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

Discussion in 'Latest ME/CFS Research' started by Esther12, Nov 2, 2011.

  1. Esther12

    Esther12 Senior Member

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    [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.)


    http://webcache.googleusercontent.com/search?q=cache:3mEMvlQcFaEJ:www.sjweh.fi/download.php?abstract_id%3D252%26file_nro%3D1+&hl=en

    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".
    Last edited: Mar 3, 2014
  2. Dolphin

    Dolphin Senior Member

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    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.
  3. Enid

    Enid Senior Member

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    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. !
  4. Esther12

    Esther12 Senior Member

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    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.
  5. Enid

    Enid Senior Member

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    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.
  6. Esther12

    Esther12 Senior Member

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    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.
  7. Esther12

    Esther12 Senior Member

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    (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.

    http://www.nytimes.com/2011/10/04/science/04angier.html?pagewanted=all
    Dolphin likes this.
  8. Esther12

    Esther12 Senior Member

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    Some additional quotes from Shorter, from the article in the first post, which I thought I'd pull out:

    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.
  9. Esther12

    Esther12 Senior Member

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    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

    Enid likes this.
  10. Enid

    Enid Senior Member

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    Much enjoyed the word "psychodrama" Esther - couldn't have put it better.
  11. Snow Leopard

    Snow Leopard Senior Member

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    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...
  12. HowToEscape?

    HowToEscape? Senior Member

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    "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?
  13. biophile

    biophile Places I'd rather be.

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    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!

    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.

    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:

    So symptoms of RSI are actually still very common and even on the rise?
  14. Sean

    Sean Senior Member

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    Shorter is beyond all hope.

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