| ... this is like walking through a minefield, but here it goes. A lot of the illnesses they're talking about in the article, like IBS, lower back pain, and CFS have a strong psychosomatic component to it for a lot of people. They essentially say this in the article--something like "this won't work for malaria, but it will work for pain." This can be a really controversial position, and it gets really twisted by a lot of people. No I'm not advocating mind-body dualism. What I'm saying is that there's top-down influences on physical symptom perception and that probably influences bottom-up processes, leading to some sort of vicious circle. I think a lot of these psychosomatic conditions are really explained by the same processes involved in the nocebo effect. There have been studies to support this, showing that psychosomatic patients report more nocebo effects in control conditions than other patients and controls. The idea you're discussing--reassurance effects--is interesting and actually really understudied I think. However, I think there's an equally plausible hypothesis, that you're kind of fighting negative psychosomatic effects with positive psychosomatic effects in certain situations. I don't think that's all of the placebo effect, but I do think there's some broader causal system involved that encompasses placebo effects, nocebo effects, and psychosomatic illnesses and effects, including more psychosomatic psychiatric conditions (e.g., conversion disorder, psychogenic seizures, etc.), as well as psychological effects on disease process (e.g., stress effects on inflammation). I kind of wish this area of research didn't get so bogged down with political infighting, which invariably happens. Patients start insisting that we're being dismissive by discussing psychosomatic processes, some researchers will spuriously start criticizing other researchers for advocating Cartesian dualism, as political smear tactic, when the real issues pertain to emergent processes and top-down mutual influences. It's a very interesting area of research with lots of potential, but tends to get oversimplified really quickly to score political points. |