screwtape wrote:John D wrote:
To start I will discuss fibromyalgia. My wife has it. It's a real thing. Your dismissing it as a non medical condition shows your ignorance. The reason we now have a disease call fibromyalgia is that medical researchers have started to figure it out. In prior generations people with fibro were just called lazy and they were vilified. I guess you like that method best. Good for you. I am happy your don't know someone who has this disease... well... maybe you do and you just call them lazy. On a side note.... it is thought that lots of mammals get fibromyalgia. It is a condition referred to a "lameness" in horses. The poor horses have so much pain they would rather be beaten than have to move. Do some reading if your really care to.
I did consider you when including fibromyalgia in that list, not wanting to cause you upset. But honesty won out. Previously someone asked about fibromyalgia and I
wrote:
Gender might not be a social construct, but illness sometimes is. If you want to get a good feel of how such patients have (always) been with us, under various labels according to society's understanding of symptoms and illness, you could do worse than to read Edward Shorter "From Paralysis to Fatigue" (here on Amazon, and be sure to see how the reviews polarise into those who have the diseases mentioned and those who don't). Apparently, to point out that such symptom constellations have been labelled otherwise (and in ways that seem laughable to us - 'green sickness'?) in the past, is somehow denying the validity or dignity of the present day sufferers. In fact, it is an attempt to understand something that has defied scientific investigation, at least, as far as showing it to be a physical disorder is concerned. Yes, there are fMRI changes in the brains of CFS/ME/FM patients, and they resemble those of chronic pain patients. In other words they are an effect rather than a cause. Yes, non-restorative sleep leads reliably to diffuse muscle pain and tenderness at the trigger points (currently acquired by fibromyalgics as their property, but also very susceptible to explanation in terms of biomechanics and the fact that evolution hasn't caught up with the change to bipedality).
My view? These people are sick. Ill. Sometimes disabled. I don't discriminate between mental and physical disorders in those terms - both are equally valid ways of being ill. Having said that, and paid due respect to the reality of their illness, I have to say also that the illness concerned seems to be psychosomatic - that is, the mind is causing bodily symptoms and illness, or at least to commonly include a psychosomatic component. If we are to make such people well again, we need to understand the truth of the genesis of their condition, but if the condition itself is either sometimes, or to some degree, a way of adopting the sick role and avoiding some uncomfortable aspects of life it is likely that there will be resistance against our attempts to relieve it or provide an accurate explanation for it. And this is what we find. The only proven interventions that are easily provided - an exercise program and tricyclic antidepressants (in tiny doses they don't work as anti-depressants but simply change sleep architecture to provide more stage IV sleep, where muscles are flaccid and probably repair the minor injuries incurred each day, relieving the muscular aching characterising non-restorative sleep. SSRI's are less good, but also used) - are often refused or tried briefly and discarded. Any exploration of underlying psychological issues is seen as an attempt to deny the reality of the symptoms and results in an alienated patient unless undertaken with great delicacy. If we could get people to stand back from themselves and see the problem as one where they could say "my brain and my body have conspired to produce an illness that is a not very useful way of dealing with life; how shall I work to reverse this?" we would get somewhere.
So let me be clear with you, John. I am glad to see you stick up for your missus, but you don't have to do so with me. I agree she's ill, and that her symptoms are real. What no one agrees on is the pathogenesis, and nobody has definitive evidence. I know lots of people with it, as patients, and I hope I have treated them kindly. The participants in the conversation I alluded to have, between us, 79 years of experience in medical practice, so we have had ample opportunity to see lots of such patients. Let us hope the whole thing is elucidated soon.
But... I want to add this thought. The term "psychosomatic" is used to imply that that such diseases are "made-up" or all "in someone's head".
It is not a good choice of words in my opinion. I will grant you a generous interpretation of this word but I think its meaning is not clear. My wife would, no doubt, agree that much of her problems could be caused by mental health issues. But, she would not agree that this makes her disease psychosomatic.
Webster says it this way:
Simple Definition of psychosomatic
: caused by mental or emotional problems rather than by physical illness
Now, we could somehow make sense of this definition, but only if we truly believed that mental illness was somehow different than physical illness. In truth, the mind and body are essentially inseparable. It is the false belief in the duality of mind/body that is the problem.
While not saying this implicitly, the term psychosomatic implies that a person should be able to simply think their way to health.
The term psychosomatic should be tossed into the wastebasket of shitty words (words that claim to mean one thing but really mean something else). Other words in this basket should include "feminism", "naturopathy", and "holistic".
