Closing diagnostic doors : The Problem of Psychologisation
Christoff Trüter
Spousal caregiver
The idea that physical health problems could be caused by psychological factors, that is mind, emotion, or behaviour, rather than by physical pathology, is hardly new. Its roots trace back to ancient civilisations, from Egypt, 1900 to 1500 BCE, to classical Greece, 5th to 4th century BCE, where hysteria-like symptoms were first described. These early ideas strongly influenced the development of medical psychologisation, later formalised in the DSM.
Psychologisation has long been one of the biggest culprits in prematurely closing diagnostic doors. It has been used to belittle, blame, stigmatise, and gaslight patients, often leaving them abandoned by the medical system for conditions that cannot yet be medically explained.
Throughout my wife's medical journey, she was frequently patronised by doctors, from gastroenterologists diagnosing functional gastrointestinal issues while laughingly advising her to eat less cake during investigations of unexplained weight gain, to neurologists assuming functional neurological problems before even examining her.
Even psychologists attempted to probe her past, aiming to fit her neurological issues into their own narrative.
We ended up withholding information about her upbringing and childhood because we did not trust doctors to avoid latching onto something and prematurely closing diagnostic doors due to their psychologisation bias.
There was an attempt to reframe this form of psychologisation in the FND diagnosis. Instead of explicitly blaming psychological factors, clinicians now attribute it to a brain network issue. Nevertheless, many clinicians, especially psychiatrists, still adhere to the psychological explanation.
But this reframing is largely smoke and mirrors, little better than the South African government renaming streets and towns shortly before an election to create the illusion of progress. At the end of the day, a rose by any other name remains a rose. Treatment still largely frames symptoms through a psychological lens, with multidisciplinary care often more rhetorical than transformative.