So, I work in psychiatry and have worked on many types of units for various reasons over my career.

My impression is the pendulum has swung so far in the other direction that the vast majority of patients left in the cold are those who do have mental health problems.

For a lot of these patients, it's not just that the physical symptoms are unexplained, it's that they don't make physical sense. For example, the same arm movement in one context causes pain; in another it's not painful at all. The tremors don't make sense, the seizures don't make sense, the EEG readings don't make sense, whatever. All the other stuff that is plausible is a long tail that overlaps with misunderstood non-psychiatric problems.

And in many cases, it's painfully obvious. Like, someone develops a mysterious unexplainable physical symptom right after they are divorced, or their child dies. Nothing can treat it except antidepressants.

But they're also very defensive about any other possibility other than an unrecognized non-psychiatric problem.

Combine this with the general zeitgeist in medical care where everything non-neurological or physical in focus is ridiculed, and it's a horrible problem.

It's all made worse by a tendency to introduce mind-body dichotomies where they don't exist, to criticize anything that isn't reductionist. That is, the logic is everything is based in the brain, so it's all physical, therefore any discussion of anything at other than that level is ridiculed, even when the people working at the higher level (mental) themselves aren't suggesting any kind of Cartesian duality.

We could go on... like all the modern psychotherapies (CBT) don't actually work any better than anything else when you look at the meta-analytic evidence, that a lot of modern cognitive science is based on two-system theories (Kahneman anyone?) which are essentially psychodynamic in all but name, that these discussions never admit for the possibility that maybe some individuals do fit a classical psychodynamic profile...

I really don't know anything in particular about this guy other than what the article stated, but I'm sort of frustrated by the tendency to think that because medicine went way overboard with psychoanalysis decades ago, that it means there wasn't something essentially accurate about it in some cases, and that every claim by every patient about their symptoms should be taken at face value because it feeds some contemporary medical paradigm.

In any event, I always feel weird defending this stuff at all because I wouldn't say I'm psychoanalytic or anything... it just increasingly seems to me that there's kind of a identity politics that plays into healthcare, where it's not really about actual evidence or plausibility or anything.

False positives and negatives get pushed around in both directions depending on your threshold. If every medically unexplained symptom is nonpsychiatric, you lose the psychiatric problems; if it's all psychiatric, you lose the nonpsychiatric cases.

Lots of evidence over many studies shows that the rate of false positive diagnoses of psychiatric somatoform disorder (that is, something is labeled as psychiatric when it's not) are not any different than for any other diagnostic category. Yet we continue to discuss them as if it's huge.