Psychological explanations of physical illness: Time for some skepticism?

17 Oct

A startling paper in Perspectives on Psychological Science:

In some patients with chronic physical complaints, detailed examination fails to reveal a well-recognized underlying disease process. In this situation, the physician may suspect a psychological cause. In this review, we critically evaluated the evidence for this causal claim, focusing on complaints presenting as neurological disorders. There were four main conclusions. First, patients with these complaints frequently exhibit psychopathology but not consistently more often than patients with a comparable “organic” diagnosis, so a causal role cannot be inferred. Second, these patients report a high incidence of adverse life experiences, but again, there is insufficient evidence to indicate a causal role for any particular type of experience. Third, although psychogenic illnesses are believed to be more responsive to psychological interventions than comparable “organic” illnesses, there is currently no evidence to support this claim. Finally, recent evidence suggests that biological and physical factors play a much greater causal role in these illnesses than previously believed. We conclude that there is currently little evidential support for psychogenic theories of illness in the neurological domain. In future research, researchers need to take a wider view concerning the etiology of these illnesses.

From the paper’s conclusion:

Given our current limited understanding of medical disease and its markers, it is perhaps not surprising that not all physical complaints can be associated with a specific, well-recognized disease process. In these circumstances, it is tempting to offer a psychological explanation. However, in this review, we have argued that such explanations are not currently supported by the evidence, at least not in the domains considered here. Further, these explanations may be harmful for the patient. To find better treatments for these illnesses, researchers and practitioners may need to retire those overworked psychological explanations that are commonly invoked in the face of uncertainty and instead adopt a completely fresh perspective. Such an approach may lead to a much deeper understanding of this perplexing collection of illnesses.

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