we use to describe the process: switches, black boxes and hypothalamic-pituitary-adrenal axes are but a few.
One pernicious version of this argument is that certain ‘personality types’ might be at higher risk of developing certain illnesses,
But correlations between this subjectively derived personality type and cardiovascular conditions are weak.
Yet another type, proposed as influencing breast cancer, is the ‘conflict‑avoidance personality’. Non-competitive and easygoing women, who are in harmonious personal relationships, are assigned this category.
So, being in a relaxed and calm state, which is so highly praised these days (because it’s the opposite of catastrophizing), is now considered a negative.
Make up your minds, psychosocial researchers: is maintaining equanimity as plus or minus when handling physical disorders?
In addition to psychogenic dismissal – where physical ill‑health is left un-investigated and untreated – psychogenic explanations effectively pathologise a patient’s personality and encourage patients to self-blame.
This raises serious ethical problems. Is it right, for example, to tell women that whether they survive breast cancer or die from it relies on arguing less and talking more, or changing their ‘personality’, when such ideas are not substantiated?
Despite the seductiveness of psychogenic explanations for physical ill-health, the oft-expressed idea that ‘our thoughts make us sick’ is not supported by the available evidence.
It is riddled with fallacies in reasoning, and causes harm to those to whom it is applied
This directly contradicts today’s popular notion that catastrophizing “causes” pain.
What catastrophizing does is cause us to dwell on our pain and this increased mental focus brings our pain to the front and center of our thoughts and feelings, making it seem greater than it is.
When we dwell on our pain, this increased mental focus brings it to the front and center of our thoughts and feelings, making it seem greater than it is.
Such intensified focus on pain can also be the result of being asked about our pain, as studies of this phenomenon must do.
Additionally, people often tend to respond to researchers’ unstated, but desired, outcomes. In subjective matters like “rate your pain level”, such confounding is impossible to avoid.