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1997 Wessely & Shorter thing (minor - more morality and philosophy than CFS).

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13,774
[edit: I cite this later in this thread: http://forums.phoenixrising.me/index.php?threads/simon-wessely-and-all-in-the-mind.13979/]

I just read this thing which has Wessely ask a couple of questions, and sound somewhat concerned about an aspect of his approach to (what he considers to be) psychosomatic conditions and social hysteria which has always seemed a problem to me.

The best way of alleviating the problems of social hysteria/psychosomatic conditions is thought to be to encourage what could be considered a dismissive view of them, and to emphasise their psychological nature (sounds familiar). But on an individual level, it's best to maintain a supportive and respectful relationship with patients. There's an inevitable tension there, and Wessely raises that point here (kind of - if one was being uncharitable we could say he was primarily concerned about his customer base). The reply is utterly lacking imo, and I'm not too sure why I'm posting this... perhaps to encourage myself to read the whole thing in more detail later.

I sometimes get the impression that Wessely realises that he's on the edge of quackery, and uses his association with the processes of 'science', RCTs, academia, etc to reassure himself that he's not crossed the line. (Although the use of RCTs to justify psychoSOCIAL interventions is somewhat problematic unless you have a few societies to play with).

edit: re the benefits of being dismissive. When I was not recovering from glandular fever, and my doctor was telling me the importance of pushing myself to stay as active as possible or I could develop something like chronic fatigue syndrome, I remember being very ignorantly dismissive of the concern: "CFS? Rubbish - I'm not the type."... That was a decade ago.)

Edit from 2015: Four years on, and having read much more of Wessely's work, I am feeling increasingly less kindly. Also, I think that his response to PACE and patient's criticism of it reveals a darker side than I had realised was there.


www.sjweh.fi/download.php?abstract_id=252&file_nro=1

On the nature and origin of psychosomatic symptoms


Lamberg. Well, I don't know whether it relates to "sisu",
but I think that "sisu" could be defined as a kind o f stub-
born attitude. Would you agree with that?

Stenman. Y e s , I have the same opinion that it is a kind o f
stubborn optimism that helps you achieve what you are up
to; even i f you lose, you have won the second prize.

Wessely. Professor Shorter-it is fascinating to hear you
talk on psychology, but can I take you back to history?
You said two things-first, that you have learned that the
essential way of dealing with these problems clinically is
to take them seriously, emphasize their genuine nature and
so on. That is clinical skill and clinical judgment.
But you also said that the way in which these syn-
dromes finally go is when the word gets out that they are
really "all in the mind" and not to be taken seriously. There
is a clear irony and contradiction between what is good
clinical practice for the individual, and what you propose
would ultimately alter the disease attributions. How are we
to resolve this irony?

Shorter. I do not see a contradiction here at all. The physi-
cian has a whole bag of psychological tricks for dealing
with chronic psychosomatic illness, chronic somatization.
It is very important not to legitimate these toxic diagnoses,
and there is no doubt that multiple chemical sensitivity and
chronic fatigue syndrome are toxic diagnoses, because they
cause the patients to become fixated upon their symptoms
and to dig in even further so that they acquire a sense of
hopelessness.
Now, you do not have to endorse the patient's illness
representations in order to treat the patient in a humane and
serious way in the patient-doctor relationship. You do not
have to contradict the patient. You can diplomatically slide
over the illness attributions in silence, at the same time
taking the patient's symptoms seriously in other ways.

Wessely. Suppose a transcript of the proceedings here was
circulated among a group of patients who believe they
have toxic dental amalgam or suffer from multiple chemi-
cal sensitivity, it would be clear that the clinicians in this
audience would no longer get any patients. Once it was
known that they had presumably endorsed the views they
had heard at this symposium, that would be the end of their
clinical practice. They would no longer be able to do the
good things that you have said. So there is a fundamental
tension between the public good, and the clinical necessity
of treating patients, and it's one that is hard to resolve.

Shorter, The tension is between the need to be effective
health care educators and the need to have patients. This is
clearly a moral choice, and I am sure everybody in this
room would opt for the side of the good guys saying, "Our
role as physicians is to educate the vast public, which
consists of millions and millions of people, that we are
dealing with hocum here, rather than to cling to these few
extra patients. We have plenty of patients after all who
have plenty of other problems".
 
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Dolphin

Senior Member
Messages
17,567
Thanks Esther12. SW didn't exactly disagree with Shorter's idea, did he, he just said it would be bad for business if it was explicitly stated.
Shorter is a historian. Has a dangerously simplistic view generally.
Sorry to hear you're ill that long.
 

Enid

Senior Member
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3,309
Location
UK
I do hope he was considering his ideas on the edge - the trouble being his et al "ideas" seem to be part of medical training ( ? in the textbooks). Ten years ago collapsed in A & E three junior Docs finding nothing (if you can exclude passing out) decided en bloc on their idea - "It's all in your mind" and produced a psychiatrist. Their uneducated antics and intrusion into real illness is unforgiveable ........ a nightmare at the time - Iwas on the way to being very ill and bedbound.

I just wonder if there is any proof of a "psychosomatic" illness. Following the Norwegian findings we have proof of ME as a definite illness - can he/they produce evidence of their theories perhaps. !
 
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13,774
Thanks Esther12. SW didn't exactly disagree with Shorter's idea, did he, he just said it would be bad for business if it was explicitly stated.

Wessely is pretty honest about his dishonesty.

I'm not sure that he thought our mistreatment was for our own good makes him more or less loathsome. I do think that a lot of patients get it wrong in assuming that he was always just motivated by some corrupt desire for cash from insurance companies. I see him as someone who wanted to help (and to build his career) but was over-confident in his own assumptions about his patients and his ability to treat them, semi-realised he'd been somewhat in error, but couldn't really back down and then tried to justify his actions to himself by emphasising the importance of RCTs, and being 'evidence based' - despite the problems of using RCTs to judge social treatments, the lack of solid evidence one way or the other, the difficulty of measuring improvements accurately, etc, etc.

Who knows though? The role Unum have played in the reforms to UK disability benefits, and are now using them to market their own private policies, makes me think that I should probably believe any conspiracy theory I read about them. They clearly are evil shits.
 

Enid

Senior Member
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UK
Sounds good to me Esther - your reasoning as to what has/is going on here. I think it was Angela Kennedy who used the phrase "gods of the gaps" too.
 
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13,774
I really shouldn't speculate as to the motivations of others (CFS patients know how badly that can go)... maybe I'll just create my own hilarious character as a fictional satire, and have some fun with that instead.
 
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13,774
(I didn't think this warranted a new thread, so I'll just whack it in here):

Here's a nice, generous view of the psychological cause of troubles in CFS researchers: Pathological altruism.

Dr. Burton had admired his oncology colleague (now deceased), yet he also saw how the doctors zeal to heal could border on fanaticism, and how his determination to help his patients at all costs could perversely end up hurting them.

If youre supremely confident of your skills, and if youre certain that what youre doing is for the good of your patients, he said, it can be very difficult to know on your own when youre veering into dangerous territory.

http://www.nytimes.com/2011/10/04/science/04angier.html?pagewanted=all
 
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13,774
Some additional quotes from Shorter, from the article in the first post, which I thought I'd pull out:

Shorter:So, clinically
I think there probably is something of a consensus on what
is to be done, that is, to let the physician permit his or her
humanity to shine through in a systematic manipulation of
the doctor-patient relationship.

Shorter: No. The term psychosomatic disease does not
exist, because by definition psychosomatic illness is with-
out an organic basis. Disease, grosso modo, should be
reserved for conditions that do have an organic basis.

Shorter. This is a wonderful story because it illustrates
perfectly the cultural molding of the somatic experience.
You were being molded by the entire culture in the form of
this particular cardiac surgeon into the belief that you
would experience pain. A lesser man, perhaps, would have
given in to that kind of molding and, in fact, responded
appropriately in the way the culture anticipates. I think it is
a wonderful comment you did not respond appropriately.
You resisted this kind of cultural molding, but many don't.
This is one of the things we have talked about at this
syn~posium.

edit: PS - the Georg Klein guy they are talking with seems like a decent person. It really stands out, compared to the rest of them.
 
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13,774
Okay... another Shorter thing. I'm posting here, as am a bit knackered for more reading now:

Multiple chemical sensitivity: pseudodisease in historical perspective
by Edward Shorter7

Pseudodisease is usually the result of a trade-off between
medical supply and patient demand. Physicians, following
a false scientific trail, supply the diagnosis of a nonexistent
disease. Patients, demanding disease labels that
sound organic, seize the new diagnosis as the explanation
of their vague and nonspecific symptoms. Thus both
parties play a role in initiating the creation of a
pseudodisease2.
Momentum builds. The physician-advocates found
specialty journals and societies and give interviews to
the press, fostering a fringe medical culture. On the patients'
side, sufferers' support groups avidly insist they
have "a real disease that medicine does not recognize",
the apparent organicity of their complaints fortified by
the ardor of their belief. Both parties bravely play out
this psychodrama until the scientific evidence finally
becomes overwhelming that the pseudodisease does not
in fact exist, and only then do they move on to the next
pseudodisease.
In the last three decades we have seen this psychodrama
played out around hypoglycemia in the 1960s and
1970s, chronic fatigue syndrome and fibrositis in the
1980s, and repetition strain injury and sick building syndrome
in the 1990s. Yet, as the ardor for chronic fatigue
syndrome and fibrositis fades in the present decade, the
most popular pseudodisease to attract fringe physicians
and chronically somatizing patients is multiple chemical
sensitivity (MCS), also known as environmental illness
and 20th century disease. This
 

Enid

Senior Member
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Location
UK
Much enjoyed the word "psychodrama" Esther - couldn't have put it better.
 

Snow Leopard

Hibernating
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Location
South Australia
Shorter: No. The term psychosomatic disease does not
exist, because by definition psychosomatic illness is with-
out an organic basis. Disease, grosso modo, should be
reserved for conditions that do have an organic basis.

This is half true. The biopsychosocial illness model/concept invalidates all concepts of "non organic" and not just "psychosomatic disease" but also "psychosomatic illness". By stating that disease needs an organic basis to be considers real, he is reinforcing the medical-psychological duality that certain psychiatrists keep complaining about.

Or to put it another way, any model of illness which does not have comprehensive understanding of the underlying biology cannot be considered a biopsychosocial model, regardless of any hypocritical action of psychiatrists...
 

HowToEscape?

Senior Member
Messages
626
"and repetition strain injury and sick building syndrome
in the 1990s."

Huh?

Then how do workers at chicken processing plants and keyboard-intensive jobs still get RSI?
 

biophile

Places I'd rather be.
Messages
8,977
Shorter: The physician has a whole bag of psychological tricks for dealing with chronic psychosomatic illness, chronic somatization. It is very important not to legitimate these toxic diagnoses, and there is no doubt that multiple chemical sensitivity and chronic fatigue syndrome are toxic diagnoses, because they cause the patients to become fixated upon their symptoms and to dig in even further so that they acquire a sense of hopelessness.

If I had an earlier diagnosis instead of being told "nothing was wrong" and falling for the typical management psychobabble to attempt a normal life despite symptoms, I would have probably avoided a lot of suffering and disappointment and impairment. If memory serves me, even the psychobabbler CFS researchers are now seeing the importance of diagnosis and relative acceptance, only took them 20 years!

Shorter: Both parties bravely play out this psychodrama until the scientific evidence finally becomes overwhelming that the pseudodisease does not in fact exist, and only then do they move on to the next pseudodisease. In the last three decades we have seen this psychodrama played out around hypoglycemia in the 1960s and 1970s, chronic fatigue syndrome and fibrositis in the 1980s, and repetition strain injury and sick building syndrome in the 1990s. Yet, as the ardor for chronic fatigue syndrome and fibrositis fades in the present decade, the most popular pseudodisease to attract fringe physicians and chronically somatizing patients is multiple chemical sensitivity (MCS), also known as environmental illness and 20th century disease.

Is Shorter claiming that the scientific evidence has become so "overwhelming" that CFS is a "pseudodisease" and therefore being left behind? I know some ME advocates view CFS as a pseudo-diagnosis, but keep in mind that psychobabblers and CFS advocates alike usually include ME under CFS or whatever the condition intended to be captured under the CFS diagnosis.

[HowToEscape?] wrote: "and repetition strain injury and sick building syndrome in the 1990s." Huh? Then how do workers at chicken processing plants and keyboard-intensive jobs still get RSI?

I'm not sure if Shorter is arguing that RSI is either: (a) not an organic disease because it is mostly a functional disorder arising from inappropriate technique or overuse that resolves with rest and/or ergonomic management, (b) just another example of "somatization".

After a quick search I found this:

"More than two thirds of workers now suffer from repetitive strain injury, costing 300million in lost working hours, a new study has found. The research from Microsoft revealed cases soared by more than 30 per cent last year because more staff than ever work on the move. [...] As a result 68 per cent of workers suffered from aches and pains, with the most common symptoms including back ache, shoulder pain and pains in hands and wrists as a result of working whilst in transit in cramped or awkward positions. [...] He said: 'We are shocked that this research indicates that the number of office injuries is on the increase due to companies not taking the right actions in investing in their staff's well being.'" (http://www.dailymail.co.uk/health/a...ce-staff-suffer-Repetitive-Strain-Injury.html)

So symptoms of RSI are actually still very common and even on the rise?
 
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13,774
I got sent this recently, and have just had time to go back and re-read it. I thought I'd post it here as it relates to a Wessely paper from the above conference (which I can't remember having read) and may be of interest.

Late psychiatrist Per Dalén wrote the comment below in 2000 in the Swedish´ monthly journal for doctors.
Translated by google- sorry - but hope the message is clear. //

http://ltarkiv.lakartidningen.se/2000/temp/PC1168 (second comment)

"Dubious to make psychiatry of something you can not handle
...
I could have also cited the psychiatrist Simon Wessely [1], who spoke about chronic fatigue syndrome at the same symposium in Finland. He sees the apparent continuity with neurasthenia (1869), and he notes that the same phenomenon under new names came to the fore in the 1950s. Nothing speaks well to state at some time been missing since the 1860s, but Wessely does attract the conclusion that this is not just a twentieth-century disease, but that it also has somewhat sort of etiologic connection with the turns of a century. ...
Where are the medical substance in the talk of shifts of century and millennium?

Gentlemen's club perspective

The genre I would love to see buried depict unexplained human suffering from a superior gentleman's club perspective, with generalizations without significant empirical basis. Psychiatry is expected to help clean away "unauthorized" ideas that lay people have taken to heart. Wessely [1] notes that organizations of patients with chronic fatigue syndrome is strongly anti-psychiatry, which should not surprise anyone. The medicine has so far failed to practically solve the chronic fatigue problems. It is worrying that making psychiatry of somewhat one can not handle, and insulting to use a psychiatry negative attitude of the patient as evidence of his psychosomatic hypothesis, which often happens. With a little more empathy more doctors would understand how people naturally react when they feel sufficiently betrayed by the medication.
Per Dalén, M.D.
....
References 1. Wessely S. Chronic Fatigue Syndrome: a 20th century illness? Scand J Work Environ Health 1997; 23 Suppl 3: 17-34. "
 

Sean

Senior Member
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7,378
With a little more empathy more doctors would understand how people naturally react when they feel sufficiently betrayed...
It never ceases to amaze me that the very profession – psychiatry/psychology – that is supposed to understand these issues and the effects they have on people, are somehow so wilfully blind to their own role in imposing and exacerbating these exact same burdens.
 
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alex3619

Senior Member
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13,810
Location
Logan, Queensland, Australia
Shorter has been at it again recently. The thing about the psychogenic brigade is they are long on rhetoric, and short on evidence and reason. Fallacies lie at the core of most of their arguments, but those arguments strongly pull at popular notions including unfounded notions in the medical profession.
 

Helen

Senior Member
Messages
2,243
I got sent this recently, and have just had time to go back and re-read it. I thought I'd post it here as it relates to a Wessely paper from the above conference (which I can't remember having read) and may be of interest.

Late psychiatrist Per Dalén wrote the comment below in 2000 in the Swedish´ monthly journal for doctors.
Translated by google- sorry - but hope the message is clear. //

http://ltarkiv.lakartidningen.se/2000/temp/PC1168 (second comment)

"Dubious to make psychiatry of something you can not handle
...
I could have also cited the psychiatrist Simon Wessely [1], who spoke about chronic fatigue syndrome at the same symposium in Finland. He sees the apparent continuity with neurasthenia (1869), and he notes that the same phenomenon under new names came to the fore in the 1950s. Nothing speaks well to state at some time been missing since the 1860s, but Wessely does attract the conclusion that this is not just a twentieth-century disease, but that it also has somewhat sort of etiologic connection with the turns of a century. ...
Where are the medical substance in the talk of shifts of century and millennium?

Gentlemen's club perspective

The genre I would love to see buried depict unexplained human suffering from a superior gentleman's club perspective, with generalizations without significant empirical basis. Psychiatry is expected to help clean away "unauthorized" ideas that lay people have taken to heart. Wessely [1] notes that organizations of patients with chronic fatigue syndrome is strongly anti-psychiatry, which should not surprise anyone. The medicine has so far failed to practically solve the chronic fatigue problems. It is worrying that making psychiatry of somewhat one can not handle, and insulting to use a psychiatry negative attitude of the patient as evidence of his psychosomatic hypothesis, which often happens. With a little more empathy more doctors would understand how people naturally react when they feel sufficiently betrayed by the medication.
Per Dalén, M.D.
....
References 1. Wessely S. Chronic Fatigue Syndrome: a 20th century illness? Scand J Work Environ Health 1997; 23 Suppl 3: 17-34. "

Thanks Esther12 for posting this. I think Dr. Dalén had some very good points and undoubtedly he supported PWME.