O'Sullivan is very clear that the vast majority of people with non-physical illnesses are not faking. In fact they often end up making it very easy to detect: for instance someone who has psychosomatic seizures every few months will often have one right in front of the neurologist or when under observation or hooked up to an EEG, even though the odds are vastly against that happening and it makes it easy to detect.

Another point is that psychosomatic illnesses are just as distressing and disabling as those with a physical cause. The symptoms, like seizures, feel just as real to the patient, and the patient's life is just as disrupted. But the stigma against psychosomatic illness means that patients are usually very reluctant to accept the diagnosis. Therapy is often effective in these cases, but patients often refuse to accept it, ending up suffering with an untreated illness.

I didn't realise this, but apparently doctors are also very reluctant to diagnose psychosomatic illnesses. Firstly they know the patients will often be hostile. Also the consequences to your reputation of diagnosing a psychosomatic illness if a physical cause is eventually found are high. The consequences the other way round are low. So patients often get unnecessary exploratory surgeries, or unnecessary drugs with side effects, if doctors play it safe.

Overall, a fascinating book.

What I'm Reading 2
Racing Weight by Matt Fitzgerald. Highly recommended book about weight management for endurance athetes (runners, cyclists, triathletes, cross-country skiers etc). There are some interesting ideas in there, especially about timing your food. But I was a bit disappointed on the whole. Some of the evidence he cites is a bit weak, e.g. one study with a tiny sample size, a correlation that's assumed to imply cause.

Also he doesn't avocate much tracking, just concentrating on eating "high quality" foods with lean protein, complex carbs etc. I'm sure that works for a lot of people but it's useless to me. Advice like eating "just a handful of nuts" is terrible for me as I could munch through kilos of them. And living with a family who don't want to eat like endurance athletes means I could not easily transform my diet this way: I think you'd either have to be single, have a partner who wants to eat the same way, or have enough free time to buy and cook and wash up completely separate meals.

What I'm Reading 3
Testosterone Rex by Cordelia Fine, who also wrote the excellent Delusions of Gender. This one looks at the actual science of testosterone and how it is often overstated in pop science as a cause of behavioural sex differences.

Firstly she points out that gender differences are often exaggerated. For instance it is often claimed that women are more risk-averse than men. Fine points out that risk-tolerance doesn't seem to be a single stable personality trait: someone with a risky hobby like skydiving may have a conservative set of investment preferences. The risk differences between men and women are not that large, and disappear in certain circumstances. If people are observed by an attractive person of the opposite sex, when playing a game men become risk-takers and women risk-averse. If playing in a single sex group those tendencies disappear: women play more ruthlessly to win. The more the stakes are increased the more likely people are to play more rationally.

Fine also points out that testosterone changes often follow social status rather than the other way round. A certain fish changes colour if it is a dominant male, and dominant males have high testosterone. But if you put a subordinate fish in with smaller males, it becomes dominant and testosterone levels rise. If you increase the testosterone levels in primates, they become more aggressive to those lower in the social order, but their position in the order does not change.

Overall, pretty interesting

Me
Coming to the end of the holidays. Been a bit dull though I've got some rest. With Omicron everywhere we didn't visit relatives or go to museums or go to a pantomime like normal. The weather was wet and miserable for a lot of the time too. Have only put on a pound so not too bad.

Update [2022-1-1 20:4:29 by TheophileEscargot]: Non-elderly family have got Omicron though seem to be doing OK. Feeling less guilty about not visiting now.

Links
Farmers used to run phone lines through barbed wire fences. Old multi-angle photographs.