Edward Shorter reviews SO'S book It's All in your Head

[parabola]

I need to contact the BMJ blog team - for them to allow this person speak of patients' families as worse than Himmler and at the same time block comments is beyond the pale - I will make a stand here on this topic as its plainly wrong - unless they are happy to denegrate patients and their families as worse than Nazi's

Or don't forewarn them, and start a petition on change.org or the like, and see if they will make it one of their featured campaigns (goes out in emails). It's a disgrace!

 

[duncan]

Here's my old writer-past-his-prime take on the tone (vs content): Crudely hyperbolic; community college grade essay penned by a tortured soul with a big chip on his shoulder - brings to mind a spurned suitor armed with a thesaurus and a desperate need to impress.

Where have all the professionals gone...?

 

[Sasha]

http://blogs.bmj.com/medical-humani...ze-winner-2016-its-all-in-your-head-reviewed/

Prof Shorter claims ME/CFS families are worse than Himmler commenting on how Dr OSullivan puts up with patients families

I've just skimmed this and I'm not concentrating well at the moment but it doesn't seem to me that Prof. Shorter is talking about the families of ME/CFS patients in particular - his remark seems to be referring to families of psychosomatic patients in general.

My apologies if I've misread it - but, especially if people are talking about petitions, it's best to be clear on the issue.

Here's the immediately preceding context (ME/CFS is dealt with earlier):

“Shahina” comes in with a contracture of the fingers of one hand. Another consultant recommends a botulinum injection. Bingo! The contracture releases instantly. Shahina is cured! Now, usually you take your therapeutic victories where you can get them. But O’Sullivan presses on. She tells Shahina that normally the botulinum works only after a day or two. “The speed at which your hand responded to the toxin makes me wonder if there is a chance that the spasm in your hand might have had a psychological rather than a physical cause.”

Shahina responds, “You think I’m mad?” No, of course not but…

This is actually a model of what not to do: throw patients into confusion with the relentless urge to enlighten them about their supposed psychological problems.

For other patients, as I have argued above, the psychiatrist is held out as the solution of choice. This is a problematic idea, and it is dismaying to see it propagated so vehemently in these pages. Psychiatrists tend to be baffled by such referrals. “This is a patient whose chief complaint is chest pain? C’mon!”

The general internist, the rheumatologist, or another neurologist should be the physicians of reference, because only they are able to build the necessary therapeutic alliance, to keep the myth of organicity semi-intact. It is this myth that patients require to retain their self-respect, while the real therapy takes places in the context of the doctor-patient relationship. What actually works is spending a lot of time with these patients and letting them tell and, if necessary, retell their stories. This is cathartic. But it is advice that is most unwelcome to many clinicians because it takes so much time.

It is not really fair for me to second-guess Dr O’Sullivan from the comfort of my armchair thousands of miles away. Physicians on the front line of medicine, at Queen’s Square and elsewhere, have to cope as best they can – and with relatives that make Himmler seem like Santa Claus. (O’Sullivan’s patience in dealing with these furies is remarkable.)

 

[jodie100]

It's a ridiculous article but I think it is best answered in a non-emotional way with solid facts rather than any further Nazi references.

 

[me/cfs 27931]

Godwin's Law in action.

https://en.m.wikipedia.org/wiki/Godwin's_law

 

[Esther12]

Godwin's Law in action. A guilt by association fallacy.

https://en.m.wikipedia.org/wiki/Godwin's_law

Isn't Godwin's Law itself a guilt by association fallacy? There must be times when a comparison with the Nazis is appropriate, and just because this is often misused by others doesn't mean that we should condemn all instances of its use.

 

[alex3619]

Isn't Godwin's Law itself a guilt by association fallacy? There must be times when a comparison with the Nazis is appropriate, and just because this is often misused by others doesn't mean that we should condemn all instances of its use.

Godwin's Law is indeed a fallacy, and not a law at all in any sense.

 

[Keith Geraghty]

Sasha

he said patients families - that Dr OSullivan has had to deal with - which includes ME/CFS families by virtue of the fact she included them in her book with a whole chapter - I doubt he was refering to patients with IBS and their families, so if not ME/CFS families - who?

My reference to them being Nazi's was an ironic example of how not to use such analogies - I finish by saying I do not want to use such references for patients, but nor should Shorter be allowed to use them for patients or their families

-

 

[Sasha]

he said patients families - that Dr OSullivan has had to deal with - which includes ME/CFS families by virtue of the fact she included them in her book with a whole chapter

Hi Keith - I agree that ME/CFS patients' families would be included.

- I doubt he was referring to patients with IBS and their families, so if not ME/CFS families - who?

It seemed to me that he was referring to the families of patients with any of the diseases that she covered, so if she covered IBS then it would seem that yes, perhaps he was also referring to the families of IBS patients.

I'm just a bit concerned that if people write to the BMJ asking why Short was singling out the families of PWME, they might (justifiably?) reply that he wasn't.

My reference to them being Nazi's was an ironic example of how not to use such analogies - I finish by saying I do not want to use such references for patients, but nor should Shorter be allowed to use them for patients or their families

I agree that his remark is inappropriate no matter which patients' families he's talking about.

 

[Justin30]

This was a dispicable act these comments....

 

[Large Donner]

You can’t prove that someone is not fatigued, or not in pain. But you can prove that they don’t have multiple sclerosis or another upper motor neuron lesion. So malingerers choose symptoms that can’t be disproven.

So how many of us went online whilst healthy searching for "non MS or another upper motor lesion conditions", to claim to have so that we could safely commence our malingering.

We all did it, right?

Also just by chance we all went down with a virus that has no connection to the ongoing condition just before cooking up this scheme purely to carry out the cunning plan to live as an easy to detect malingerer?

are appropriate symptoms. (And the culture has largely ceased to sanction “paralysis” as a convincing symptom – too easy to disprove with a negative Babinski.)

I think he is proving a negative intelligence.

 

[alex3619]

We all did it, right?

[Satirical] Well, yeah. First I invented a time machine, went forward in time several decades till after the www was around, looked it up, and went back in time. Dammit, I forgot to bet on a sure thing. I guess I will have to do it again if I want to be rich. [End Satire]

What I observe is that we get sick, disbelieve it ourselves if its not severe, then find, many years later, that we have similar symptoms to millions of other patients. Then there are the cluster outbreaks. If we could orchestrate this kind of thing, on this scale, based on having symptoms that are undetectable (and NONE of the major symptoms cannot be physically verified) then we would be super-geniuses.

Argument out of ignorance does not serve society.

 

[GreyOwl]

Coyne's tweet and @duncan's comment earlier in the thread seem to suggest another interpretation? That Shorter was attacking the book? Is there another interpretation I'm missing, or am I just confused?

 

[Skippa]

Any Jewish patients feel like accusing him of anti-semitism? Make them squirm a bit...

 

[aaron_c]

I can see this being a decent soundbite for the next time we warrant attention from the news media. You know, "An article from the British Medical Journal compared patient advocates to Nazis."

I would bet that pretty much every group with an opinion has been compared to Nazis somewhere on the internet. But how many have been called Nazis in one of the oldest medical journals in the world? It's hard to think of a better one-sentence illustration of the ridiculous institutional bias we face.

So thank you Edward Shorter, and thank you BMJ.

Edit: I just read the whole review (ya, should have done that before) and...eh. I see that it is harder to use this as an example given that he was offending so many groups at once. On the other hand someone should take offense and we have as good a claim as any group.

 

[chipmunk1]

At the bottom of the page there are some links to other recommended articles, this one for example:

The Most Influential Physicians in History, Part 4: The Top Ten

http://www.medscape.com/features/sl...ans-part-4?src=trendmd_pilot&trendmd-shared=1

The top 10 includes Charcot and Freud. No wonder that some parts of medicine are in such a poor state.

 

[Keith Geraghty]

I agree - its a very clear attempt to denegrate patients and their families and it should be remembered and publicised as an example of the discourse and hermeutic attacks on patients with medically unexplained symptoms

 

[JayS]

Any Jewish patients feel like accusing him of anti-semitism? Make them squirm a bit...

In this context I think it'd be a bit of a reach. I'm not much for that particular type of finger-pointing unless it's pretty darned blatant, and while he's downright offensive about ME, this is just really poorly chosen hyperbole.

 

[duncan]

Coyne's tweet and @duncan's comment earlier in the thread seem to suggest another interpretation? That Shorter was attacking the book? Is there another interpretation I'm missing, or am I just confused?

I hope my comments did not suggest another interpretation. Shorter's observations about us clearly seem incendiary, and are egregious on several levels.

It is just that he also appears willing to highlight shortcomings in O'Sullivan's book. I find myself oddly okay with that part.

 

[GreyOwl]

See, I missed that. Now I'm going to have to read it again