Wednesday, May 31, 2006

Mind over matter

I'm very slowly making my way through the most recent Skeptics' Circle, since lord knows I have nothing else to do besides get rejected (and pre-rejected) for jobs. In the course of this, I found this post dealing with a condition called "electrical sensitivity," in which people manifest physical symptoms as a supposed response to the presence of electromagnetic fields. Anyone who keeps up with the latest "secret killer" quackery can guess what those symptoms are: fatigue, nausea, dizziness, palpitations, difficulty concentrating. About the same symptoms as "aspartame poisoning" or any of a number of faddish, overdiagnosed food and chemical sensitivities. About the same symptoms that everyone suffers from sometimes, and that opportunists can therefore exploit.

A set of symptoms, incidentally, that tend to overlap with the symptoms of a somatization disorder.

The writer of the electrical sensitivity post is well aware that this disorder is bad science -- he's writing about it on a blog called Bad Science. And he does an admirable job bringing up important doubts about the validity of the (statistically very few) experiments that support the existence of electrical sensitivity -- it's really thorough and interesting, and I haven't even plunged into the 159 comments yet. But he's not quite willing to go so far as to say these people are somatizing. He writes: "I don'’t think people who report being hypersensitive to electrical fields are hypochondriacs: I think they have real and distressing symptoms, but I also think, in the light of the evidence above, that electromagnetic fields probably aren't causing those symptoms, and they may remain unexplained for the moment." And later: "Calling people who believe they experience symptoms because of electromagnetic fields 'hypochondriacs', weak-minded, or oversensitive: is offensive, unhelpful, and most damnably of all, untrue. Denying the reality of people's symptoms is similarly offensive and unhelpful. I will give no quarter on this."

Now, I'm all in favor of trying not to offend large swaths of the population, particularly if that means going easy on people who are sick. But I have the same issue with this as I've had with all the chronic fatigue syndrome or fibromyalgia sufferers who expressed indignance and rage at being told their disorders are psychosomatic. See, it's one thing when you're using "hypochondriac" as a catch-all dismissive term, or when a doctor says "it's all in your head" as a synonym for "I'm not going to treat you." This is unacceptable. But is it really helpful to completely rule out the possibility that these symptoms are psychosomatic? It's amazing the effect that the brain can have over the body -- in fact, the brain is part of the body, so actually it's not that surprising. Mental anguish can cause real physical symptoms, and they're no less real for originating in a part of the body that also governs emotions and memories. We don't do patients any favors by pretending that physical symptoms can't have psychological roots.

Decrying people who sneer "hypochondria" at genuinely suffering patients is one thing. But rejecting the possibility of somatization just because some people use "psychosomatic" and "fictional" interchangeably -- well, that's just not helping anyone. An illness can be simultaneously psychosomatic and very much physically real. That's what the "somatic" part means, after all, but people usually stop at the "psycho." I'm all for patient advocacy, but I don't think "ignoring explanations that might hurt the patient's feelings" qualifies as advocacy. We need to get rid of the stigma surrounding the word "psychosomatic," and the idea that it is synonymous with "fake" or "whiny" or "not physical." Because when you rule out that possibility, anyone who has a somatically real, psychologically-based illness will not only continue to suffer, but will probably go through numerous unnecessary, expensive, and often embarassing tests attempting to find a physical reason for their pain. Until we're able to treat somatization as a potential explanation, we're going to have a lot of people suffering for nothing.

2 Comments:

Lynne said...

Incidentally, I thought that there was some recent work that suggested that some people have a genetic predisposition towards chronic fatigue syndrome, and that this supported the contention that there is a chemical (non-somatic) reason for it. I don't remember details of that, though.

I'm as skeptical as you are about 'electrical sensitivity' and most of these other theories (poisoning from mercury fillings and vaccinations, the water fluorination evil conspiracy, etc.). But I'll contend that there *are* at least some disorders that can have a physical, not psychosomatic, root, that yet have very vague symptoms like these - fatigue, headaches, brain fog, diminished sex drive, etc. I agree that psychosomatic problems are serious and not fake, though.

6/01/2006 5:46 PM  
jess said...

But of course the brain is full of chemicals. Depression has a genetic component and is based largely on a chemical imbalance, and nobody would say that it has nothing to do with the mind.

It's the misuse of the word that gets to me -- do we just need a new word that means psychosomatic but doesn't have the stigma?

And yes, some diseases have vague symptoms, although usually not ONLY vague symptoms -- but you don't always want to wait for the non-vague symptoms, because what if your fatigue and headaches are from a brain tumor? Sure. But they are hallmarks of medical bullshit nonetheless. If this were Truth Tables I'd say that Q -> V, where Q is quackery and V is vague symptoms, but ~(V -> Q). Still, when you see the smokescreen, you want to be on the lookout for the fire.

The fluorination conspiracy is a perfect example, btw.

6/01/2006 9:54 PM  

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