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Culture War Roundup for the week of April 24, 2023

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I'm not finding any recent papers by John Sarno as an author, just ones referencing his book (or, in a couple cases, including it as part of the experimental criteria by making people read it). There's a few (cfe here or here), but they're not very encouraging. The mechanism being nonsensical Freudian bullshit isn't unusual, and a lot of medical science falls in that category and can still be right on accident, but the scientific procedure is disappointingly bad even by the standards of the time.

The weak version -- that stress can augment inflammation and a variety of other pain-related things, including sometimes turning marginally-healthy people into marginally- (or chronically-) sick ones, is pretty plausible, including to anyone who's had a chronic illness. Indeed, there's a pretty wide variety of illnesses where stress -- sometimes meaning tiredness or lack of rest or energy expenditure but mostly meaning how worried they are -- including some (IBS, eczema, fibromygalia) where that's part of the bog-standard description. Sarno's techniques are probably helpful for this sort of stuff, in the sense that they keep you from basically marinating in it and provide some distractions (though I think there are some unstated risks and downsides).

I'm somewhat more skeptical of the stronger one, that these more severe problems are due to stressors. People do not, in bulk, go to doctors complaining about IBS or Crohn's Disease or even eczema. Famously, Crohn's is one of those things people tend to end up going to doctors with a pile of 'normal' non-chronic non-pain symptoms for years, and only getting filed properly in if they get an early endo/colonoscopy, or a lucky bit of advice (cw: severe psychic damage, tumblr). But these conditions don't tend to focus on highly neurotic people, or those with unusually stressful childhoods, or with histories of abuse. Conversely, you can stress someone out to upset their gut pretty easily, but it's actually pretty hard to do so in just the right way that their large or small intestines produce large abscesses trying to escape their abdomen.

And we have past evidence of other stress-tied digestive track illnesses where microbial infections end up being pretty strongly correlated. And found out in the 1980s!

There's some merged case -- a lot of people have h pylori infections and don't report stomach ulcers, and not everyone exposed to the microbe develop an infection, and it's probably not all strains of microbe and genetic predisposition, so you can come up with a mechanism where stress reduces immune activity or increases inflammation or whatever. Or perhaps herniated discs are things that show up in x-rays with readily-created biological models, but they're also more likely to be chronically painful for and maybe even caused by a culture that allows people to try lifting heavy things in stupid ways while also being more sedentary in general.

But this turns into a mind-body-model-of-the-gaps, in a way that kinda undermines the relevance of the model at all.

I don't know (and don't think!) that this covers everything. I'm still not sure wear fibromygalia falls, for one better-known example. But the limited insight on trying to separate these categories leaves me skeptical in general -- Sarno's bread-and-butter was lower back pain, and that's absolutely ludicrous as a category.