Skewed
Posted: Sun Feb 19, 2006 5:53 am
Thought you might like this from the forward to
the book SKEWED:
Psychiatric hegemony and the manufacture of mental illness in
Multiple Chemical Sensitivity, Gulf War Syndrome,
Myalgic Encephalomyelitis and Chronic Fatigue Syndrome.
Martin J. Walker
ISBN 0-9519646-4-X
http://www.satori-5.co.uk/word_articles/mcs/skewed.html
Foreword
Per Dalen, MD, PhD, Associate Professor of Psychiatry, University of
Gothenburg, Sweden
Medical culture is obsessed with mechanisms of disease, but actual causes
are not a favourite topic. We don't know enough about causes to inspire the
lay public and ourselves with confidence in our science by discussing them.
Our lack of success in preventing many important diseases is of course
largely due to ignorance. It is not uncommon for a medical scientist to
mention an unsolved problem in terms like "the exact causes are not yet
known, but." The discussion is then usually moved to the safer ground of
mechanisms.
One tacit assumption is that we should first of all learn as much as
possible about the many biochemical and physiological mechanisms that may be
involved in the production of symptoms, autoimmunity for instance, or
changes in neurotransmitter levels. With a more complete biological
'Meccano', it should be possible to build more and more comprehensive models
of how various diseases develop. Will this automatically lead to causal
understanding at the level where prevention becomes possible? Not
necessarily, I am afraid. New causal knowledge may more often be found
serendipitously and in other more direct and less time consuming ways than
this inching along in the search for mechanisms. However, such a direct
approach is usually not encouraged by the scientific community.
There is an additional reason why mechanisms are important in medicine. When
we draw the line between science and non-science in the health field, we
usually exclude procedures and theories that cannot be understood in terms
of accepted mechanisms. Homeopathy is a case in point. It doesn't really
matter if it works in practice; its theory is utterly at odds with
conventional medical thought. Any positive results in patients are simply
explained as placebo effects. In this way knowledge of mechanisms becomes
indispensable as a badge of scientific authority.
................
A generation ago physicians usually trusted their own clinical judgements,
but in recent years the notion of "evidence based" medicine has altered
this. We are now supposed to look for evidence, preferably statistical
evidence, in the current literature. In some areas, such as somatization,
there is simply no solid evidence, and yet the grapevine is silent about
this. A vacuum is created where other forms of persuasion can find their way
to the medical profession.
It is interesting that another blind spot can be found in the area of
placebo. Somatization and placebo are like the two sides of a coin. Both are
believed to possess great power, the one of causing disease, the other of
restoring health, Their mechanisms of operation are essentially unknown, and
systematic studies have in fact yielded little or no evidence in clinical
situations.
There is no denying it; medicine uses a double standard in relation to
scientific evidence. The placebo has been an integral part of our medical
culture since the 1950s. Somatization gained prominence relatively recently.
Scientific ideas normally have an interesting history, including a genealogy
and a record of arguments pro and con. Important ideas rarely enter the
scene fully fledged and unruffled by controversies, but somatization was
presented even without a reference to psychoanalysis.
Today we are sometimes told that somatization is the disease process to
consider when physicians fail to explain the symptoms of the patient. The
rather too flattering implication would be that medical science can now
explain so many things that most of the remaining problems can be bundled
together under a collective psychiatric label without further investigation.
The truth, however, as we have seen, is that causal understanding is poorly
developed. Explaining symptoms means something else here.
When an officially accepted diagnosis has been found in a given case, for
example, multiple sclerosis, the principal symptoms of the patient are seen
as constituent parts of a familiar picture, and predictions can be made
about prognosis, possible treatments can be chosen, et cetera. The physician
is satisfied by this result, even though the cause of multiple sclerosis
remains unknown, prevention is impossible, and treatments do not offer much
hope of permanent recovery.
..........................
For some years now I have been convinced that the concept of somatization is
being exploited for reasons that are only partly transparent. Scientifically
there is no basis for the remarkable expansion of this field. The lives of
large numbers of patients are touched and often made more difficult by what
is going on. Psychiatry is apparently being abused, and it is, of course,
very important to find out more about the background in order to do
something about it. This is an area where concerned citizens have already
begun to organise.
In Skewed, Martin Walker investigates the vested interests involved in the
problem of somatization and "unexplained illness". On reading the
manuscript, I found that viewing this apparently medical question from a
sociological perspective gave me a new insight into this growing area of
ostensibly psychiatric disorders. Readers who are not yet familiar with the
tragic erosion of the truth-seeking scientific spirit in medical research
will, I hope, also find this book an excellent introduction to these
problems.
the book SKEWED:
Psychiatric hegemony and the manufacture of mental illness in
Multiple Chemical Sensitivity, Gulf War Syndrome,
Myalgic Encephalomyelitis and Chronic Fatigue Syndrome.
Martin J. Walker
ISBN 0-9519646-4-X
http://www.satori-5.co.uk/word_articles/mcs/skewed.html
Foreword
Per Dalen, MD, PhD, Associate Professor of Psychiatry, University of
Gothenburg, Sweden
Medical culture is obsessed with mechanisms of disease, but actual causes
are not a favourite topic. We don't know enough about causes to inspire the
lay public and ourselves with confidence in our science by discussing them.
Our lack of success in preventing many important diseases is of course
largely due to ignorance. It is not uncommon for a medical scientist to
mention an unsolved problem in terms like "the exact causes are not yet
known, but." The discussion is then usually moved to the safer ground of
mechanisms.
One tacit assumption is that we should first of all learn as much as
possible about the many biochemical and physiological mechanisms that may be
involved in the production of symptoms, autoimmunity for instance, or
changes in neurotransmitter levels. With a more complete biological
'Meccano', it should be possible to build more and more comprehensive models
of how various diseases develop. Will this automatically lead to causal
understanding at the level where prevention becomes possible? Not
necessarily, I am afraid. New causal knowledge may more often be found
serendipitously and in other more direct and less time consuming ways than
this inching along in the search for mechanisms. However, such a direct
approach is usually not encouraged by the scientific community.
There is an additional reason why mechanisms are important in medicine. When
we draw the line between science and non-science in the health field, we
usually exclude procedures and theories that cannot be understood in terms
of accepted mechanisms. Homeopathy is a case in point. It doesn't really
matter if it works in practice; its theory is utterly at odds with
conventional medical thought. Any positive results in patients are simply
explained as placebo effects. In this way knowledge of mechanisms becomes
indispensable as a badge of scientific authority.
................
A generation ago physicians usually trusted their own clinical judgements,
but in recent years the notion of "evidence based" medicine has altered
this. We are now supposed to look for evidence, preferably statistical
evidence, in the current literature. In some areas, such as somatization,
there is simply no solid evidence, and yet the grapevine is silent about
this. A vacuum is created where other forms of persuasion can find their way
to the medical profession.
It is interesting that another blind spot can be found in the area of
placebo. Somatization and placebo are like the two sides of a coin. Both are
believed to possess great power, the one of causing disease, the other of
restoring health, Their mechanisms of operation are essentially unknown, and
systematic studies have in fact yielded little or no evidence in clinical
situations.
There is no denying it; medicine uses a double standard in relation to
scientific evidence. The placebo has been an integral part of our medical
culture since the 1950s. Somatization gained prominence relatively recently.
Scientific ideas normally have an interesting history, including a genealogy
and a record of arguments pro and con. Important ideas rarely enter the
scene fully fledged and unruffled by controversies, but somatization was
presented even without a reference to psychoanalysis.
Today we are sometimes told that somatization is the disease process to
consider when physicians fail to explain the symptoms of the patient. The
rather too flattering implication would be that medical science can now
explain so many things that most of the remaining problems can be bundled
together under a collective psychiatric label without further investigation.
The truth, however, as we have seen, is that causal understanding is poorly
developed. Explaining symptoms means something else here.
When an officially accepted diagnosis has been found in a given case, for
example, multiple sclerosis, the principal symptoms of the patient are seen
as constituent parts of a familiar picture, and predictions can be made
about prognosis, possible treatments can be chosen, et cetera. The physician
is satisfied by this result, even though the cause of multiple sclerosis
remains unknown, prevention is impossible, and treatments do not offer much
hope of permanent recovery.
..........................
For some years now I have been convinced that the concept of somatization is
being exploited for reasons that are only partly transparent. Scientifically
there is no basis for the remarkable expansion of this field. The lives of
large numbers of patients are touched and often made more difficult by what
is going on. Psychiatry is apparently being abused, and it is, of course,
very important to find out more about the background in order to do
something about it. This is an area where concerned citizens have already
begun to organise.
In Skewed, Martin Walker investigates the vested interests involved in the
problem of somatization and "unexplained illness". On reading the
manuscript, I found that viewing this apparently medical question from a
sociological perspective gave me a new insight into this growing area of
ostensibly psychiatric disorders. Readers who are not yet familiar with the
tragic erosion of the truth-seeking scientific spirit in medical research
will, I hope, also find this book an excellent introduction to these
problems.