psychosocial: of or involving the influence of social factors or human interactive behaviour.

psychosomatic: 1 (of an illness, etc.) caused by or aggravated by mental conflict, stress, etc. 2 of the mind and body together.

Now, Table 1 in the BMJ paper that Ben cited (http://www.bmj.com/cgi/content/full/332/7555/1430) lists the following risk factors as “psychosocial”:
Stress; anxiety; negative mood or emotions; poor cognitive functioning; pain behaviour.

Number 1 in this list of “psychosocial” risk factors is “stress”, which is not mentioned in the Oxford dictionary’s definition of “psychosocial”, but is specifically mentioned in the dictionary’s definition of “psychosomatic”. So I don’t think you could blame anyone for thinking that the terms “psychosocial” and “psychosomatic” are virtually synonymous.

Perhaps medical professionals use a different definition of “psychosomatic” from that used in everyday language typified by the Oxford Dictionary definition (like the way “significant” has a precise meaning to statisticians which can be at odds with the definition used in ordinary language)?

Ben – it would be really helpful if you could define precisely what you mean by “psychosomatic” and “psychosocial”.

So people just insert their own definitions based on what the words sound like.

Psychosocial sounds like psychosomatic, which we all know means that someone is not really ill.

Cognitive behaviour therapy sounds like seeing a psychiatrist, which people only do if they’ve got something wrong with their thoughts not their bodies.

Plus, most people can’t accept that something can be ‘real’ and ‘(partly) in the mind’. The cognitive dissonance makes misinterpreting the facts very easy.

As a physical therapist I frequently encounter medically unexplained pain. More commonly, I see erroneously explained pain symptoms, usually in the guise of (or together with) a medical diagnosis. I can definitely feel your pain of being misperceived.

I concur with your thoughts that “medically unexplained symptoms and the mechanisms of psychological factors in ill health are officially the most interesting thing in medicine right now”. I look forward to see what your research and clinical practice produces.

The whole episode was a shame because in general I admire Ben’s communication of medical and scientific issues.

This book and the reviews may be interesting. I found it fascinating with explanations and likely mechanisms for many ‘traditional healing’ practices. One of the best ‘treatments’ for these ongoing connundrums is meditation –lots of valid research –costs nothing and does not require anyone else to do it . I am not advocating this as a panacea due to the obvious social factors that can’t be eliminated by sitting still !

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=1640390&dopt=Citation

Citation? Spitting blood and observable lung damage were a bit of a giveaway that it wasn’t. The psychosomatic angle came after the discovery of the bacillus, particularly through the work of Thomas Holmes. His studies – still valid, I think, looked at the role of stress in infection: (a) why not everyone infected with the bacillus got ill, and b) how mindset and stress factors affected the chance of recovery.

> They are already obfuscating the sham vs non-sham by vague comments of closeness of needles and depth.

While their comments may be vague, surely they’re not irrational. No-one’s seriously suggesting (are they?) that sticking a needle into someone’s flesh has no effect, so it seems reasonable to suppose that how deep you stick the needles, how many needles you stick in, and how closely together you stick them should affect that effect. If suggestions of what the effect is are vague, then I’d've thought more research would be a better idea than outright dismissal. After all, pretty much every bit of scientific knowledge we have started out as vague, then got more precise as a result of experimentation.

misterjohn,

> It’s interesting how the chiropractor leaps in to say “We don’t just do spinal manipulation”, having been told that it has a negative impact on recovery!

Purely anecdotal, but a chiropractor cured my back pain where all my GP was interested in doing was prescribing me ibuprofen. (Regardless of the efficacy of ibuprofen, I still resent being given a prescription for it, enabling me to buy for a mere 6 quid what would usually cost me 50p.) Certainly didn’t have a negative impact on my recovery, and I know it wasn’t purely psychosomatic for the simple reason that my hamstrings are now demonstrably longer than they were, demonstrated through simple before-and-after trying-to-touch-my-toes experiments. (Took me bloody months of stretching).

Anyway, like I said, I know that’s anecdotal, but it still illustrates a point. I think a big problem with back pain is the same as with the common cold: there is no such thing as the common cold; it is merely a catch-all phrase for a very large number of different viruses, all of which provoke similar reactions from our immune systems and therefore appear the same if you look at symptoms instead of causes. This is why science, as we are so often told, “has yet to come up with a cure for the common cold”. Same with “back pain”: that’s not a disease, it’s a symptom. So talk of whether chiropractic — or anything else — works on it is doomed to inaccuracy. Chiropractic certainly does work on some problems which lead to back pain, and probably doesn’t work on some others. Same as ibuprofen. Looking at a group of patients with back pain and discovering that cure A makes 80% of them worse and 20% of them better tells you that you have at least two different causes of back pain, not that cure A doesn’t work.

As for people’s tendency to think that “psychological” means “not real”, I blame that Descartes. The problem is that most people don’t think that what goes on in their minds is a part of their body. Whereas, in fact, psychological is a subclass of physical.

I agree. What, if anything, is known about this? I’d guess placebo could work on at least some non-human species and the only claims I recall seeing about acupuncture or homeopathy working on animals were anecdotal and looked like the association implies causality fallacy anyway.

The letter writer did get the wrong end of the stick of course, the question being (as Ben acknowledges in this piece) whether the use of a term, “psychosocial”, that probably wasn’t familiar yet managed from its sound to have negative connotations for that individual helped trigger him to dive headlong for the wrong end of that stick.

Communication is key, and the way of engaging with the audience can grab them or put them off. Ben’s stuff is at the forefront of communicating about science because he does it so well, making the ideas quite simple so that lay people can easily grasp them.

I still think it was the wrong tack to take on the programme itself though. It would have been ideal for a general discussion on back pain: “yes, acupuncture (and fake acupuncture) have been shown to be effective. Equally effective (n.b. I don’t know this for sure) and cheaper is taking 2 paracetamol and going for a 10 km walk every day for a month.” But on the back of the study that was under discussion, it might have been better to be more positive while emphasising that placebo acupuncture worked just as well and talk less about the cost-effectiveness. But then stick me in front of a mike and all you would have heard is ers and ums.

http://news.bbc.co.uk/1/hi/health/7084644.stm

It’s interesting how the chiropractor leaps in to say “We don’t just do spinal manipulation”, having been told that it has a negative impact on recovery!