People are incredibly reluctant to believe that ailments might actually be partly or mainly psychological. Chronic fatigue, fibromyalgia, chronic lyme disease, back pain, are all things that sincere people truly are suffering from...that may be mainly psychological/psychosomatic but lots of people refuse to consider it. Probably due to the general dismissal of mental illnesses and being told for years "it's all in your head". I think partly, people with these conditions are sometimes accused (or think they're being accused) of malingering; I don't think that's the case very often, I think they legitimately feel the symptoms they report, but the root cause may be in the mind/brain rather than the rest of the body.
Yes, some back pain is due to repetitive stress injuries or physical structures out of place or whatever. But as this study shows, looks like it has a strong psychological component as well. I suspect we'll (some day) get better treatments for all the things I mention, if mental illness stigma ends and they can be honestly considered from all possible causes.
Edit: to be clear, I'm not saying that all cases of back pain or CFS or whatever are psychosomatic - just that it shouldn't be dismissed, especially when the treatments are relatively low-risk.
My dad has been fighting cancer for the past 13-ish years. He recently told me that he's expected to live another six months or so because he has ran out of treatment options. Though we've known for most of these past years that his cancer is terminal, I feel like him telling me the news set something off inside of me.
Starting shortly after the time of hearing this news, I started to feel subtle, hard-to-pinpoint discomfort near my tailbone & perineum (sorry, TMI). I went to the doctor multiple times, had all types of exams and scans, but everything was coming back as "normal". My symptoms got worse as weeks went on, and I became incredibly anxious, though I was not able to recognize it as "anxiety".
At the peak of all this I found myself having what I would assume was an anxiety or panic attack. I could not control my breathing, started sweating, feeling like I was about to pass out. My wife was able to calm me down by helping me breath. I would break down crying on the phone trying to schedule doctors appointments (I'm 30 years old). I was unable to sleep at all for several days in a row even though I felt completely exhausted. Had to take time off (Incredibly thankful for coworkers/managers who were understanding) Chest pain, digestive issues, etc.
It's been a weird few months, but I finally think (hopefully) I am starting to get back to my "normal" self. The experience has taught me at least a couple things:
- Mental / emotional heath is something that is taken for granted. Now I have a new perspective on the importance of trying to maintain it and want to be understanding toward others.
- I think some (all?) of my symptoms were definitely related to what was going on in my life, and how things played out as I tried to fix them. This is hard for me to wrap my head around, but really I have found no other logical explanation.
From my own (anecdotal) experience, stress most definitely plays out in physical ways in your body. Throughout the day or night, you can be tightening muscles without knowing it. They can eventually fatigue and set off a chain of other muscles compensating for it, etc. They can even cramp up in ways that they push on nerves, resulting in nerve-pain symptoms. It's all fairly logical, but for some reason there's this preconception that there is absolutely no linkage between our bodies and minds, which makes people look everywhere else first. The worst cases tend to be cyclical, where your worsening symptoms add to your stress, which leads to more symptoms, etc.
The caveat is that sometimes, it's not just stress. You shouldn't neglect your symptoms, if they persist.
I read the book after a recommendation on this site in fact. It was eye opening to say the least how conditions like ADHD, PTSD, childhood trauma, anxiety and depression have both psychological and physiological effects. Some of which are surmountable (trauma in adult hood) whereas early childhood trauma can leave long term physical changes to the brain and body making it something that has to be managed.
The first 2/3 of the book is very illuminating the last 1/3 a little polemic on healthcare policy and funding.
That is unfortunately the case with me and it took me several years to start realizing that prolonged stress can result in this cascading effect where muscles tightening can distort your body slightly. This in turn can put strain on muscles initially unaffected which can themselves become locked because you cannot release the initial strain. By the time I started realizing it I couldn't answer anymore the question what it feels like for my body to be relaxed.
So sorry to hear what you were going through. My partner had something similar due to the stress from the pandemic. What helped her the most was actually a regular psychiatrist appointment.
Did you do something specific when you took your time off and saw your symptoms disappear? Curious what helped you the most.
So sorry to hear about your dad and your symptoms, that sounds very tough. I'm very glad to hear you're feeling closer to your "normal" self, I hope that continues.
Anxiety/stress/panic attacks are no joke. I think a lot of us in technical fields discount the "mind" - "it's a brain, it's just a meat computer" - and while I don't ascribe any supernatural aspect to it, the brain/mind can have really powerful impacts on the body.
Just to chime in, it's not only people who work in technical fields.
I had similar symptoms (chest/back pain, lethargy) from stress from the pandemic + overwork a year ago.
And I studied psychology and knew that these things could happen, but when it first happened to me I thought I had heart problems (not likely since no familial history + obvious lifestyle risks).
It went away as soon as I quit and went for some therapy, not because I didn't like the job, but there was no way for me to mentally get away from it.
That’s a powerful story. I’d encourage you to try yoga. Do the Beachbody 3 week yoga retreat. Then continue doing one of the final “flow” routines every day. It’s 30 mins and is very accessible. It cured my chronic back pain and has eliminated anxiety about a range of things. After 4 years of doing this its also left me with an insanely strong core and great flexibility.
The Black Lotus app [0] is an incredible help to deal with mental issues related to stress, anxiety and lack of focus/mindfulness.
Personally, I have used it twice successfully to come out of sudden mental anxiety I found brewing in myself.
Thoughts are also a form of energy – if they don't get channelized or remain unspent in your subconscious/unconscious, they can create mental problems. Meditation and related activities, prescribed as part of the RARE framework of this app, help in cleaning these otherwise overlooked corners of our mind.
I was one of them. I thought panic attacks were some stupid made up thing for weak people, same with anxiety and the rest of them. Then it happened to me. And it affected so many things you wouldn't believe, from chest pains to fatigue to brain zaps to esophogal tremors to stool color even.
I will gladly eat crow, I'm only admitting as much because I understand how easy it is to dismiss psychosomatic ailments. When you don't have any to worry about, it's nearly impossible to begin to comprehend. I liken it to ghosts...some folks swear they've seen or experienced them, but I don't see how it's possible. I half expect to be proven wrong on that, also.
I believe ghost sightings are real - but caused by visual system trying to map inconclusive/limited information to something it already has a pattern for, and once a pattern (no matter how absurd) is found, it latches onto it.
AFAIK what we "percieve" of the world is anyway a hallucination produces by our brain based on sensory input. And particular conditions can mess this up briefly.
I've seen things twice that weren't there and realized what was going on only when got closer. First was when in the middle of the night I saw through a half open door my son (1 y at the time) walking in a room - I entered the room, and realized it was not plausible he could have been where I saw him a second a go. I backtracked what I saw and realized there was play carpet with road patterning on the floor, plus miscellanious kids stuff on the background. It was nearly pitch black. From my pov the scene mapped to my son in my visual system, and then it maintained this pattern just long enough for me to "see him walking".
Second was when I during a normal day observed what only could be two crows fighting or mating on a small tree. I got close. Really close. Then it suddenly 'stopped' being two crows and I realized it was just a black plastic bag fluttering in the wind.
I have no idea how to teach people of the fragility of our cognition in a way that would not involve a pathology as you had - realizing fragility of psyche is real similarly as death is real - but I feel realizing this would make people more emphatic towards all sorts of problems our fellow humans have.
Pareidolia (/ˌpærɪˈdoʊliə, ˌpɛər-/;[1] also US: /ˌpɛəraɪ-/)[2] is the tendency for perception to impose a meaningful interpretation on a nebulous stimulus, usually visual, so that one sees an object, pattern, or meaning where there is none.
People have a lot of difficulty understanding things they haven’t experienced.
This leads to a number of people treating other people’s behavior as if they were doing it. If the only reason they would not be successful is laziness, then everyone who doesn’t succeed is lazy.
To them, it isn’t fair that other people get stuff “for free” when they had to work for it.
> People are incredibly reluctant to believe that ailments might actually be partly or mainly psychological.
There are two simple reasons why people don't want their ailments to be psychological.
First, there are no real tests for determining if something is psychological or physical. Doctors just test for some stuff, and if the tests come back negative or inconclusive, they just explain it away as "psychological." You can never be sure whether you have a physical problem or whether your doctor is just lazy.
Second, the medical system just gives up on you if the issue is psychosomatic. There are no treatment protocols that work, so agreeing that something is psychological is just having your case tossed on the trash heap to be ignored.
Modern medicine does have a light side and a dark side. On the light side are known ailments with known tests and treatments. On the dark side is everything fuzzy and uncertain. Doctors HATE being faced with ambiguity, and patients know that if their case falls into the dark side that treatment and recovery are hopeless.
> Second, the medical system just gives up on you if the issue is psychosomatic. There are no treatment protocols that work, so agreeing that something is psychological is just having your case tossed on the trash heap to be ignored.
Maybe it's because we need to change our approach to psychotherapies in general. The reason psychology as a whole is not considered hard science is because replication is hard and in some cases impossible (good luck finding subjects who haven't heard about the Stanford prison experiment today). Why don't we accept this is just the way it works. That some therapies will work for some people and won't work at all for others (or might even make their symptoms worse). That therapy needs much more time than a pill to work - instead of hours, we're talking weeks and months, possibly years. That the evaluation of the results always has an element of subjectivity: sure, you can measure some physiological aspects, but there is always the internal component of well-being.
> There are two simple reasons why people don't want their ailments to be psychological.
Another reason is that most people find it scary if someone starts tinkering with their psyche. I honestly think that every therapy should start with strategies to overcome this fear.
You couldn't have picked a worse example than CFS to include in that list - a syndrome that for decades was dismissed as psychosomatic, and that many people (read: most notably medical professionals) today still dismiss as such, despite the evidence that no, actually there's some kind of physical dysregulation going on (probably triggered in many cases by a viral infection.)
Interestingly...well to me, at least, I went to the doctor for being constantly tired when I was younger. The doctor asked how many friends I had, I said oh a few, then diagnosed me with depression and recommended an antidepressant. I left and never went back.
Two or so years later I got a long term girlfriend, who told me I quit breathing in my sleep and gasped for air. Obviously, this is something you don't even think of yourself.
I didn't go on CPAP, but did see an ENT who did a couple sinus surgeries and put me on steroids for chronic sinus inflammation. That treatment changed my whole life. The fatigue disappeared immediately.
That was almost my exact experience with a former girlfriend, except my advising her about sleep apnea.
I was amazed no one had mentioned it to her before, as she had quite lengthy pauses and then gasps after them, all night! Scared the hell out of me, until I finally said something, and she went for a sleep study.
It's so wild. The first time I woke up to her hitting and shaking me, she was visibly disturbed by it as I'm sure you were. And here we are our whole lives not even knowing we are doing it!
Hey can you please PM me a bit more info on how you were treated and some facts about your case if you are comfortable to?
I have been using CPAP for years but my case is weird: I was diagnosed in my early 20s, I was not and am not overweight, I only drink socially (so less than once per week), I don't and have never smoked, etc.
CPAP has massively improved my life, I'm feeling much better, but honestly my sleep specialist was kind of shit when it came to answering questions. When I asked about surgeries and the like he just said "No, we can't do that" and I couldn't get him to elaborate on why.
I never pushed it because I used to be too poor and I was too exhausted to bother with screwing with my treatment but I'm reconsidering that. Don't worry I won't take anything you say as medical advice or anything, I just... I dunno I guess I'm curious to hear about the experiences of someone who had a different treatment avenue in some depth. It might make me feel for comfortable/proactive about seeking a second opinion and pushing for specific answers
So to avoid confusion here, my surgery wasn't some alternative to CPAP per se, but fixed my breathing issue. In short, my nose got so restricted I could barely breathe from it at all.
My journey began by seeing a doctor for it, who tapped on my forehead and said I don't have a sinus infection, take an allergy pill and go away. Nothing but pseudofed ever helped at all, and that got expensive and restricted.
Then I saw an allergy doctor, who said that's a stupid test and did an MRI and found that I have something like a constant sinus infection, and inflammation everywhere. He sent me to an ENT, which honestly is probably where I should have started. As a side note, I did try allergy shots for about a year with no luck.
The ENT has these cool but odd feeling cameras they shove deep into your nose to see around. It's a horrible feeling tbh, sometimes you feel it in your eye or even tooth(nerves, I guess). He determined I had polyps really bad and a deviated septum, so in one marathon surgery did both.
Afterwards, it was great, and slowly got worse. ENT said polyps were coming back, so put me on a daily sinus rinse with budesonide(sp?). So each night I rinse my nose with that, and have for going on 8 years now I guess. It's kinda gross, you wouldn't believe all the snot that comes out after the steroids open everything up, which usually takes about 20 mins.
Ah thanks. I've had the scope shoved in my nose it is terrible (I had a chuckle after getting tested for COVID because boy is that camera worse).
I definitely don't have a constant sinus infection, so it sounds like your situation isn't at all like mine. At least probably not. Nonetheless I really appreciate your time writing all of that out, thank you
I managed to recover from ME/CFS 20 years ago (with no symptoms since). It was entirely through psychological/behavioural changes that I was able to recover.
>actually there's some kind of physical dysregulation going on
The only replicated findings are with the HPA axis (the stress system). There are some studies pointing towards impaired mitochondrial respiration due to reduction in the link step between pyruvate and the TCA cycle. However, if you take a quick look on google scholar, you'll see that that link step is downregulated by the glucocorticoid receptor (the stress system again), so that would seem to be the likely cause.
There are also some studies showing reduced work capacity after repeat CPET. But again, the HPA axis influences CPET performance, so that is a possibility there as well.
The point is: just because there is "physical dysregulation" doesn't mean it can't be caused by stress or psychology. That is literally how the brain works (if it didn't, we wouldn't be alive and conscious). Psychology is intrinsically linked to the immune system, HPA axis, autonomic nervous system. Psychological stress has been repeatedly shown to cause neuroinflammation, cyyokine release, impairment of the parasympaethetic nervous system, to name a few.
Further, here is landmark position paper from Mayo from mid 2021 [1] on ME/CF. It’s an absolutely brutal disease: absolutely no cure, no treatments, give or take 5% chance of ever beating it, and almost 50% of people are house or bed bound for the rest of their life and even more can’t work.
Graduated exercise (run 1 mile today, 1+X tomorrow) and talk therapy (CBT, etc) have been contra indicated for a few years now and the former can actually make the condition worse.
For something first diagnosed in 1958 (but observed since 1889/1880/1917, and also medieval times) to have absolutely no progress or even a unifying theory of how it works while it’s believed to impact up to a million Americans is absolutely baffling.
ME/CF is a total beast and monster of a disease. That’s why the suicide rates are so high.
If you actually read the paper where that 5% figure comes from (Cairns,2005) you'll see that it is for untreated, naturalistic recovery. Looking at recovery after treatment (e.g. MRT) the figures are more like 30-35%. Heck, even the Rituximab trial resulted in 38% remission at 4 year follow-up just due to the placebo effect!
If you read the more recent work, there's figures of 80/90/95%+ mentioned from the ME/CF national association as well as several of the hospital associated treatment centers.
I mean I hope you're right, and it's 35%+, and anecdotally and on a branch here, some of the eerily similar but inconclusive SARS, avian flu, and Covid linked cases seem to be recovering faster from self reported individual data points. But I can't prove this.
What's interesting, and seems to either support or intermingle with an earlier point you made is a recent paper that showed if you had childhood trauma you were (this might be the wrong word) either more susceptible or more likely to be in the MECF group. Which suggests, to your point, maybe the cohort has "weaker" psychological baselines. What's not clear, is once you get it, if that baseline is at all relevant to the actual disease (just like it doesn't matter if you initially got it from the Epstein Barr virus or another viral infection). But it sort of aligns with what you're saying.
However the counterfactual is hard to work against. We know CBT/ACT/DBT/etc are highly effective for other issues.....all these people that are essentially disabled (can't work, require care, often can't even be materially ambulatory). Why wouldn't the self select into CBT/ETC? And if you're right, why wouldn't you see a tsunami of self reported or clinically measured recoveries? And therefore the consensus articles would say "do therapy". But they don't. Theres an old medical school anecdote: listen to the patient sometimes they're telling you the diagnosis. In economics you could draw the comparison to the concept of revealed preferences; we don't have to go through all this hand wringing of mechanisms and (im arguing slandering and blaming the victim) others. If you're right, shouldn't you see these landmarks papers saying "hey xyz protocol of ABC therapy plus DEF manual therapy produces an XX% recovery". Where is that paper? Because you'd think the MDs that work in this space would know about it and center their care around it. Id argue it doesn't exist, it's just internet warriors making stuff up.
>And therefore the consensus articles would say "do therapy". But they don't.
The problem is twofold. [1] There is a widespread prejudice against psychosomatic illness. and [2] There have been some mis-steps, e.g. PACE trial which put deconditioning and fear of activity front and centre. This caused a huge and predictable backlash, as clearly some fear of activity is rational with this illness.
>why wouldn't you see a tsunami of self reported or clinically measured recoveries?
But due to the prejudice, most people just get on with their lives once they recover. When you put your story out there (as I have done) you get hit with a huge ton of personal attacks and abuse. People deny you had the illness in the first place and they say incredibly nasty things about you. I see this on a daily basis.
>Because you'd think the MDs that work in this space would know about it and center their care around it. Id argue it doesn't exist, it's just internet warriors making stuff up.
You do see some. Fred Friedberg. B Van Houdenhove. Wyller. etc. But most patients hate these people, or at least actively ignore them, because they simply don't believe it.
> We considered 2 exposures of interest: 1) specific underlying medical conditions and 2) the number of conditions. We captured data on both exposures by using ICD-10-CM diagnosis codes from inpatient or outpatient hospital records in PHD-SR from January 2019 up to and including a patient’s first inpatient encounter for COVID-19. We used 1 encounter with an ICD-10-CM code to establish the presence of an underlying condition because few patients had multiple encounters in this hospital database. We excluded 3 ICD-10-CM codes (ie, oxygen support, dependence on a ventilator, and tracheostomy) listed during the patient’s COVID-19 encounter because they could be part of COVID-19 treatment.
...
> To further differentiate underlying conditions from acute complications of COVID-19, a panel of physicians (K.K.W., W.M.K., H.G.R., B.B., N.T.A., J.M.N.) classified the 314 CCSR categories into “likely underlying” (274 categories; eg, asthma); “indeterminate,” which could include underlying or acute complications or both (29 categories; eg, cardiac dysrhythmias); or “likely acute” (11 categories; eg, acute pulmonary embolism).
Am I reading this correctly that they are determining "likely underlying fear and anxiety disorder" from a single ICD-10 code that was likely generated at the time of admission for severe COVID-19? If that's correct, it seems rather flawed at determining if these people had an actual underlying anxiety condition or if the anxiety was due to severe COVID-19 symptoms(moderate to severe difficulty breathing, lack of sleep, lack of food/fluids and pain).
I would say that "dismissing" something as psychosomatic is the type of "oh it's all in your head" bullshit that, yes, has happened far too much in the history of ailments like CFS (and still happens today, I'm sure). And I'm completely against that.
But at the same time, I know people with CFS who refuse treatment like CBT, antidepressants, counselling, getting more regular exercise, on the grounds that it must be a viral/bacterial infection, or genetic, or autoimmune. Those things are all possible and should be researched - but so should the idea that it's partly or largely a mental illness. And there may well be physical dysregulation - that can be caused by the brain in many ways.
Regular exercise makes it worse because of PEM [1], and graduated exercise therapy is contra indicated [4] because their ATP energy system doesn’t fully work [2]. You could cripple them by forcing progressive exercise dogmatically. Talk therapy is no longer recommended [2] and many antidepressants are not effective [3].
If you read the book Why Zebras Get Ulcers by Sapolski there’s this story about the African farmer who has his cow die, and can no longer farm or support his family after. Sapolski says in America you’d give antidepressants, in Africa you’d just chip in and buy a new cow.
No offense, and as respectfully as possible while getting the point across, but you’re being a dick to your friend. These people bounce between doctors for years [5] because there’s no FDA approved diagnostic test, with a hyper complex disease that’s literally debilitating to them do you really think you can drive by diagnose and they just missed completely obvious and first pass treatment options? Your comment is the “I could build it in a weekend” response to ShowHN.
Edit: note, I believe in somatic experiencing of symptoms, as described in the link to this threads article. For example there’s quite a few stories in the biography of Chairman Mao [6]of high status officials suffering “neurotic crises” and requiring bed bound recuperation, arguably because of the repressive environment they lived in. But ME/CF is completely different.
4. https://me-pedia.org/wiki/Graded_exercise_therapy quote: “ Graded exercise therapy (GET) is a form of physical therapy for the treatment of chronic fatigue syndrome (CFS) where physical activity is gradually increased over time. It is a treatment that was offered to ME/CFS patients in the UK by the National Health Service (NHS) as specified in the NICE guidelines from 2007-2021, but the recommendation was removed by the 2021 NICE guidelines because of high rates of harm.”
5. https://www.omf.ngo/what-is-mecfs/ quote “ People with ME/CFS often go years before diagnosis, and 90% of sufferers have never been properly diagnosed.”
I think you're reading more into my comment then is there. I didn't say anything about forcing progressive exercise or GET, CBT may not be widely effective but there are other forms of talk therapy not mentioned in your links, and your CureTogether link is self-reports, which also shows meditation as one of the most successful. And I'm a bit offended, you know nothing about my relationship to those in my life with CFS, I obviously don't tell them "it's all in your head, get some exercise", I just wish they'd be more open to different possibilities.
I think CFS is likely a complex ailment, probably really several different things grouped together because of similar symptoms. Some of the people with what we call "CFS" may have some kind of post-viral syndrome, some may have a genetic disease, some may have depression/anxiety/stress, some may have a combination. I think the real error is stated pretty well in one link I found (somewhere in one of your links): "We now have evidence confirming what millions of people with this disease already know, that ME/CFS isn’t psychological," - to say outright that a disease that isn't yet well understood is absolutely not psychological is dangerous. CFS isn't measles or diabetes, we simply do not know the full cause(s) yet, period.
How do they measure success of the talking therapies? Because I know people who just buy cannabis on the black market and won't tell doctors about it - they improve but not down to the therapy. They attend talk therapies out of fear of being discharged. It's a huge waste of resources. Nobody I know got helped by these.
First you’re opining on what the disease is? It’s actually the converse to your preposition: it’s a giant symptom cluster (50+) and no one generally believes it’s multiple diseases lumped together. Read the Mayo paper.
The rest of your comment has a logical fallacy which renders it moot: do they have a diagnoses, yes/no? If yes, then your “try other things” and “maybe it’s psychological” comments make no sense and are refuted clinically. It’s like saying “is your computer turned on? No? Ok, it’s probably a software bug. Let’s just be open to possibilities and not be close minded here.”
Also a) you’re assuming they didn’t try therapy. And b) “they’d be open to more possibilities”…like what specifically? The self reports is 20k data points and they got bought by 23andMe; but we could pull PubMed and get to the same result. Nothing seems to work and more importantly other than a believed onset from a post-viral infection, there’s no known even rudementary understanding of how it works. Clinically there’s no known above zero effectiveness non-“say no to everything” modality. What do you suggest these people that have spent 2 to 3 years probably trying everything imaginable attempt?
Like it’s so straight forward. Try talk therapy for a year and then try anti depressants. Oh it didn’t work across a gigantic cohort? And the scientific community generally agrees psychological isn’t a recommended approach? Very Donald Trumpian to say “who knows who knows, let’s keep an open mind here” with no backing on data to stand on other than an intrinsic belief regarding a clinical topic.
You’re suggesting a high rate of false positives. The links show an expected 91% of false negatives (I’m assuming due to the sheer difficulty of diagnosis) and literally no comment of false positives. Not clear how you can defend that assertion.
The Mayo paper seems to be quite slanted against psychological aspects.
There is quite a lot of research, and it shows that both stressful life events and viral infections tend to be triggers. (We know that viral infections are physiologically stressful, in that they activate the HPA axis).
There is also an abundance of evidence that psychological therapy and multidisciplinary rehabilitation helps patients. So this definitely isn't just laziness in saying "maybe it's psychological".
Yeah I mean 23 MDs went to retreat to try to summarize current best understanding of this disease versus your individual opinion.
Which evidence? And why did Mayo/British NIH/CDC/WHO happen to miss this "abundance of evidence"? Without pointing to wonky stuff, how could all those cumulative people employed at those organizations be wrong, and you random internet stranger with no citations happen to have nailed it? I'm assuming you're not claiming Mayo is somehow dishonest. So are you claiming they're incompetent? If neither on what ground do you assert its incorrect?
This is like arguing with an anti-vaxxer who argues "we just don't know, I heard the jab makes you infertile". Almost seems like a waste to even bother replying.
No, that hasn't been proven. If you look at the Fluge and Mella study that you're referncing for this, you'll see that the scatter graphs overlap, so the evidence isn't terribly convincing. Also, the downregulation of the pyruvate link step that they found is consistent with increase glucocorticoid receptor activity (the stress system).
>Talk therapy is no longer recommended
That's a pretty skewed review you posted. All the evidence points to CBT being effective for CFS. Certainly it can hurt patients when applied improperly, such as forcing patients to ignore exacerbation of symptoms. But that doesn't mean it is all bad.
The former point is super interesting. Can you link to the overlapping scatter graphs?
If that underlying assumption is wrong it's even more mysterious how these patients are so tired. You then have to pivot to the cytokime storm position.
Something I only discovered recently is how much of an impact sustained mental stress/anxiety can have on your body. It puts your body into a state of fight or flight, which eventually wears you down. It's a very valid root cause to look for in diagnosis.
Sample size of 35 and mindfulness is not novel or new. It probably does help some people. However, a huge grain of salt should be taken with any diagnosis illness/disease being due to stress or psychosomatic. Some doctors immediately jump to this after doing very little due diligence and diagnostics. It should be a diagnosis of absolute last resort.
Stanford does have a CFS clinic investigating pathogen-related causes[1].
They literally have you go through "Worry Less, Live More: The Mindful Way Through Anxiety Workbook", so it's at least building off of it in some way. Mindfulness with a pain-oriented focus is not new.
Looking at their patient groups on Table 1, it seems MBSR and Usual Care had participants with more spinal injections and surgical interventions. MBSR and Usual Care have higher "Pain bothersomeness" scores and "Roland Disability Questionnaire Scores" at the start.
It's a very small-scale pilot study. I am very skeptical it's not a ploy to try to sell his books.
MBSR teacher (well, learning!) here. I would also be skeptical based purely on the sample size, but MBSR as a treatment is pretty well researched and documented. It's been around for 40+ years and there is fairly extensive supporting research [1].
So - I wouldn't be in any way surprised if there are other related treatments which have high levels of efficacy...
>It should be a diagnosis of absolute last resort.
No, it should be equal.
>Stanford does have a CFS clinic investigating pathogen-related causes[1].
They haven't come up with anything, and their scientists are problematic: Montoya getting fired for sexual harassment, and Davis saying that anyone who doesn't think CFS has a molecular basis is a fool.
Okay, what is the consistent testing/diagnostic methodology that accurately measures stress and psychosomatic impact across patients?
Typically it is going to be a diagnosis of exclusion. If you think you're diagnosing someone with stress/psychosomatic causes before comprehensive testing, imaging and/or specialists visit have been done, then you're jumping the gun, and potentially adding further stress to the patient as they try to follow a regimen that has little effect at helping their condition.
Yes, the doctor should explore all possible causes with the patient. Tests can be done, and the doctor can also discuss stress. That is generally how it is done. Quite often in these cases there will be no final diagnosis.
That sounds a lot like a diagnosis of last resort. Especially if the best tool available for measuring stress is a yes/no question to the patient and a 5-question anxiety questionnaire. Hardly definitive evidence of stress/psychosomatic causes, especially if it comes back "negative".
Yeah, part of the problem is in the wording too. It's incorrect to say "it's all in your head" because this makes it sound like the person experiencing the pain is just imagining it or that it's entirely a construct of their mind. What Sarno points out is that there might be some underlying physical issue at play, but it's the extent of the pain that has a psychological component to it. As an example, two people can have the same exact x-ray of their back showing some alignment or other issue. One person will experience extraordinary pain and the other barely any at all. The fact that this is left unexplained by chiropractors (who are mostly kooks IMO), for example, should be a big red flag. How can it be that people who are supposedly experts in this field cannot explain for a basic a discrepancy like this?
I think the right way to open people up to this is to acknowledge and validate their pain, that it's real (not "in your head"), but have them consider that the mind-body connection could explain more than perhaps they had previously realized. If you start out the gate with "it's all in your head", not only in this not correct, but it turns the person off because it sounds dismissive and pseudo-scientific.
>One person will experience extraordinary pain and the other barely any at all. The fact that this is left unexplained by chiropractors (who are mostly kooks IMO), for example, should be a big red flag. How can it be that people who are supposedly experts in this field cannot explain for a basic a discrepancy like this?
Not sure what chiropractors have to do with this, you can see an MD for your back pain too but they'll be equally hard pressed to find the reason for the difference. And that's simply because there are countless variables-- x-rays don't show you cell level differences between the patients, central sensitization in the brain plays a part, different pain tolerance(ie something as simple as being a redhead is associated with increased pain), the level to which a certain amount of pain causes psychological distress can also change, coping mechanisms used, etc
Except that it is all in our heads, ultimately. Pain is a sensation in our brains, based on inputs from everything else. That "everything else" is often our physical nerves, but can also be everything else going on in our heads. If someone needs to meld the idea of psych-driven pain with physical pain, trying to deny that they come together in our heads can backfire. It is more important to focus on what we even mean by pain being "real", and that it being in our heads does not invalidate it in the slightest. It is real, and there are more paths to recovery to explore.
However, quite dangerously, those ailments are also often misdiagnosis's.
Fibro was a misdiagnosis for me, and I nearly died because I accepted it and worked on a psychological and rehab program rather than continue to pursue symptoms.
> are all things that sincere people truly are suffering from...that may be mainly psychological/psychosomatic
The back pain being cause by physical issues is not exception.
The doctors and physiotherapists that wrote articles I read, had talks I has seen and the ones people I know visited never mentioned that. Instead, they recommended to fix the posture a set of "exercise" routines for rehabilitation. They also explained back damage as a mechanism.
And those actually worked. Back pain can be very often helped, if you fix posture and do rehabilitation. It is not exception for it to be purely physical.
The moment you claim it is psychological, the people who have fixable mechanical issue, won't get any help. And that help, quite apparently, actually makes difference. And not just with back pain.
There are different kinds of back pains, and for a few years I had them on and off, and it very likely was posture related. The first time I tried a good lumbar support my pain almost disappeared while using it. It was such a relief that even now, a decade later, I have that lumbar support for all the chairs I sit in - home or work - even when I'm pain free.
However, my pain was unusual (did not fit the usual symptoms people normally have). There are other types of back pains. Sarno was always insistent that a physiological cause always be investigated, and if one is found, to treat it accordingly. Absent that, he would recommend a psychological approach. One thing he highlighted that I've anecdotally found to be true when discussing with others[1]: The pain often disappears near/after retirement. And almost all physiological problems get worse with age - not better.
Me personally: Sarno's approach didn't work with other pains (ones he claims are within the scope of this type of pain). I don't know what the cause is - doctors never found anything and physical therapists have told me they've never dealt with my types of pains. Maybe it is psychological, but I must emphasize: Sarno's approach didn't work for me.
[1] A former boss is an example. He said he had severe back pain on and off for so many years - had to take time off from work, etc. Nothing really worked. But eventually, in his mid 50's it went away and he doesn't know why. He's near retirement (senior guy with money), kids all grown up and graduated from college (or near graduating). Once a lot of his life worries got resolved, so did his pain.
> Sarno was always insistent that a physiological cause always be investigated, and if one is found, to treat it accordingly. Absent that, he would recommend a psychological approach
That is much different the what post I responded to claims tho. Or what title claims too. The comment I responded to frames these issues being primary about psychological being and then maybe some few exceptional people having physical cause. And even that is supposed to have strong psychological component as well.
This is quote:
> Yes, some back pain is due to repetitive stress injuries or physical structures out of place or whatever. But as this study shows, looks like it has a strong psychological component as well
What you say in your cment is "when all attempts to find and fix physical issues failed, remaining patients have more luck trying psychological treatment then physical one again".
Which is much weaker claim. It does not imply that psychological is strong component nor that only some back pain is cause by physical. It implies some of it, when you exclude all known physical causes, might be psychological.
[1] This here is pure speculation. The changes you described affect also lifestyle and behavior, not just stress. That story does not prove original issue was psychological, it just shows we can't always tell what the cause was.
Fair enough, but do you have any actual evidence that actual physiological causes are the majority? 2 people I know have bad back pain due to car accidents. For everyone else, no clear source of the back pain has been found. Occasionally they point to issues with herniated discs or pinched nerves, which makes sense, but from what I've read, most people who have such conditions do not suffer chronic back pain, which makes it a dubious cause.
My PCP doesn't bother treating back pain that isn't due to an obvious injury. He said that in his decades of looking into it, he's observed:
1. None of the treatments out there show good evidence of actually working vs a placebo.
2. While it often recurs, each episode almost always resolves on its own.
He does not believe it has a psychological cause - he's just frustrated with the current state of medicine regarding it and doesn't want his patients to go through a treatment believing they're actually treating the underlying condition. He will prescribe whatever the patient asks for (pain killers, physical therapy, etc).
The only time he pays attention is when the pain extends to the legs, which is the minority of the times.
> 2 people I know have bad back pain due to car accidents. For everyone else, no clear source of the back pain has been found.
That is anecdotal and clear source of back pain in your story requires one big event. Mine experience is anecdotal too. For people I know, it was bad posture causing damage over time (when sitting mostly) and the physiotherapy with rehabilitation exercises helped.
> Fair enough, but do you have any actual evidence that actual physiological causes are the majority?
Do I need to do hunt for that since the original claim was "majority is psychological" was not just without proof, but with blatantly bad logic in it? "We excluded people where physical treatment helped" does not lead to results you can use about overall efficacy of any treatment.
> he's just frustrated with the current state of medicine regarding it and doesn't want his patients to go through a treatment believing they're actually treating the underlying condition. He will prescribe whatev
This honestly sounds like a bad doctor. He does not even makes attempt at diagnosing known physical causes of back pain. The physiotherapy/rehabilitation exercises that were recommended to me and people I know were simple and did helped. It required maybe 10 minutes a day.
I understand that there might be different causes and unknowns, but doctor who is not even trying being unable to improve any patients is not exactly an argument.
I agree with all of this but just to add, the pain can indeed be a real physical issue directly caused by mental health.
For example, anxiety often causes muscle tension and bad posture which can lead to real mechanical pain causing issues. I suffer from panic attacks and they are a very physical experience. My temperature stops regulating itself properly and I get GI problems. This is likely an indirect consequence of the adrenaline surge, but there are other known and theorised ways that your mental state can influence your body.
The brain is involved in all pain. The fact that the brain can help fix it doesn't mean it's psychosomatic. It just means you can interrupt the process at some place other than where the damage is.
Chronic pain is aggravatingly hard to trace to the source. Maybe it's psychosomatic, maybe it's not. Calling it psychosomatic causes stigma -- it implies that it's fake and their choice. But they do want to get better.
It's more than just thinking yourself healthy. It requires some counterintuitive ways to create new pathways. It's great that there is more research showing an improved way.
I imagine for most people with back pain there is a physical component, they didn’t have back pain as children, but if we had full control of the brain we could turn off the pain sensation if it’s not useful.
Many doctors believe what you say and dismiss patients as psychosomatic if they can't find anything obvious. Sometimes they refer them to psychiatrists or insinuate they are drug seeking. It's a disgrace. This treatment from health "professionals" almost drove me to suicide.
Actually my own research got me into a path of finding out I have a rare disease and I had to pay private consultants to help with diagnosis. Only then and a threat of lawsuit got the doctors treat me seriously and I actually got help.
There can also be physical issues that can be masked psychologically. You can train your brain to ignore and mask many pains and aches and dull them down. IMHO, managing pain can definitely be done psychologically, at least to some extent.
Being too aware of the pains, obsessing over them, and being anxious and stressed definitely aggravate the conditions in my experience. Having an otherwise healthy balanced life in terms of work, relationships etc. with healthy amount of stress, makes some of the ailments very manageable or a non-issue.
I knew a guy who had an extremely stressful job and a bad skin condition, it cleared up as soon as he left. The brain and body are extremely connected.
It’s odd that “all in your head” means “not a serious problem” or “you can fix it by yourself”.
It seems to me that a problem being located in the head/brain/mind is, almost by definition, particularly difficult to fix, let alone to fix without external guidance.
You are unwittingly just promoting yet another form of back pain snake oil and there is already plenty. If I had fallen into the idea that my back pain was “just in my head” I would have gotten no where. I encourage anyone suffering to get an MRI as early as possible so at least you know what is wrong. Doctors and chiropractors will regularly misdiagnose you. There are lots of ways a back can go bad and everyone has their pet advice which probably doesn’t apply to you.
Yes, some back pain is due to repetitive stress injuries or physical structures out of place or whatever. But as this study shows, looks like it has a strong psychological component as well. I suspect we'll (some day) get better treatments for all the things I mention, if mental illness stigma ends and they can be honestly considered from all possible causes.
Edit: to be clear, I'm not saying that all cases of back pain or CFS or whatever are psychosomatic - just that it shouldn't be dismissed, especially when the treatments are relatively low-risk.