Sometime during the spring of last year (2011), I became gravely ill. By the end of March I could hardly walk, I couldn’t remember words and had trouble speaking when I could remember them, I became easily lost, I experienced a constant headache and extended panic attacks, and my mind was encapsulated in what I can only describe as a nearly impenetrable haze. I became depressed and despondent, too scared to drive a car and too fatigued to get out of bed (almost, in both cases – I managed to keep my job, somehow, and I regularly drove myself to the hospital). I thought I was going crazy or dying, or both.
I visited no fewer than 15 doctors over the next five months, and was preemptively diagnosed with a cornucopia of ailments, including Meniere’s disease, rheumatoid arthritis, chronic sinusitis, hepatitis, Epstein-Barr virus, syphilis, HIV, fibromyalgia, and lupus. In following with conventional, scientific medicine, the initial diagnosis is the “hypothesis” stage, after which comes the “experiment” stage: testing. I was tested for all of these conditions and more, and the results all invalidated the hypotheses/diagnoses. At that point all but one of those 15 doctors diagnosed me as having anxiety/depression – it is both handy and very telling that those two words are always lumped together like that – and concluded that my symptoms were psychosomatic.
I visited no fewer than 15 doctors over the next five months, and was preemptively diagnosed with a cornucopia of ailments, including Meniere’s disease, rheumatoid arthritis, chronic sinusitis, hepatitis, Epstein-Barr virus, syphilis, HIV, fibromyalgia, and lupus. In following with conventional, scientific medicine, the initial diagnosis is the “hypothesis” stage, after which comes the “experiment” stage: testing. I was tested for all of these conditions and more, and the results all invalidated the hypotheses/diagnoses. At that point all but one of those 15 doctors diagnosed me as having anxiety/depression – it is both handy and very telling that those two words are always lumped together like that – and concluded that my symptoms were psychosomatic.
And to test that hypothesis... yes, well, that’s the problem.
To spoil the surprise, I was eventually diagnosed with both neurological Lyme disease and thalassemia beta-minor, two clinical diagnoses that were confirmed with a battery of serological tests. But we only reached that point after I flatly told my doctors they were wrong and, along with the help of some diligent friends and a skeptical psychiatrist, continued to insist on ever more comprehensive testing. Had we not pursued that course, I would still be stuck with a diagnosis of anxiety/depression and would be either completely immobilized or dead by this point.
So mine is a cautionary tale, and one that is not specific to me alone: among my personal friends a fellow archaeologist was recently diagnosed with depression after visiting a doctor to complain about several months of severe fatigue, forgetfulness, intermittent fevers, muscle aches, sleeplessness, digestive malfunction, and malaise. The idea that depression can cause forgetfulness, fatigue, sleeplessness, and/or malaise is not much of a stretch, given that those feelings are largely subjective, but digestive malfunction can be observed in a laboratory and a fever can be observed with a two-dollar thermometer from Wal-Mart. Yet depression, or the more expansive anxiety/depression, remains the official diagnosis. It is the causative agent that explains the correlation between a set of symptoms that, for all intents and purposes, need not necessarily have anything to do with one another. Such a diagnosis is not only a handy method for waiving away a pestilential patient, it is also possibly correct. Who knows? However, in terms of scientific integrity, it is complete bullshit.
The main thrust of my argument is this: when you suspect an ulterior agent, be it a condition or a disease or a device or whatever, it is both logically and scientifically wretched to posit an agent that cannot be tested. Take a popular example: a data distribution shows a positive correlation between consumption of ice cream and rates of skin cancer, yet it goes against sound reason to assume that the two are directly related. So you concoct a bunch of hypotheses:
- Ice cream is a luxury food, so as people get more wealthy they can afford both ice cream and tanning salons;
- Ice cream is a staple of the cultural type who likes to go tanning, and the connection is thus sociological;
- People consume more ice cream when it gets warmer, so overall rates of both ice cream and skin cancer will increase as a result of more sunny days;
- People standing in line to get ice cream are exposed to sunlight while they stand there;
….and then you set about testing them.
1. Tanning salon visitation in the study area does not increase during the study period, and in fact seems to decrease – invalidated.
2. Ice cream is not a staple of “tanning culture,” because avid tanners are highly image-conscious by default and thus shy away from fattening foods – invalidated.
3. Weather records indeed reflect a general upswing in temperatures in the study area during the study period – supported.
4. The days of the “ice cream stand” are long-gone, and most people in the study area buy their ice cream from indoor shops – invalidated.
This example demonstrates a well-worn academic truism: correlation does not necessarily mean causation, and a causative agent can indeed be something ulterior and not immediately obvious within a set of correlating data. This is when it is important to be able to think outside the box, up to a point…
Here, then, is that point: all of the ulterior agents of causation posited above can be tested, resulting in their respective hypotheses being supported or invalidated. The trouble begins when people start introducing untestable agents. Of the myriad examples of this, I am especially irked by three forms of untestable agency: spiritual, supernatural, and mental.
Suppose, instead of ice cream and cancer, you’ve got a mysterious and unpleasant illness and a “cure” that seems to work but, as in ice cream and cancer, the idea of direct causation goes against sound reason. A favorite among anthropologists is malaria and shamanic healing ceremonies, which have – depending upon your source – a rate of success statistically comparable to that of modern medicine. Assuming this to be true, what’s the explanation?
Psychologists have provided one, and (unfortunately and ingratiatingly) it has become perniciously pervasive throughout the whole of modern medical practice: the psychosomatic hypothesis. Simply put, this is the idea that the human mind is of such considerable caliber that it can cause the body to mimic or even manifest physiological ailments, and/or lessen or even totally eradicate them.
This is not so unbelievable: innumerable experiments have proven that the human mind can indeed manifest and/or provide relief from physical maladies in certain situations. Good so far, but what are the parameters of those situations, and to what degree of certainty are they known? In fact most doctors, when asked this question, simply shrug and say something like, “Well… I suppose the possibilities are endless.” (That’s a direct quote from a doctor who diagnosed me with anxiety/depression before a series of blood tests showed me positive for both Lyme disease and thalassemia.) To put that another way: they don’t know. But the answer “I don’t know” is not an answer that anyone in the modern medical community is willing to say, and for the somewhat justifiable reason that a doctor telling a patient “I don’t know” is a good way for that doctor to be charged with malpractice. In our society the doctor is supposed to be omniscient. He or she knows the human body down to its individual cells and can recite the entire canon of medical conditions, including their symptoms and treatments, verbatim. An answer of “I don’t know” throws the ball back into the patient’s court, where it can easily wind up in the hands of a lawyer.
This is not so unbelievable: innumerable experiments have proven that the human mind can indeed manifest and/or provide relief from physical maladies in certain situations. Good so far, but what are the parameters of those situations, and to what degree of certainty are they known? In fact most doctors, when asked this question, simply shrug and say something like, “Well… I suppose the possibilities are endless.” (That’s a direct quote from a doctor who diagnosed me with anxiety/depression before a series of blood tests showed me positive for both Lyme disease and thalassemia.) To put that another way: they don’t know. But the answer “I don’t know” is not an answer that anyone in the modern medical community is willing to say, and for the somewhat justifiable reason that a doctor telling a patient “I don’t know” is a good way for that doctor to be charged with malpractice. In our society the doctor is supposed to be omniscient. He or she knows the human body down to its individual cells and can recite the entire canon of medical conditions, including their symptoms and treatments, verbatim. An answer of “I don’t know” throws the ball back into the patient’s court, where it can easily wind up in the hands of a lawyer.
While I sympathize with healthcare practitioners caught between these two menacing forces, the simple fact is that handing out psychosomatic diagnoses in a hospital setting is like handing out counterfeit money in a bank – good for making people feel as though their needs have been served, but ultimately totally worthless. To return to the hypothetical example of malaria and shamanism mentioned above, the four simplest explanations of such a correlation would be:
- It’s spiritual, e.g., soul or spirit energy is being healed in ways not obvious in a quantifiable, material sense.
- It’s magical, e.g., direct causation is indeed occurring, but through employment of a type of non- or super-natural energy that is highly elusive and wholly unknown to science.
- It’s mental, e.g., either the condition was all in the patient’s mind, or else it was the power of the patient’s mind (the “placebo effect”) that cured the condition.
- It’s a mystery, i.e., “I don’t know.”
Because the fourth one is absolutely taboo in our culture where medical practice is concerned, arguably more so than even the first two, we can effectively say that the supposed or hypothesized answer will never be that one.
So what’s wrong with the resulting picture? Quite simply, none of the above hypotheses is testable, at least not to a degree that even begins to approach useful certainty (again: #4 is off the table). They are all based on faith, in other words – faith in spirituality or faith in the supernatural or faith in the power of the mind – and not in the material positivism on which the scientific method is based.
So what’s wrong with the resulting picture? Quite simply, none of the above hypotheses is testable, at least not to a degree that even begins to approach useful certainty (again: #4 is off the table). They are all based on faith, in other words – faith in spirituality or faith in the supernatural or faith in the power of the mind – and not in the material positivism on which the scientific method is based.
All of which is beside one glaring point, which is that any one of those hypotheses might well be the truth. There may indeed be spiritual forces, or supernatural forces, or mental forces capable of creating or eradicating serious medical conditions. There is certainly a place in the human world for faith, and I for one am glad of that. But the bedrock fact is not that these explanations aren’t possible; it’s that they aren’t testable, and therefore aren’t scientific. No reasonable person would ever expect a medically-trained professional with a white coat and stethoscope to pronounce him or her “cursed” or the victim of “black magic,” yet these same professionals routinely pronounce patients as having “anxiety” or “depression” as if those conditions were capable of manifesting literally any symptomology. How? By what neurological pathways? Demonstrated by what biochemical signatures? As a result of what physiological mechanisms? What, simply, is the method by which the human mind can sicken and/or cure the human body?
Theories abound, but the general answer is that nobody knows.
By way of discussion, I would like to mention that the existence of psychosomatic conditions is a well-documented and effectively proven phenomenon, at least to the degree that they have been shown to occur with regularity in comparison with predictive models (but again: nobody is certain how). Recent studies have linked the psychological condition of “heart break” with extreme physiological discomfiture, and studies that go back into ancient times have demonstrated that, according to the old saw, laughter is indeed a very effective medicine. I am not attempting to refute the existence of psychosomatic symptoms, somatoform diseases, or the placebo effect, any more than I am attempting to say that spirits don’t exist or that magic is impossible. There is literally no limit to what is possible.
However, in sum, the problem with introducing psychosomatic hypotheses into hospital settings is one of both dismissiveness and blatantly unethical science. Handing a diagnosis of “it’s all in your mind” to a patient is tantamount to tossing the scientific method, with its insistence on positive causation and testable hypotheses, straight out the proverbial window. It is not a way to make patients leave satisfied or cured; it is simply a way to make them leave. When a patient presents with, for example, severe fatigue, forgetfulness, intermittent fevers, muscle aches, sleeplessness, digestive malfunction, and malaise, a diagnosis of depression might well be apt but it had better be followed by a thorough and precise explanation of the biological processes by which depression is indeed linked with those symptoms. Otherwise the diagnosis might as well be “your humors are out of balance,” and then we’re right back in the Dark Ages.
