Psychosomatic illness: final post

Physical manifestations of unhappiness are something we all experience; they are not personality flaws or signs of weakness, they are a part of life. Life is hard sometimes. It is harder for some than for others. We all manifest that hardship in different ways.

Each of these diagnoses is considered either entirely medically unexplained or only partially explained and with a large psychological component:
 
Amalgam poisoning, irritable bowel syndrome, candida syndrome, chronic fatigue syndrome, fibromyalgia, chronic Lyme disease, Morgellon's syndrome, formication, electromagnetic poisoning, environmental or chemical sensitivities, food intolerance.

 I recently went to a dinner party where every person bar two, at a table of ten, reported that they had an intolerance of or allergy to at least one foodstuff. Most had developed the allergy in middle age, which is not how an allergy typically behaves...People look for explanations for changes in their bodies, something to account for every unpleasant feeling. There is an unwillingness to accept behavioral or emotional factors, or the effects of aging, as an explanation. Society and the media are often available to provide a more agreeable answer and to add to the symptom pool available

The question that we, the unaffected, must answer for ourselves is, can we give a disability that has its roots in behavioral or psychological factors the same respect that we offer to a physical disease? If the answer is yes, then none of the other controversies matter any longer.

The placebo effect is another illustration of the mind-body connection--you might call it the psychogenic cure. Also widely and deeply misunderstood. Did you know, for instance, that the placebo effect works even if you are aware of it? Understanding this makes me skeptical of some of the self-experimentation people sometimes do. "Try X, it worked for me!" is a terrible, terrible argument. And it remains terrible no matter how much useless precision the author gives you about so many milligrams of whatever at whatever time of day immediately after exercise. I'm looking at you, Tim Ferriss! (Scott Alexander is also guilty of this to a lesser extent.) Did you do a randomized double-blind study on yourself? I don't fucking think so. You have no idea whether a given treatment worked on your body or your mind.

This doesn't mean that you should never try unproven remedies. My personal conclusion is that we should pay a lot more attention to the costs of the treatments we choose. Lots of home remedies are acceptable for this reason. If you think that valerian tea helps you sleep or ginger ale alleviates nausea, go ahead and use it without worrying too much about randomized controlled trials—your cost is only a small amount of money and trouble. In other words, the cost-benefit ratio is more likely favorable when the cost is negligible.

But with treatments that are much more costly, such as surgery, medications with serious side effects, and any involvement with the mental/behavioral health system, you need to be a lot more careful in assessing the likely benefits. For example, do you think the doubtful benefit of antidepressants is worth the 40-60% chance of loss of libido, to name just one of their costs?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108697/

I have my own answer to this, of course (sex is great), but my real message is to pay attention to the costs, and to be skeptical of the success stories you hear.