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Notes -
On fakes and faking:
There are a few interesting patterns I’ve seen regarding discourse around certain things being “fake,” or that certain people are “faking” or have “faked” something, wherein one finds distinct claims being either accidentally mistaken or deliberately conflated. And while there are definite culture war examples — sometimes in multiple areas — my initial examples are going to be less so.
[1.] “Person X is faking (very real) condition Y” versus “Condition Y is fake”:
A notable fictional example is in the South Park episode “Le Petit Tourette,” wherein Cartman fakes having Tourette syndrome to get away with randomly swearing. To quote from the Wikipedia summary:
[2.] “Condition X is fake; those who claim to have it are perfectly fine” versus “Condition X is fake; those who claim to have it actually suffer from Condition Y”:
Here, my example is Morgellons. I remember one memorable comment online from a doctor (back when I first encountered this particular internet rabbit-hole), responding to one “Morgellons” sufferer’s claim that doctors ‘refuse to give them a diagnosis,’ that no, doctors have been giving them a diagnosis, the same diagnosis, over and over: delusional parasitosis.
[3.] “The video/book is fake, as in staged” vs. “The video/book is fake, as in nonexistent”:
Here, examples of the first are any “mockumentary” or “found footage” movie — i.e. “The Blair Witch Project” is fake. This is the sort of claim that moon-landing conspiracy theories make. The second example, in comparison, is saying that something is fake like the way “Goncharov” is a fake movie — it doesn’t actually exist, and anyone who claims to have watched it is lying (in the case of “Goncharov,” as part of the game/fun.) Generally, what I see here in terms of ambiguity/equivocation is someone making a claim of the second type which people then “debunk” as if they had made the first type of claim.
Thoughts?
I am convinced, beyond reasonable doubt, that psychosomatic disorders are real.
So are the overwhelming majority of doctors.
In the majority of cases, this is not a problem for the patient. In fact, a lot of the time they're happy that the miscellaneous aches and pains that plague them are not indicative of a more serious condition, and can be dispelled with a combination of reassurance/therapy/antidepressants/neuropathic drugs.
This does not always work. Quite often, patients are unhappy/depressed for eminently sensible reasons that are beyond our, or their, ability to fix. The catch-all term for this, at least in the UK, is "Shit Life Syndrome". The prognosis is often terminal.
On the other hand, we have the Munchies, the 'ol sufferers of Munchausen syndrome, or worse by proxy, where some other poor bastard, be it a child or elderly relative unable to speak up for themselves, is subject to their torments.
They certainly are less than happy to be caught, even less happy about being treated for it, and unfortunately, in most cases, can't be committed involuntarily, only duly ignored in the future. Of course, if a case of abuse can be brought against them on behalf of those in their care, all the better.
And there are all kinds of hypochondriacs who aren't happy unless taking at least three medicines a day. On the plus side, they're quite scrupulous about it, which is more than I can say about many people who need them more.
Are there false positives and negatives? Undoubtedly. Someone, somewhere, is going to have a legitimate disease, likely an obscure one, and their concerns dismissed. But make no mistake, such incidents are in the firm minority. Most people who are dismissed by multiple doctors are dismissed because there is little that can be done, or nothing to do in the first place beyond tell them that they don't have what they're convinced they have.
I feel like this misses the case where the "real" and psychosomatic overlap.
There are some conditions that are "real" but rare and their "popularity" far outstrips the rate of the sufferers of the "real"/"physical" condition. Here we have things like various exotic mental disorders/syndromes, pain conditions, digestive disorders, allergies, fatigue conditions (most recently long COVID), auto immune disorders and transexualism.
Also, people who have the conditions likely have some of the conditions that causes psychosomatic symptoms similar to the condition, often because the condition itself causes or encourages behaviour leading to depression, anxiety, inactivity and or isolation.
How does a doctor tell whats going on? How does the social security system? How does the general public? How does the person themself?
As soon as something like this goes mainstream it inevitably gets dragged down in partisan politics.
I don't get paid nearly enough to get dragged into the debate on Fibromyalgia, Long COVID and the like. Especially the latter.*
But, for what it's worth, I have never seen a case of fibromyalgia in India, and even googling for cases here turns about zilch. On the other hand, sequelae after a severe viral illness is quite common, and whether or not COVID deserves a specific carveout is something I don't have a strong opinion on.
Make of that what you will.
*It has come to my attention that I don't get paid at all, but if someone wants to rectify that, Google the BMA rate card. And that does not include the 500% hazard pay rates I demand for trans medical care, or opinions on that.
My suspicion is that this is a trans type situation. Yes there are real trans patients. Yes there are cultural contagion trans patients. Yes there are borderlines (and others) with identity instability manifesting as trans thought character.
Likewise with Long COVD et al you have a mix of those pathologies being rolled together and it really reduces clarity and makes it unclear to what extent it is a real thing. Some people likely do have mangled CNS/PNS as a result of viral illness, others are maybe looking for a more ego syntonic expression of their depressive symptoms.
I know less about fibromyalgia but my understanding is that some physicians are emphatic it's a real thing and more investigation will make real bio markers or whatever abundantly clear.
Not seeing any fibromyalgia in India is interesting but its possible that it's in some way culture-bound, or environment-bound - higher parasite burden, rougher lives may prevent the sensitization or whatever else is going on under the hood.
There was a study done of "long COVID" which demonstrated that the only symptom of long COVID patients that was correlated with actually having tested positive for COVID at some point was loss of taste and smell. So yes, there are real and there are fake, but there's a whole lot more fake than real. And I suspect the same is true of trans patients. A few have a mental illness specific to that (call it "gender dysphoria" or whatever), a large number have cluster B personality disorders, and an even large number are pure social contagion.
I don't know if I believe in such a thing as long COVID, I do think that some people have gone online to make a whole condition out of post-viral syndrome and the like.
But Trinity College Dublin is at least half-assed respectable, and their eggheads are claiming that something is going on with leaky blood vessels?
Newspaper report here, link to published paper here. Again, I have no idea if Nature Neuroscience is a reputable journal or one of those 'you pay, and we'll publish any old rubbish" efforts. But the bit about serum from patients with (alleged) long COVID producing inflammatory markers in cultured cells would seem to indicate that there is indeed something there:
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Identity instability is a literal symptom of borderline. Not surprising if these people (when unstable) have trans thought content. If you throw the long COVID equivalent into your research studies, it's going to give you a ton of junk data and hide whatever thing is really going on.
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Great, a comment refresh ate everything.
But here's two screenshots of my Google results, I suspect yours would look very different.
https://ibb.co/cwqnt5K https://ibb.co/Bcxb3Jr
It's not that there's precisely zero fibromyalgia here, but I've never seen it diagnosed and don't know of a diagnosis through at least two degrees of separation. Old research papers, legitimate and more sketchy clinics advertising, pure puff pieces. One article from 2014.
I also can't recall formal diagnosis of Long COVID here either, and believe me I've treated more than my fair share of COVID patients, and everyone and their dog has caught it. I have seen symptoms that could be attributed to it, or at least COVID serves as the best proximate cause.
I would guess a culture of "toughing it out" and "oh god we have tons of real health problems" limits the role for these softer diseases.
Also thank you for introducing me to "crore."
Trust an American to show appreciation for non-standard and awkward methods of counting! I'll take millions any day, as a matter of fact I mentally convert from those to crore rather than vice versa.
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