Psychologization: Difference between revisions

From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history
m (Text replacement - "|year=|" to "|")
(tidy)
Line 1: Line 1:
'''Psychologization''' or '''psychologisation''' or '''psychiatrization''' is the overemphasis or exaggeration of the role of psychological factors in illness when there is "little or no evidence to justify it".<ref name="Spandler2017" /> Psychologization is also known as the [[Martha Mitchell]] effect.
'''Psychologization''' or '''psychologisation''' or '''psychiatrization''' is the overemphasis or exaggeration of the role of psychological factors in illness when there is "little or no evidence to justify it".<ref name="Spandler2017" /> Psychologization is also known as the [[Martha Mitchell effect]].


{{Quote frame|"Psychologisation is a common practice but one which can put patients' lives at risk and undermine the general population's confidence in medicine and those who practise it".<ref>{{Cite journal|last=Goudsmit|first=EM|author-link=Ellen Goudsmit|last2=Gadd|first2=R|author-link2=|last3=|first3=|last4=|first4=|last5=|first5=|last6=|first6=|last7=|first7=|last8=|first8=|date=1991|title=All in the mind? The Psychologisation of Illness|url=|journal=The Psychologist|volume=4|issue=|pages=449-453|doi=|pmc=|pmid=|access-date=|quote=is the overemphasls and exaggeration of the role of psychological factors in illnesses which are generally considered to have a physiological and/or blochemical aetiology|via=|author-link3=|author-link4=|author-link5=|author-link6=}}</ref>|author=Goudsmit and Gadd (1981)}}
{{Quote frame|"Psychologisation is a common practice but one which can put patients' lives at risk and undermine the general population's confidence in medicine and those who practise it".<ref name="Goudsmit1991">{{Cite journal|last=Goudsmit|first=EM|author-link=Ellen Goudsmit|last2=Gadd|first2=R|author-link2=|date=1991|title=All in the mind? The Psychologisation of Illness|url=|journal=The Psychologist|volume=4|issue=|pages=449-453|doi=|pmc=|pmid=|access-date=|quote=is the overemphasls and exaggeration of the role of psychological factors in illnesses which are generally considered to have a physiological and/or blochemical aetiology|via=}}</ref>|author=Goudsmit and Gadd (1981)}}


==Evidence ==
==Evidence ==


The best known example of psychologization can be found in the treatment of stomach ulcers, where were assumed to always have a psychological cause until the discovery of the bacteria responsible.<ref>{{Cite web|url=https://mpkb.org/home/alternate/psychosomatic|title=Psychosomatic explanations for disease (MPKB)|last=|first=|authorlink=|last2=|first2=|authorlink2=|date=|website=The Marshall Protocol Knowledge Base|archive-url=|archive-date=|url-status=|access-date=2019-08-19}}</ref>
The best known example of psychologization can be found in the treatment of stomach ulcers, where were assumed to always have a psychological cause until the discovery of the bacteria responsible.<ref name="mpkb">{{Cite web|url=https://mpkb.org/home/alternate/psychosomatic|title=Psychosomatic explanations for disease (MPKB)|last=|first=|authorlink=|last2=|first2=|authorlink2=|date=|website=The Marshall Protocol Knowledge Base|archive-url=|archive-date=|url-status=|access-date=2019-08-19}}</ref>


In 1956 [[George Engel|Engel]], creator of the [[biopsychosocial model]] of illness, according to historian [[Edward Shorter]], Engel "asked why patients with ulcerative colitis often seemed to develop headaches when the bowel illness was quiescent. His theory was that when headaches appeared in these patients, 'there was evidence of strong conscious or unconscious aggressive or sadistic impulses. When bleeding occurred, 'the patient was feeling to varying degrees helpless, hopeless, or despairing. The bottom line, not entirely convincing to all gastro-enterologists, was 'Bleeding... characteristically occurs in the setting of a real, threatened, or fantasized loss, leading to psychic helplessness.'13"<ref>{{Cite book|last=Shorter|first=Edward|author-link=Edward Shorter|author-link2=|author-link3=|author-link4=|author-link5=|date=2005|editor-last=White|editor-first=Peter|editor-link=Peter White|title=Biopsychosocial medicine: An integrated approach to understanding illness|url=https://books.google.co.uk/books?id=chwtWAt76JoC&pg=PA4&lpg=PA4&source=bl&hl=en#v=onepage&q&f=false|journal=|volume=|issue=|pages=1-19|quote=|via=}}</ref>
In 1956 [[George Engel|Engel]], creator of the [[biopsychosocial model]] of illness, according to historian [[Edward Shorter]], Engel "asked why patients with ulcerative colitis often seemed to develop headaches when the bowel illness was quiescent. His theory was that when headaches appeared in these patients, 'there was evidence of strong conscious or unconscious aggressive or sadistic impulses. When bleeding occurred, 'the patient was feeling to varying degrees helpless, hopeless, or despairing. The bottom line, not entirely convincing to all gastro-enterologists, was 'Bleeding... characteristically occurs in the setting of a real, threatened, or fantasized loss, leading to psychic helplessness.'13"<ref>{{Cite book|last=Shorter|first=Edward|author-link=Edward Shorter|date=2005|editor-last=White|editor-first=Peter|editor-link=Peter White|title=Biopsychosocial medicine: An integrated approach to understanding illness|url=https://books.google.co.uk/books?id=chwtWAt76JoC&pg=PA4&lpg=PA4&source=bl&hl=en#v=onepage&q&f=false|volume=|pages=1-19|quote=|via=}}</ref>


"[[Niall McLaren|McLaren]] notes that some psychiatrists repeatedly invoke Engel's [[Biopsychosocial model|biopsychosocial "model"]] and that they accept without demur (or references) that it is a reality, when nothing could be further from the truth." <ref name=":0">{{Cite journal|date=2002-01-01|title=The myth of the biopsychosocial model|url=https://www.tandfonline.com/doi/abs/10.1046/j.1440-1614.2002.01076.x|journal=Australian and New Zealand Journal of Psychiatry|volume=36|issue=5|pages=701–701|doi=10.1046/j.1440-1614.2002.01076.x|issn=0004-8674}}</ref>
"[[Niall McLaren|McLaren]] notes that some psychiatrists repeatedly invoke Engel's [[Biopsychosocial model|biopsychosocial "model"]] and that they accept without demur (or references) that it is a reality, when nothing could be further from the truth." <ref name="McLaren">{{Cite journal|date=2002-01-01|title=The myth of the biopsychosocial model|url=https://www.tandfonline.com/doi/abs/10.1046/j.1440-1614.2002.01076.x|journal=Australian and New Zealand Journal of Psychiatry|volume=36|issue=5|pages=701–701|doi=10.1046/j.1440-1614.2002.01076.x|issn=0004-8674}}</ref>


==Psychologization in ME/CFS ==
==Psychologization in ME/CFS ==
Line 16: Line 16:


{{Quote frame|text=Lupus, multiple sclerosis, AIDS, and Lyme disease suffered similar fates before “tissue evidence” was available. Patients were belittled by armchair speculators masquerading as scientists. Who among us believes this was helpful? A simple “I don’t know” would have been better than specious speculation.<br >The authors confuse absence of evidence with evidence of absence. They are not the same. Absence of evidence may reflect insufficient research, inadequate technology, poor methods, flawed paradigms, closed minds, or lack of clinical experience; for example, in 1980, there was no clear evidence that AIDS was viral—blood products were considered “safe.”<ref name="English2000"/>|
{{Quote frame|text=Lupus, multiple sclerosis, AIDS, and Lyme disease suffered similar fates before “tissue evidence” was available. Patients were belittled by armchair speculators masquerading as scientists. Who among us believes this was helpful? A simple “I don’t know” would have been better than specious speculation.<br >The authors confuse absence of evidence with evidence of absence. They are not the same. Absence of evidence may reflect insufficient research, inadequate technology, poor methods, flawed paradigms, closed minds, or lack of clinical experience; for example, in 1980, there was no clear evidence that AIDS was viral—blood products were considered “safe.”<ref name="English2000"/>|
author=Thomas English|source=[[Annals of Internal Medicine]] (2000)}}
author=Thomas English|source=Annals of Internal Medicine (2000)}}


==Notable studies ==
==Notable studies ==
*1993, All in her mind! Stereotypic views and the psychologisation of women's illness<ref>{{Cite journal|journal=Health Psychology Update|url=https://books.google.co.uk/books?hl=en&lr=&id=E1afUMVG0VEC&oi=fnd&pg=PA7|title=All in her mind! Stereotypic views and the psychologisation of women's illness|last=Goudsmit|first=Ellen M|last2=|first2=|date=1993|publisher=|isbn=|editor-link=|volume=12|location=|pages=28-32|language=en|chapter=|quote=|author-link=Ellen Goudsmit|editor-last2=|editor-link2=}}</ref> [https://books.google.co.uk/books?hl=en&lr=&id=E1afUMVG0VEC&oi=fnd&pg=PA7 (Full text)]
*1993, All in her mind! Stereotypic views and the psychologisation of women's illness<ref name="Goudsmit1993">{{Cite journal|journal=Health Psychology Update|url=https://books.google.co.uk/books?hl=en&lr=&id=E1afUMVG0VEC&oi=fnd&pg=PA7|title=All in her mind! Stereotypic views and the psychologisation of women's illness|last=Goudsmit|first=Ellen M|last2=|first2=|date=1993|publisher=|isbn=|editor-link=|volume=12|location=|pages=28-32|language=en|chapter=|quote=|author-link=Ellen Goudsmit|editor-last2=|editor-link2=}}</ref> [https://books.google.co.uk/books?hl=en&lr=&id=E1afUMVG0VEC&oi=fnd&pg=PA7 (Full text)]


*2002, Bio-psycho-social reasoning in GPs' case narratives: The discursive construction of ME patients' identities<ref>{{Cite journal|last=Horton-Salway|first=Mary|author-link=Mary Horton-Salway|date=2002-10-01|title=Bio-Psycho-Social Reasoning in GPs’ Case Narratives: The Discursive Construction of ME Patients’ Identities|url=https://doi.org/10.1177/136345930200600401|journal=Health|language=en|volume=6|issue=4|pages=401–421|doi=10.1177/136345930200600401|issn=1363-4593|pmc=|pmid=|access-date=|quote=|via=}}</ref> [http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.940.9969&rep=rep1&type=pdf (Full text)]
*2002, Bio-psycho-social reasoning in GPs' case narratives: The discursive construction of ME patients' identities<ref name="Horton2002">{{Cite journal|last=Horton-Salway|first=Mary|author-link=Mary Horton-Salway|date=2002-10-01|title=Bio-Psycho-Social Reasoning in GPs’ Case Narratives: The Discursive Construction of ME Patients’ Identities|url=https://doi.org/10.1177/136345930200600401|journal=Health|language=en|volume=6|issue=4|pages=401–421|doi=10.1177/136345930200600401|issn=1363-4593|pmc=|pmid=|access-date=|quote=|via=}}</ref> [http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.940.9969&rep=rep1&type=pdf (Full text)]
*2002, The myth of the biopsychosocial model<ref name=":0" /> [https://doi.org/10.1046%2Fj.1440-1614.2002.01076.x (Abstract)]
*2002, The myth of the biopsychosocial model<ref name="McLaren" /> [https://doi.org/10.1046%2Fj.1440-1614.2002.01076.x (Abstract)]


*2008, Obstructions for quality care experienced by patients with chronic fatigue syndrome (CFS)—A case study<ref name="obstruction">{{Cite journal|last=Gilje|first=Ann Marit|author-link=Ann Marit Gilje|last2=Söderlund|first2=Atle|author-link2=Atle Söderlund|last3=Malterud|first3=Kirsti|author-link3=Kirsti Malterud|author-link4=|author-link5=|date=Oct 2008|title=Obstructions for quality care experienced by patients with chronic fatigue syndrome (CFS)—A case study|url=https://linkinghub.elsevier.com/retrieve/pii/S0738399108001936|journal=[[Patient Education and Counseling]]|language=en|volume=73|issue=1|pages=36–41|doi=10.1016/j.pec.2008.04.001|quote=|via=}}</ref> [https://linkinghub.elsevier.com/retrieve/pii/S0738399108001936 (Abstract)]
*2008, Obstructions for quality care experienced by patients with chronic fatigue syndrome (CFS)—A case study<ref name="obstruction">{{Cite journal|last=Gilje|first=Ann Marit|author-link=Ann Marit Gilje|last2=Söderlund|first2=Atle|author-link2=Atle Söderlund|last3=Malterud|first3=Kirsti|author-link3=Kirsti Malterud|author-link4=|author-link5=|date=Oct 2008|title=Obstructions for quality care experienced by patients with chronic fatigue syndrome (CFS)—A case study|url=https://linkinghub.elsevier.com/retrieve/pii/S0738399108001936|journal=[[Patient Education and Counseling]]|language=en|volume=73|issue=1|pages=36–41|doi=10.1016/j.pec.2008.04.001|quote=|via=}}</ref> [https://linkinghub.elsevier.com/retrieve/pii/S0738399108001936 (Abstract)]
Line 32: Line 32:


==Letters, articles and talks ==
==Letters, articles and talks ==
* 2000, Functional somatic syndromes<ref name="English2000">{{Cite journal|last=English|first=T. L.|author-link=Thomas English|author-link2=|author-link3=|author-link4=|author-link5=|date=Feb 15, 2000|title=Functional somatic syndromes|url=https://www.ncbi.nlm.nih.gov/pubmed/10681297|journal=[[Annals of Internal Medicine]]|volume=132|issue=4|pages=329|issn=0003-4819|pmid=10681297|quote=Lupus, multiple sclerosis, AIDS, and Lyme disease suffered similar fates before “tissue evidence” was available. Patients were belittled by armchair speculators masquerading as scientists. Who among us believes this was helpful? A simple “I don’t know” would have been better than specious speculation.<br >The authors confuse absence of evidence with evidence of absence. They are not the same. Absence of evidence may reflect insufficient research, inadequate technology, poor methods, flawed paradigms, closed minds, or lack of clinical experience; for example, in 1980, there was no clear evidence that AIDS was viral—blood products were considered “safe.”|via=}}</ref>
* 2000, Functional somatic syndromes<ref name="English2000">{{Cite journal|last=English|first=T. L.|author-link=Thomas English|date=Feb 15, 2000|title=Functional somatic syndromes|url=https://www.ncbi.nlm.nih.gov/pubmed/10681297|journal=Annals of Internal Medicine|volume=132|issue=4|pages=329|issn=0003-4819|pmid=10681297|quote=Lupus, multiple sclerosis, AIDS, and Lyme disease suffered similar fates before “tissue evidence” was available. Patients were belittled by armchair speculators masquerading as scientists. Who among us believes this was helpful? A simple “I don’t know” would have been better than specious speculation.<br >The authors confuse absence of evidence with evidence of absence. They are not the same. Absence of evidence may reflect insufficient research, inadequate technology, poor methods, flawed paradigms, closed minds, or lack of clinical experience; for example, in 1980, there was no clear evidence that AIDS was viral—blood products were considered “safe.”|via=}}</ref>
* 2013, Disease-modifying therapies for nonrelapsing multiple sclerosis: Absence of evidence does not constitute evidence of absence<ref name="Dunn2013">{{Cite journal|last=Dunn|first=J.|author-link=Jeffrey Dunn|author-link2=|author-link3=|author-link4=|author-link5=|date=2013-10-31|title=Disease-modifying therapies for nonrelapsing multiple sclerosis: Absence of evidence does not constitute evidence of absence|url=http://dx.doi.org/10.1212/01.cpj.0000436215.95884.89|journal=Neurology: Clinical Practice|volume=3|issue=6|pages=515–518|doi=10.1212/01.cpj.0000436215.95884.89|issn=2163-0402|quote=|via=}}</ref>
* 2013, Disease-modifying therapies for nonrelapsing multiple sclerosis: Absence of evidence does not constitute evidence of absence<ref name="Dunn2013">{{Cite journal|last=Dunn|first=J.|author-link=Jeffrey Dunn|date=2013-10-31|title=Disease-modifying therapies for nonrelapsing multiple sclerosis: Absence of evidence does not constitute evidence of absence|url=http://dx.doi.org/10.1212/01.cpj.0000436215.95884.89|journal=Neurology: Clinical Practice|volume=3|issue=6|pages=515–518|doi=10.1212/01.cpj.0000436215.95884.89|issn=2163-0402|quote=|via=}}</ref>


== See also ==
== See also ==
Line 40: Line 40:
* [[Martha Mitchell Effect]]
* [[Martha Mitchell Effect]]
* [[Medically unexplained physical symptoms]]
* [[Medically unexplained physical symptoms]]
* [[Functional neurological symptom disorder|Functional Neurological Symptom Disorder]]
* [[Functional neurological symptom disorder|Functional Neurological Symptom Disorder]] (FND)
* [[Bodily distress disorder]]
* [[Bodily distress disorder]]
* [[Wessely school]]
* [[Wessely school]]
Line 49: Line 49:


== References ==
== References ==
{{Reflist}}
[[Category:Psychology]]
[[Category:Psychology]]
[[Category:Psychological paradigm]]
[[Category:Psychological paradigm]]
<references />

Revision as of 02:23, November 30, 2021

Psychologization or psychologisation or psychiatrization is the overemphasis or exaggeration of the role of psychological factors in illness when there is "little or no evidence to justify it".[1] Psychologization is also known as the Martha Mitchell effect.

"Psychologisation is a common practice but one which can put patients' lives at risk and undermine the general population's confidence in medicine and those who practise it".[2] — Goudsmit and Gadd (1981)

Evidence[edit | edit source]

The best known example of psychologization can be found in the treatment of stomach ulcers, where were assumed to always have a psychological cause until the discovery of the bacteria responsible.[3]

In 1956 Engel, creator of the biopsychosocial model of illness, according to historian Edward Shorter, Engel "asked why patients with ulcerative colitis often seemed to develop headaches when the bowel illness was quiescent. His theory was that when headaches appeared in these patients, 'there was evidence of strong conscious or unconscious aggressive or sadistic impulses. When bleeding occurred, 'the patient was feeling to varying degrees helpless, hopeless, or despairing. The bottom line, not entirely convincing to all gastro-enterologists, was 'Bleeding... characteristically occurs in the setting of a real, threatened, or fantasized loss, leading to psychic helplessness.'13"[4]

"McLaren notes that some psychiatrists repeatedly invoke Engel's biopsychosocial "model" and that they accept without demur (or references) that it is a reality, when nothing could be further from the truth." [5]

Psychologization in ME/CFS[edit | edit source]

Patients with ME/CFS have reported that clinicians often trivialize their symptoms and psychologize too much, and that this can lead to long term medical neglect and abuse.[6]

Lupus, multiple sclerosis, AIDS, and Lyme disease suffered similar fates before “tissue evidence” was available. Patients were belittled by armchair speculators masquerading as scientists. Who among us believes this was helpful? A simple “I don’t know” would have been better than specious speculation.
The authors confuse absence of evidence with evidence of absence. They are not the same. Absence of evidence may reflect insufficient research, inadequate technology, poor methods, flawed paradigms, closed minds, or lack of clinical experience; for example, in 1980, there was no clear evidence that AIDS was viral—blood products were considered “safe.”[7] — Thomas English, Annals of Internal Medicine (2000)

Notable studies[edit | edit source]

  • 1993, All in her mind! Stereotypic views and the psychologisation of women's illness[8] (Full text)
  • 2002, Bio-psycho-social reasoning in GPs' case narratives: The discursive construction of ME patients' identities[9] (Full text)
  • 2002, The myth of the biopsychosocial model[5] (Abstract)
  • 2008, Obstructions for quality care experienced by patients with chronic fatigue syndrome (CFS)—A case study[6] (Abstract)

Book chapters[edit | edit source]

Letters, articles and talks[edit | edit source]

  • 2000, Functional somatic syndromes[7]
  • 2013, Disease-modifying therapies for nonrelapsing multiple sclerosis: Absence of evidence does not constitute evidence of absence[10]

See also[edit | edit source]

Learn more[edit | edit source]

References[edit | edit source]

  1. 1.0 1.1 Spandler, Helen; Allen, Meg (August 16, 2017). "Contesting the psychiatric framing of ME/CFS" (PDF). Social Theory & Health. 16 (2): 127–141. doi:10.1057/s41285-017-0047-0. ISSN 1477-8211.
  2. Goudsmit, EM; Gadd, R (1991). "All in the mind? The Psychologisation of Illness". The Psychologist. 4: 449–453. is the overemphasls and exaggeration of the role of psychological factors in illnesses which are generally considered to have a physiological and/or blochemical aetiology
  3. "Psychosomatic explanations for disease (MPKB)". The Marshall Protocol Knowledge Base. Retrieved August 19, 2019.
  4. Shorter, Edward (2005). White, Peter (ed.). Biopsychosocial medicine: An integrated approach to understanding illness. pp. 1–19.
  5. 5.0 5.1 "The myth of the biopsychosocial model". Australian and New Zealand Journal of Psychiatry. 36 (5): 701–701. January 1, 2002. doi:10.1046/j.1440-1614.2002.01076.x. ISSN 0004-8674.
  6. 6.0 6.1 Gilje, Ann Marit; Söderlund, Atle; Malterud, Kirsti (October 2008). "Obstructions for quality care experienced by patients with chronic fatigue syndrome (CFS)—A case study". Patient Education and Counseling. 73 (1): 36–41. doi:10.1016/j.pec.2008.04.001.
  7. 7.0 7.1 English, T. L. (February 15, 2000). "Functional somatic syndromes". Annals of Internal Medicine. 132 (4): 329. ISSN 0003-4819. PMID 10681297. Lupus, multiple sclerosis, AIDS, and Lyme disease suffered similar fates before “tissue evidence” was available. Patients were belittled by armchair speculators masquerading as scientists. Who among us believes this was helpful? A simple “I don’t know” would have been better than specious speculation.
    The authors confuse absence of evidence with evidence of absence. They are not the same. Absence of evidence may reflect insufficient research, inadequate technology, poor methods, flawed paradigms, closed minds, or lack of clinical experience; for example, in 1980, there was no clear evidence that AIDS was viral—blood products were considered “safe.”
  8. Goudsmit, Ellen M (1993). "All in her mind! Stereotypic views and the psychologisation of women's illness". Health Psychology Update. 12: 28–32.
  9. Horton-Salway, Mary (October 1, 2002). "Bio-Psycho-Social Reasoning in GPs' Case Narratives: The Discursive Construction of ME Patients' Identities". Health. 6 (4): 401–421. doi:10.1177/136345930200600401. ISSN 1363-4593.
  10. Dunn, J. (October 31, 2013). "Disease-modifying therapies for nonrelapsing multiple sclerosis: Absence of evidence does not constitute evidence of absence". Neurology: Clinical Practice. 3 (6): 515–518. doi:10.1212/01.cpj.0000436215.95884.89. ISSN 2163-0402.