Re: social rejection of unverifiable syndromes - migraine

[Guest guest]

"Episodic migraine...only became credible as biologically "real" in the 1960s with the introduction of a newly effective and much lauded preventive migraine drug,methysergide, actually derived from LSD, which may help explain apossible side effect of terrifying hallucinations..." Thanks, . That gave me a good belly laugh. It's a wonder we don't all end up in the looney bin, isn't it? penny <usenethod@...> wrote: This was refreshing to encounter in the so-Freudian NY Times. I had todouble check to make sure I wasnt reading the Post. Specifically it'sfrom an NYT blog on chronic daily headache (author also has a book onthe same subject)."Episodic migraine, which was classified as "psychogenic" over theFreud-governed middle decades of the 20th century, only becamecredible as biologically "real" in the 1960s with the introduction ofa newly effective and much lauded preventive migraine drug,methysergide, actually derived from LSD, which may help explain apossible side effect of terrifying hallucinations. (It's best known asthe brand name Sansert, which was discontinued in the U.S. in 2002because of potential harm to the heart and kidneys). The superiortriptans of the 1990s also helped make migraines more legit."http://migraine.blogs.nytimes.com/2008/02/19/leaving-the-rabbit-hole/index.htmlIt'd be interesting to see whether her characterization of the historyis well supported. After all, biomedical science was no joke in 1960;today we think of the biomed workers of that time as basically ourpeers - which is not necessarily true or as true of say the workers ofthe 1930s. I haven't heard of a disease being called psychogenic atthat late a date, and then proven physiological by a simple,overwhelmingly clear critical experiment (as opposed to a balance ofevidence). It points up the hubris of concluding psychogenicity on thebasis of negative evidence, which is of course still done.

[Guest guest]

> It's a wonder we don't all end up in the looney bin, isn't it?

Hey, I actually may get there yet! Well, no, not really.

While it is foolish for doctors to *conclude* that CFS is psychogenic,

it is totally acceptable to my mind for healthy doctors to wonder

whether CFS *could* be psychogenic - since not everyone may judge the

evidence for its physiologicity to be overwhelming. After all, if you

don't have CFS yourself, you have nothing to convince you of its

physiologicity other than objective measurements along with your own

subjective assessment of the sanity of CFS cases, who you might not

know closely and personally.

In contrast, as a CFS case you would hope that people who have known

you personally and closely would not conclude you are an idiotic

weenie nutcase - and that they would feel that you never could become

a nutcase unless you became gravely physiologically deranged in the

brain (ie psychotic - grossly unable to percieve and reason well). Yet

in fact we know that this hope regularly fails to be realized. It's

not enough to drive me crazy, nor is it almost enough. Maybe " almost

almost. "

[Guest guest]

It is never acceptable for doctors to wonder if CFS could be

psychogenic. Such a belief is unfalsifiable, and therefore belongs

to the realm of philosophy, not science. That is, how would the

doctor demonstrate that a particular patient's CFS is psychogenic?

It can't be done. The moment that a physician entertains this

notion is also the moment that he/she knows that the only " evidence "

that can be used to support the idea is the enhanced esteem given to

him/her by society. It's about credentials, not evidence.

To even wonder such a thing is to also adopt deep hypocrisy. The

idea is supposedly motivated by the lack of physical findings, yet

the entertainment of psychogenic explanations is done, up front, in

the full knowledge that physical findings will not be found to

support a psychogenic view.

There is more hypocrisy: many CFS patients oppose the conclusion

that their disease is psychogenic. Yet the physician expects the

patient, and society, to accept the psychogenic view if that is the

physician's conclusion (and to even wonder if CFS could be

psychogenic is to believe that that is a possible, final

conclusion). But does anybody believe that, were the tables turned,

the doctor would forfeit his/her own sovereignty to declare his/her

extreme physical suffering to have an organic basis? Of course

not. Few people willingly do this. To expect PWCs to do this is,

then, transparently hypocritical.

If the plight of the undiagnosed ill is to change, it will change

when their most basic position is that (i) lack of physical findings

justifiably deprives the physician of confidence, but does not

empower that physician to entertain non-empirical viewpoints, such

as psychogenic explanations, demon possession, etc.; (ii) the

implementation of psychological theories with the effect of

depriving PWCs of a robust differential diagnosis and of treatments

that presuppose an organic basis to the disease will not be debated

with the courtesy afforded to each other by scientists, but will be

opposed for what it is—bigotry; (iii) lack of confidence in an

insufficiently supported organic explanation does not justify

inaction—great suffering demands that additional tests be ordered

and/or that the PWC be given the option of implementing best-guess

therapeutic trials (as is done with the wholly non-empirical

diagnoses of depression, ADD and pain with the implementation of

antidepressants, stimulants and narcotics, respectively.); (iv) the

inadequacy of physical findings demands a good faith NIH-funded

search for better ones; (v) admission of ignorance is not a

sufficient basis for terminating a therapeutic relationship—

physicians have a monopoly on prescription medication and laboratory

testing, and are therefore morally bound to proactively pursue

diagnosis/treatment of the PWC until that PWC declares therapeutic

success or dies; alternatively, physicians may renounce their

monopoly on laboratory testing and prescription medications, thereby

empowering PWCs to pursue their own therapy unfettered by legal

constraints.

Matt

>

>

> While it is foolish for doctors to *conclude* that CFS is

psychogenic,

> it is totally acceptable to my mind for healthy doctors to wonder

> whether CFS *could* be psychogenic - since not everyone may judge

the

> evidence for its physiologicity to be overwhelming. After all, if

you

> don't have CFS yourself, you have nothing to convince you of its

> physiologicity other than objective measurements along with your

own

> subjective assessment of the sanity of CFS cases, who you might not

> know closely and personally.

>

[Guest guest]

,

Throughout the history of "modern" medical "science", doctors have run

screaming from the room rather than admit ignorance or the need for

further study. They generally do this by psychologizing the illness in

question. Hence, MS was once known as "slacker's disease", etc.

While this is predictable and "understandable" in the same way that we

predict and understand that sociopaths will behave in certain

conscienceless ways, it is not "understandable" in the sense of

"forgivable" or "overlookable".

I have never understood why a practitioner who doesn't know a patient

well at the personal level should assume the worst.

When she initially fell ill, my late wife had an IQ of 180 on the old

scale, in other words, she was in fairly rarefied company of perhaps 70

or 75 people in the entire U.S. with that intellectual capacity. She

was an accomplished systems analyst, working her way up the corporate

ladder at a large company (ironically, a pharmaceutical manufacturer),

after getting a computer science degree in just 3 years, yet with a 4.0

GPA. Yet, when she went to Mayo Clinic for initial diagnostic work,

she was told that all tests were negative and to "come back when you

are sick". So I am prompted to wonder what kind of water she'd have to

walk on, precisely, to be given the benefit of the doubt? Assuming

that doubt was even warranted.

To my mind, she got flipped like that because of complacency, laziness,

arrogance, and lack of love ... not because they didn't know her at a

personal level. Indeed, the whole system dehumanized her from the

get-go. There was no interest in knowing her at a personal

level.

Here was arguably the state of the art in medicine in the mid 1970's,

and they had no curiosity to dig deeper, even though they had the

facilities and talent. That to me is unconscionable.

All of this is based on a false dichotomy that demands that in the

absence of physiologic evidence, there must be a psychological

problem. It is very handy that allopaths embrace the mind-body

connection when it is convenient for them, and ignore or disparage it

when it is not. It is also handy that they like to play at being

therapists when it suits them, even though they know nothing about it.

Yet they would take umbrage at a therapist who offered an opinion on,

say, brain surgery.

And it's not just any physiologic evidence they demand. It must be, as

you put it, "overwhelming", or better still, "widely accepted" in a way

that guarantees that aligning with the patient can be done without

risking the horrors of being made fun of by your sophomoric colleagues

or having your career path become in any way muddy.

The only doctor ever dealt with that I would not like to take a

bazooka to up close and personal, had a basic assumption that he was

operating from a place of relative ignorance. He was curious, kind,

patient, dogged, humble, respectful and creative, which is what a

difficult and poorly understood illness demands. And those are the

qualities that most doctors are midgets at.

How he got that way and stayed that way in spite of his profession, is

beyond me.

--Bob

wrote:

> It's a wonder we don't all end up in the looney bin, isn't it?

Hey, I actually may get there yet! Well, no, not really.

While it is foolish for doctors to *conclude* that CFS is psychogenic,

it is totally acceptable to my mind for healthy doctors to wonder

whether CFS *could* be psychogenic - since not everyone may judge the

evidence for its physiologicity to be overwhelming. After all, if you

don't have CFS yourself, you have nothing to convince you of its

physiologicity other than objective measurements along with your own

subjective assessment of the sanity of CFS cases, who you might not

know closely and personally.

In contrast, as a CFS case you would hope that people who have known

you personally and closely would not conclude you are an idiotic

weenie nutcase - and that they would feel that you never could become

a nutcase unless you became gravely physiologically deranged in the

brain (ie psychotic - grossly unable to percieve and reason well). Yet

in fact we know that this hope regularly fails to be realized. It's

not enough to drive me crazy, nor is it almost enough. Maybe "almost

almost."

[Guest guest]

Wow, did you hear that? It was a great big sigh of relief. Thanks, Matt. pennyphagelod <mpalmer@...> wrote: It is never acceptable for doctors to wonder if CFS could be psychogenic. Such a belief is unfalsifiable, and therefore belongs to the realm of philosophy, not science. That is, how would the doctor demonstrate that a particular patient's CFS is psychogenic? It can't be done. The moment that a physician entertains this notion is also the moment that he/she knows that the only

"evidence" that can be used to support the idea is the enhanced esteem given to him/her by society. It's about credentials, not evidence.To even wonder such a thing is to also adopt deep hypocrisy. The idea is supposedly motivated by the lack of physical findings, yet the entertainment of psychogenic explanations is done, up front, in the full knowledge that physical findings will not be found to support a psychogenic view.There is more hypocrisy: many CFS patients oppose the conclusion that their disease is psychogenic. Yet the physician expects the patient, and society, to accept the psychogenic view if that is the physician's conclusion (and to even wonder if CFS could be psychogenic is to believe that that is a possible, final conclusion). But does anybody believe that, were the tables turned, the doctor would forfeit his/her own sovereignty to declare his/her extreme physical suffering to have an

organic basis? Of course not. Few people willingly do this. To expect PWCs to do this is, then, transparently hypocritical.If the plight of the undiagnosed ill is to change, it will change when their most basic position is that (i) lack of physical findings justifiably deprives the physician of confidence, but does not empower that physician to entertain non-empirical viewpoints, such as psychogenic explanations, demon possession, etc.; (ii) the implementation of psychological theories with the effect of depriving PWCs of a robust differential diagnosis and of treatments that presuppose an organic basis to the disease will not be debated with the courtesy afforded to each other by scientists, but will be opposed for what it is—bigotry; (iii) lack of confidence in an insufficiently supported organic explanation does not justify inaction—great suffering demands that additional tests be ordered and/or that the

PWC be given the option of implementing best-guess therapeutic trials (as is done with the wholly non-empirical diagnoses of depression, ADD and pain with the implementation of antidepressants, stimulants and narcotics, respectively.); (iv) the inadequacy of physical findings demands a good faith NIH-funded search for better ones; (v) admission of ignorance is not a sufficient basis for terminating a therapeutic relationship—physicians have a monopoly on prescription medication and laboratory testing, and are therefore morally bound to proactively pursue diagnosis/treatment of the PWC until that PWC declares therapeutic success or dies; alternatively, physicians may renounce their monopoly on laboratory testing and prescription medications, thereby empowering PWCs to pursue their own therapy unfettered by legal constraints.Matt>> > While it is foolish for doctors to *conclude* that CFS is psychogenic,> it is totally acceptable to my mind for healthy doctors to wonder> whether CFS *could* be psychogenic - since not everyone may judge the> evidence for its physiologicity to be overwhelming. After all, if you> don't have CFS yourself, you have nothing to convince you of its> physiologicity other than objective measurements along with your own> subjective assessment of the sanity of CFS cases, who you might not> know closely and personally.>

[Guest guest]

AMEN! )

Matt, thanks for taking the trouble to give such an elaborate exposé on the topic.

Nelly

[infections] Re: social rejection of unverifiable syndromes - migraine

It is never acceptable for doctors to wonder if CFS could be psychogenic. Such a belief is unfalsifiable, and therefore belongs to the realm of philosophy, not science. That is, how would the doctor demonstrate that a particular patient's CFS is psychogenic? It can't be done. The moment that a physician entertains this notion is also the moment that he/she knows that the only "evidence" that can be used to support the idea is the enhanced esteem given to him/her by society. It's about credentials, not evidence.To even wonder such a thing is to also adopt deep hypocrisy. The idea is supposedly motivated by the lack of physical findings, yet the entertainment of psychogenic explanations is done, up front, in the full knowledge that physical findings will not be found to support a psychogenic view.There is more hypocrisy: many CFS patients oppose the conclusion that their disease is psychogenic. Yet the physician expects the patient, and society, to accept the psychogenic view if that is the physician's conclusion (and to even wonder if CFS could be psychogenic is to believe that that is a possible, final conclusion). But does anybody believe that, were the tables turned, the doctor would forfeit his/her own sovereignty to declare his/her extreme physical suffering to have an organic basis? Of course not. Few people willingly do this. To expect PWCs to do this is, then, transparently hypocritical.If the plight of the undiagnosed ill is to change, it will change when their most basic position is that (i) lack of physical findings justifiably deprives the physician of confidence, but does not empower that physician to entertain non-empirical viewpoints, such as psychogenic explanations, demon possession, etc.; (ii) the implementation of psychological theories with the effect of depriving PWCs of a robust differential diagnosis and of treatments that presuppose an organic basis to the disease will not be debated with the courtesy afforded to each other by scientists, but will be opposed for what it is-bigotry; (iii) lack of confidence in an insufficiently supported organic explanation does not justify inaction-great suffering demands that additional tests be ordered and/or that the PWC be given the option of implementing best-guess therapeutic trials (as is done with the wholly non-empirical diagnoses of depression, ADD and pain with the implementation of antidepressants, stimulants and narcotics, respectively.); (iv) the inadequacy of physical findings demands a good faith NIH-funded search for better ones; (v) admission of ignorance is not a sufficient basis for terminating a therapeutic relationship-physicians have a monopoly on prescription medication and laboratory testing, and are therefore morally bound to proactively pursue diagnosis/treatment of the PWC until that PWC declares therapeutic success or dies; alternatively, physicians may renounce their monopoly on laboratory testing and prescription medications, thereby empowering PWCs to pursue their own therapy unfettered by legal constraints.Matt>> > While it is foolish for doctors to *conclude* that CFS is psychogenic,> it is totally acceptable to my mind for healthy doctors to wonder> whether CFS *could* be psychogenic - since not everyone may judge the> evidence for its physiologicity to be overwhelming. After all, if you> don't have CFS yourself, you have nothing to convince you of its> physiologicity other than objective measurements along with your own> subjective assessment of the sanity of CFS cases, who you might not> know closely and personally.>

[Guest guest]

> It is never acceptable for doctors to wonder if CFS could be

> psychogenic. Such a belief is unfalsifiable, and therefore belongs

> to the realm of philosophy, not science. That is, how would the

> doctor demonstrate that a particular patient's CFS is psychogenic?

> It can't be done.

I think you meant to use " nonconfirmable " in place of the word

unfalsifiable. The psychogenic hypothesis of episodic migraine has

already been falsified. The analogous psychogenicity proposition is

falsifiable for CFS. Arguably, it isn't confirmable - since

epidemiological associations with objectively-identified psychotrauma

prior to syndrome onset seem to provide the sole possible clear

positive evidence, and I'm not sure you can get enough decent evidence

that way in practice, though it is possible a priori. Other than that

there is only negative evidence, which doesn't prove anything.

I don't know what philosophers of science think about nonconfirmable

propositions, but I find it acceptable for a doctor or scientist to

wonder whether a nonconfirmable proposition might be true, whether or

not they are practicing science in having that thought.

> To even wonder such a thing is to also adopt deep hypocrisy. The

> idea is supposedly motivated by the lack of physical findings, yet

> the entertainment of psychogenic explanations is done, up front, in

> the full knowledge that physical findings will not be found to

> support a psychogenic view.

My wording was ambigious, but what I had in mind was a person who is

wondering about the cause of the syndrome in general. It sounds like

you are talking about the question of the cause of an individual case.

Regardless, I don't see why considering a certain proposition at a

certain time (whether it's before or after performing a certain

investigation) constitutes hypocrisy or contradiction. To consider a

certain hypothesis or proposition is to be aware of it, not to have an

evaluation of it.

> There is more hypocrisy: many CFS patients oppose the conclusion

> that their disease is psychogenic. Yet the physician expects the

> patient, and society, to accept the psychogenic view if that is the

> physician's conclusion (and to even wonder if CFS could be

> psychogenic is to believe that that is a possible, final

> conclusion).

I wonder whether the mitochonrion ancestor was a parasite or a prey

item of the eukaryote ancester before mitochondrial endiosymbiosis,

but I am not sure either conclusion is possible. There are a lot of

things that might be true but can never be proven.

> But does anybody believe that, were the tables turned,

> the doctor would forfeit his/her own sovereignty to declare his/her

> extreme physical suffering to have an organic basis? Of course

> not. Few people willingly do this. To expect PWCs to do this is,

> then, transparently hypocritical.

I'm not sure what I think about that (remember I am trying to consider

the perspective of someone with no experience of disease, not my own

perspective). Regardless, I wasn't talking about declaring any

proposition to be true - only whether I found it repugnant for a

person to wonder whether a proposition might be true.

> If the plight of the undiagnosed ill is to change, it will change

> when their most basic position is that (i) lack of physical findings

> justifiably deprives the physician of confidence, but does not

> empower that physician to entertain non-empirical viewpoints, such

> as psychogenic explanations, demon possession, etc.;

If a (healthy) external investigator isn't confident of a physical

cause, why (in terms of hiw own perspective, not ours) or how does he

avoid wondering about or entertaining other causes?

> (ii) the

> implementation of psychological theories with the effect of

> depriving PWCs of a robust differential diagnosis and of treatments

> that presuppose an organic basis to the disease will not be debated

> with the courtesy afforded to each other by scientists, but will be

> opposed for what it is—bigotry; (iii) lack of confidence in an

> insufficiently supported organic explanation does not justify

> inaction—great suffering demands that additional tests be ordered

> and/or that the PWC be given the option of implementing best-guess

> therapeutic trials (as is done with the wholly non-empirical

> diagnoses of depression, ADD and pain with the implementation of

> antidepressants, stimulants and narcotics, respectively.); (iv) the

> inadequacy of physical findings demands a good faith NIH-funded

> search for better ones; (v) admission of ignorance is not a

> sufficient basis for terminating a therapeutic relationship—

> physicians have a monopoly on prescription medication and laboratory

> testing, and are therefore morally bound to proactively pursue

> diagnosis/treatment of the PWC until that PWC declares therapeutic

> success or dies; alternatively, physicians may renounce their

> monopoly on laboratory testing and prescription medications, thereby

> empowering PWCs to pursue their own therapy unfettered by legal

> constraints.

I agree with all that but I don't think it contrasts with what I wrote.

[Guest guest]

,

Physical symptoms exist. The odds are almost overwhelming that the

cause of those symptoms are at least in part physical. The problem is

that we can't get over our own hubris and admit how little we know and

how unsophisticated and incomplete our understanding of health,

disease, and medicine are.

There is no particular reason to make the leap from "unknown cause" to

"mental illness" other than the unwarranted assumption that each

disease you encounter is properly defined, fully understood, has a

single cause, and a single cure, and that if such a cause exists, it

likely exists within a body of medical understanding that is assumed to

be of fairly high quality, and fairly comprehensive. Well okay,

another reason to make the leap is that you have contempt for your

patients, whom you consider idiots if they have the temerity not to

respond to your treatments.

Contrary to popular belief, mental health professionals have a

significantly clearer picture of mental illness, its causes, and what

treatments would be effective (albeit often time consuming and

expensive) than medical doctors have of physical illness.

suffered the indignity of being sent to the shrink several times during

her life, mostly by the Social Security disability review process, and

every single time, she was certified sane, and in fact, more sane than

most people -- coping well, courageously and realistically with very

difficult losses caused by her very real symptoms. One shrink even

remarked in his letter to SSD to not waste his time with sane people.

Yet, every few years, it was necessary to repeat this process, because

mental illness is irrationally seen as the only possible explanation

for physical symptoms that medicine does not as yet properly understand.

I shudder to think how much this has hindered progress against various

illnesses like CFS/ME, MCS/EI, and chronic infection in general. All

of this crap just for the sake of maintaining the ego of practitioners

and the comfort of the status quo.

It's almost pure evil.

--Bob

wrote:

If a (healthy) external investigator isn't confident of a physical

cause, why (in terms of hiw own perspective, not ours) or how does he

avoid wondering about or entertaining other causes?

[Guest guest]

You sound like my daugher's college psych teacher. (he's a neurological researcher). From my daughter's reports, he has extreme contempt for medical doctors and their complete lack of understanding of how the body/brain actually works. He does have sympathy for them because of the system they're trained in, but as far as understanding illness, he says we'd be a whole lot better off if we could be treated by medical researchers, who at least have some idea of how things work. In his view, doctors are just out there "practicing" without really understanding much of anything. And not helping much either. (He sounds quite opinionated, and my daughter seems quite enamored with him. I like him too. Remember, he's the one who said he believes that many illnesses are probably caused by undiagnosed bacterial infections. :-) penny Bob Grommes

<bob@...> wrote: ,Physical symptoms exist. The odds are almost overwhelming that the cause of those symptoms are at least in part physical. The problem is that we can't get over our own hubris and admit how little we know and how unsophisticated and incomplete our understanding of health, disease, and medicine are.There is no particular reason to make the leap from "unknown cause" to "mental illness" other than the unwarranted assumption that each disease you encounter is properly defined, fully understood, has a

single cause, and a single cure, and that if such a cause exists, it likely exists within a body of medical understanding that is assumed to be of fairly high quality, and fairly comprehensive. Well okay, another reason to make the leap is that you have contempt for your patients, whom you consider idiots if they have the temerity not to respond to your treatments.Contrary to popular belief, mental health professionals have a significantly clearer picture of mental illness, its causes, and what treatments would be effective (albeit often time consuming and expensive) than medical doctors have of physical illness. suffered the indignity of being sent to the shrink several times during her life, mostly by the Social Security disability review process, and every single time, she was certified sane, and in fact, more sane than most people -- coping well, courageously and realistically with very difficult losses caused by her very real symptoms.

One shrink even remarked in his letter to SSD to not waste his time with sane people. Yet, every few years, it was necessary to repeat this process, because mental illness is irrationally seen as the only possible explanation for physical symptoms that medicine does not as yet properly understand.I shudder to think how much this has hindered progress against various illnesses like CFS/ME, MCS/EI, and chronic infection in general. All of this crap just for the sake of maintaining the ego of practitioners and the comfort of the status quo.It's almost pure evil.--Bob wrote: If a (healthy) external investigator isn't confident of a physicalcause, why (in terms of hiw own perspective, not ours) or how does heavoid wondering about or entertaining other

causes?

[Guest guest]

Bob, I broadly agree with all your points from this and your other

reply; I'm just not sure believing in the possibility of

psychopathogenesis makes a person a reprobate or someone who shouldn't

be engaged.

I don't dig the idea of psychopathogenesis, obviously (and consider

myself resoundingly sane). And I never really believed in it even when

I was healthy. But I am not sure it's totally beyond the ken for some

person to contemplate. After all we all have our few follies at least...

I do think it's intellectually indefensible to *conclude* or

provisionally conclude in favor of a psychopathogenesis. That

conclusion could not possibly be warranted. Even then, I think we need

to just explain to people why that's so; it's the only really

practical thing to do. Even more politeness, then, is called for if we

engage someone who is merely contemplating a psychogenic hypothesis

rather than concluding it.

Of course I'm not saying go to a doctor who is even remotely

contemplating such a hypothesis; that would tend to be a waste in most

cases. As I mentioned to Matt, though my wording was ambiguous in my

prior post, in my attempt to appreciate the perspective of those who

consider psychogenicity, I was thinking more of " thinkers " (be they

MDs or whatever) and of the process of intellectual debate over the

long term (several years at least) - I wasn't thinking of physicians

as practitioners. I haven't been to a doc since '05, and the last 15

MDs or MD/PhDs I encountered were teaching one of my classes or giving

an academic talk or had lab fellowships... and I read and think biomed

all day myself... so when I think about disease, I always think

science and sort of half-forget that people actually consult doctors

in person... thus it was natural for me to make a somewhat ambiguous

statement by forgetting the larger context of things.

> >

> > If a (healthy) external investigator isn't confident of a physical

> > cause, why (in terms of hiw own perspective, not ours) or how does he

> > avoid wondering about or entertaining other causes?

> >

>

[Guest guest]

> I haven't been to a doc since '05, and the last 15

Let me tell you somethin... it also seems like its been 5 years since

'05, and 9 years since '03. I could swear time has just been slowing

right on down... beats the opposite I guess...

[Guest guest]

>so when I think about disease, I always think>science and sort of half-forget that people actually consult doctors>in person...

, you really crack me up!

I am the same, I don't even have a GP anymore, (fortunately I have an open Infectious Disease doctor, I still have to do most of the work myself).

I keep having to pinch myself to stay calm when talking to "normals" when they say "the doctor told me..."

I can be more Tonyesque than Tony EVER imagined (in fact that was my only objection to Tony's ravings: not realising we were in near total agreement re how most doctors talk crap)

Nelly

[infections] Re: social rejection of unverifiable syndromes - migraine

Bob, I broadly agree with all your points from this and your otherreply; I'm just not sure believing in the possibility ofpsychopathogenesis makes a person a reprobate or someone who shouldn'tbe engaged.I don't dig the idea of psychopathogenesis, obviously (and considermyself resoundingly sane). And I never really believed in it even whenI was healthy. But I am not sure it's totally beyond the ken for someperson to contemplate. After all we all have our few follies at least...I do think it's intellectually indefensible to *conclude* orprovisionally conclude in favor of a psychopathogenesis. Thatconclusion could not possibly be warranted. Even then, I think we needto just explain to people why that's so; it's the only reallypractical thing to do. Even more politeness, then, is called for if weengage someone who is merely contemplating a psychogenic hypothesisrather than concluding it. Of course I'm not saying go to a doctor who is even remotelycontemplating such a hypothesis; that would tend to be a waste in mostcases. As I mentioned to Matt, though my wording was ambiguous in myprior post, in my attempt to appreciate the perspective of those whoconsider psychogenicity, I was thinking more of "thinkers" (be theyMDs or whatever) and of the process of intellectual debate over thelong term (several years at least) - I wasn't thinking of physiciansas practitioners. I haven't been to a doc since '05, and the last 15MDs or MD/PhDs I encountered were teaching one of my classes or givingan academic talk or had lab fellowships... and I read and think biomedall day myself... so when I think about disease, I always thinkscience and sort of half-forget that people actually consult doctorsin person... thus it was natural for me to make a somewhat ambiguousstatement by forgetting the larger context of things. > >> > If a (healthy) external investigator isn't confident of a physical> > cause, why (in terms of hiw own perspective, not ours) or how does he> > avoid wondering about or entertaining other causes?> >>