Is modern medicine descending into pseudoscience, or is scientific medicine still going strong? Unfortunately, I think both of these things can happen at the same time. On the one hand, scientific research in medicine is progressing nicely. We are seeing the results of scientific breakthroughs made decades ago, with monoclonal antibody therapies, new therapeutic targets, the beginning of real genetic therapy, brain-machine interface applications, and many others. Advanced scientific medicine is not going anywhere.

But at the same time I feel that we have lost the cultural narrative on health and disease. Gurus, health influencers, snake oil peddlers, the supplement industry, paraprofessionals, and science deniers have had a massive impact on the broader culture. The health industry has been “goopified”. A lot of alternative medicine talking points have been internalized – especially the notion that there is an alternative to real medicine. Ideas such as being “natural”, irrational fear of toxins, and that all problems are potentially nutritional, are often not even questioned, or recognized as an underlying assumption.

One such alternative narrative is the mind-body connection. This one is complex, because there is a mind body connection, but the CAM wellness version is to go way beyond the actual relationship to claim some mystical mysterious connection, usually to justify a familiar list of dubious treatments. One manifestation of this phenomenon is so-called “somatic therapy”.

Here is an explanation of what that is, from Harvard:

“A somatic therapist helps people release damaging, pent-up emotions in their body by using various mind-body techniques. These can vary widely, ranging from acupressure and hypnosis to breathwork and dance.”

The idea is that negative emotions or the effects of psychological trauma can become “trapped” in the body. This begins with a well-established premise, that psychological stress can manifest physically, and takes it a few steps further, beyond the evidence and beyond reason. In so doing it likely reverses the arrow of causation.

To quickly summarize a large and complex body of literature, what does happen is that anxiety, depression, or stress have specific physical manifestations. They can disturb sleep, cause muscle tension, and release stress hormones. They can even sometimes cause specific neurological symptoms. Those physical manifestations may have their own consequences, and even feed back into the negative emotional state. A lack of sleep, for example, can exacerbate anxiety and depression. Somatic symptoms can make people who are already anxious even more anxious about their health.

The standard approach to such situations is essentially to treat everything – treat the underlying psychological stressor while managing the physical manifestations. Improve the sleep, treat the muscle tension, but also treat the anxiety with proven interventions.

Somatic therapy goes beyond that approach, claiming that the muscle tension, for example, is now causing the anxiety by trapping it in the body. It would be one thing if this were just a metaphor, but it isn’t. It is a reframing of standard medical care into wellness speak, establishing a basis for whatever “mind-body” intervention the practitioner wants to sell. Look at the short list given above – acupressure, breathwork, and dance.

Acupressure is complete nonsense, based upon pseudoscience. There are no acupoints, there is no chi or meridians, and there is no evidence that any intervention based upon these prescientific notions have any specific benefit.

Breathwork is just more of the same phenomenon – slow breathing, which can certainly be relaxing. But proponents add the claim without justification that it actually works through a physical effect, altering vagal tone. As evidence they point to heart rate variability, a noisy measure with unclear implications that serves well as a Rorschach test.

The result of all this is an internal system of claims and philosophy, mostly based on placebo effects, with hand-waving claims about mechanism, and all based on the thinnest of evidence. This resembles a prescientific system of medicine, like the four humors.

Practitioners are just going with what sounds good, based upon an evolving wellness mythology. But at no point do they do high quality science that actually addresses the fundamental question – are these claims true? Does the intervention have any specific efficacy? Is the underlying philosophy based in reality?

Unless you use science to sincerely address these questions there will be a tendency for belief and practice to drift off into fantasy land. That basically describes the entire wellness industry. Without a solid grounding in science, the only real feedback loops are – what feels good, and what makes money.



Posted by Steven Novella