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Is tolerance to psychobabble the biggest issue in medicine today?

Discussion in 'Action Alerts and Advocacy' started by alex3619, Aug 31, 2014.

  1. alex3619

    alex3619 Senior Member

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    Psychobabble is psychiatry that is not adequately founded in evidence or reason, and frequently has circular and defensive secondary hypotheses making it intractable to scientific inquiry. Its more about rhetoric than reason, and more about claims than evidence.

    I don't want to say much right now, not the least because my internet is unstable, but in another thread I raised the question that tolerance to psychobabble might be the biggest issue in medicine.

    Most of psychogenic medicine, as well as much of the biopsychosocial (BPS) school of thought, is probably psychobabble.

    Doctors and scientists, as well as government agencies and ministers, routinely ignore these issues. Yet there are scientists, psychiatrists and academics who do speak out against it. I am also aware of both scientists and doctors who privately are against psychobabble, yet publicly I don't hear a squeak.

    I have a lot of my own ideas about what is wrong. This thread however is to canvas as wide a variety of issues as possible. Please post your ideas, especially if you can think of a way to begin to fix this.

    We need mainstream doctors, scientists and bureaucrats to take a stand. We need evidence favoured over claims, and reason favoured over rhetoric. Mostly however we need to break the culture of acceptance by silence. This whole issue is mired in dogma, it discredits the entire medical profession, and its evidence that we never left the Age of Mythology.

    What can advocacy do? What should be our goals? How do we raise awareness of these issues? How do we support the scientists, doctors and especially psychiatrists to speak out?

    This is based both on the history of my investigations, plus this thread: http://forums.phoenixrising.me/inde...arch-collaborative-uk-cmrc-tymes-trust.32302/
     
    Last edited: Aug 31, 2014
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  2. BadBadBear

    BadBadBear Senior Member

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    I think tolerance to psychobabble is a huge issue.

    IME, if you go to the doctor and say you are tired, all they will do is attribute the condition to "stress". And then the RX is antidepressants and/or graded exercise and/or CBT. It took forever for my spouse to get DX'd with celiac because he had stomach aches, which the doctor simply called "stress". It was celiac disease, for crying out loud!! He didn't need to talk to someone!! If they can't diagnose celiac disease, how will they ever be able to diagnose something as complex as CFS/ME??

    I have noooo idea what to do about it, other than seeking out alternative health care providers. For me, the question in the US, is why can't I use my insurance $$ for alternative care practitioners?

    Until the flow of money changes, I can't see the system becoming less corrupt or any less entrenched in it's own ignorance.

    I am looking forward to reading the ideas that others will have.
     
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  3. Snowdrop

    Snowdrop Rebel without a biscuit

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    I'm definitely not at my best at the moment but I do want to comment, constructively I hope, and say that although we are looking at this a a science issue I see it in a wider context. Science is practiced by people and the problem of pyschobabble I think belongs to a broader human social context. I believe the concepts that would help understand the persistence of BPS (at least in part) have to do with empathy, and blame.

    Maybe this doesn't seem related and I hope I can be clear. I think unless someone is a genuine psychopath that they will have empathy but that empathy can turn cruel when the empathy becomes too difficult for a person to cope with. This can and does at times produce a culture of blame toward the sufferer (I don't like the word victim).

    As someone with ME I feel a lot of kinship with other groups of people who also suffer the same kind of abuse and neglect because they are vulnerable. The BPS school is but one manifestation of this difficulty on the part of the non sufferer to deal with a large intractable problem of suffering. Another is the 'head in the sand' approach, "I see nothing'.

    I don't at all claim that this is the whole picture or even the biggest part. Just a likely overlooked aspect. Much of the problem is institutional as you have pointed out Alex.

    So to recap, empathy fatigue = blame the sufferer (generally by saying it's all in your head/psychological stress)

    I vaguely recall reading there have been studies done to this effect. Emphasis on vaguely. :rolleyes:
     
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  4. heapsreal

    heapsreal iherb 10% discount code OPA989,

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    Psychobabble is the basket one is put in when it's too hard to work out. Then the witch doctors are allowed free rane to use their Psychobabble treatments.
     
  5. Aileen

    Aileen Senior Member

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    That is because it is useful to them. Dr. has a patient he doesn't know what to do with. So instead of trying harder to figure out the problem or treatment, he refers the patient to a psychiatrist.

    The Dr. gets rid of the problem but at the same time looks like he is actually doing something. He knows that it isn't "stress" or other nonsense and that the psych can't do anything for the patient but it relieves the Dr. of his problem.

    The only way these people will be motivated to change is if there is a negative consequence to them if the status quo continues. We need to get people to say "no" to being pushed off on the psychs for no good reason.

    In countries with taxpayer-funded health care, people need to start complaining to their members of parliament when the Dr. isn't earning his money. The problem is that patients need to take more responsibility for themselves and most don't want to. That is really the underlying problem, I believe.
     
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  6. halcyon

    halcyon Senior Member

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    I think it's human nature to be skeptical. When you go to a doctor with an obvious, visible illness it's hard for them to be skeptical of your illness. When you go a doctor with ME/CFS symptoms, a lot of which are invisible or require extensive testing to uncover, it's very easy for the doctor to be skeptical. It requires extensive workup and countless tests to prove to them you are not well, and that requires far more work than a lot of doctors are willing to do, as heaps mentioned.

    I don't know when medicine became so preoccupied with "stress" as a cause of illness, but it has become an easy out for doctors unwilling to go through the effort of workup on a complex illness. It's a horrible meme that's perpetuated by doctors and regular people alike, it's extremely unscientific, and it needs to stop.

    One thing we can do as patients is to not accept psychobabble as an answer from doctors. I know this is difficult because it requires you as the patient to know more than you should have to know but it's the only way to not get pushed around.

    I'm not sure that there's much else we can do but wait. As medical science advances it will elucidate the true nature of illnesses and slowly leave the pseudoscience and dogma behind.
     
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  7. heapsreal

    heapsreal iherb 10% discount code OPA989,

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    I don't think it's a matter of the doctor not working hard enough for us, it's just that there is a lot of things that don't have an answer.

    Things like antidepressants make one feel better about feeling like shit I guess for some, and doctors will then just treat symptomatically.

    I guess there needs to be an Avenue for doctors to push patients towards a researcher.

    I guess it sux to have an illness that doctors can't treat and research is in its infancy.

    Psychobabble i guess tries to give us some sort of answer when there really is no answer????
     
  8. barbc56

    barbc56 Senior Member

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    I disagree with this. IMHO, we need treatments that reflect science based medicine. The conventional medical community certainly doesn'the have all the answers but neither does alternative medicine. Probably less .

    Barb
     
  9. Sasha

    Sasha Fine, thank you

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    I think that to be effective, advocacy against a poor scientific position has to come from other scientists.

    The problem with advocacy by patients on this issue is that we're tarred with the brush of having psychosomatic conditions and that undermines our credibility. We've got a vested interest in one position - we're clearly not neutral in anyone's eyes. (I'm not saying that scientists are neutral or don't have vested interests: I'm just talking about how most people are going to view things). Scientists listen to other scientists.

    It's great that there are scientists who are tackling this issue and it would be greater if more "came out" about it. We need those scientists networking and building a public position, much like our biomedical scientists are now doing.

    Question is, what can we do to help them do that? What is it, specifically, that we'd like them to do?

    Personally, I think a conference would be a first great step. That's something that the scientists have got to want to set up for themselves, unless anyone has the energy to help do that - of course IiME are basically patients and supporters who managed to get a great conference going, but it may be better if scientists set up their own conference so that they're seen as impartial.

    If I were an anti-psychogenic scientist, one of the things that would most likely get me interested in setting up a conference would be a reasoned but heartfelt plea from scientists who themselves had fallen sick and were suffering from the BPS model. Another (perhaps even better) would be an approach from someone like Dr Nigel Speight (that guy's a hero) who fights for children with ME who have been taken from their parents because of a false belief that their illness is psychogenic and that their parents are enabling/Munchausenning.
     
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  10. Sasha

    Sasha Fine, thank you

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    @alex3619 - I think you mentioned James Coyne and someone else on another thread. Is there already a substantial number of scientists who have publicy come out against the pyschogenic position? Do you know who they are? Have they already formed some sort of group?
     
  11. barbc56

    barbc56 Senior Member

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    I think we need to emphasize the importance of critical thinking skills in general and how to use these skills to counter many beliefs from psychobabble in general and behaviorism specifically as it only looks at outward manifestation of behavior and discounts things like motivation and why a behavior occurs.

    Hope this makes sense. I could write a book on the deficiencies of behaviorism but too tired tonight and will try try to write tomorrow.

    Barb
     
    Last edited: Sep 1, 2014
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  12. alex3619

    alex3619 Senior Member

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  13. alex3619

    alex3619 Senior Member

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    I have not even talked to many of these, they are from mainstream psych mostly, not here. I have a list of books written on this, somewhere. Most of the people who stand up and decry this are psychs who had a good hard look at what actually happens and could not believe it. Allen Frances, who has campaigned against DSM-V, is one of these, though he did oversee DSM-IV.
     
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  14. barbc56

    barbc56 Senior Member

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  15. alex3619

    alex3619 Senior Member

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    This is a big part of it I think. For some reason most people, including doctors, are happy with a possible answer even if its a really bad one. They are afraid of saying "I don't know". I think this is a huge part of the issue. My book is tentatively titled "Embracing Uncertainty". "I don't know" needs to be in every doctor's vocabulary of phrases/lexicon.
     
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  16. alex3619

    alex3619 Senior Member

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    Doctors are usually not taught critical thinking. They are taught thinking procedures that often work, and are fast .... and based on heuristics. When you consider that 80-97% of professionals who need to understand statistics fail a basic test in the US, including doctors and economists, you realize that the problems are systemic. I may blog on this soon, if I am up to blogging some time.

    Doctors are taught to make educated guesses for the most part. This substitutes for reason and evidence. Its supposed to be based on reason and evidence, but I see this lack far too often. That is a huge problem with evidence based medicine. You cannot practice it unless you have the skills. When most doctors tell me that something is evidence based, what they usually mean is they read someone else claiming its evidence based, or read reviews making this claim etc. Few actually go to the research and do the hard work. This is a problem.

    Behaviourism had huge problems, but so does every other school of psych. We only ever guess at motivations, nearly all this stuff is unproven theory. Too much of psych is subjective. Modern behaviorism research is more empirical, but does not make the overblown claims of the past, or at least not as much.

    One issue I have with behaviour modification though is you really need to understand the behaviour and its impact, not just have a theory, before you try to change it.
     
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  17. alex3619

    alex3619 Senior Member

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    https://www.facebook.com/councilevidence

    This might be of interest for some. Its about the council of evidence based psychiatry. Like EBM in general, and even BPS, the idea is laudable, but what counts is the actual implementation. EBM and BPS are failing us.
     
  18. Keela Too

    Keela Too Sally Burch

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    There is another thing I wonder about - our love of the mystic in fiction.

    Now I'm a scientist, but we all love a good film or story where the hero/heroine just "knows" by their amazing intuition exactly what to do next in order to save the day.

    So in stories we tolerate and admire the person who seems to have supernatural powers of intuition. Take any of the Agatha Christie novels, and crimes are solved by getting into the mind of the criminal.

    Look also at how we love taking quizzes to gain insight into ourselves - there is a rash of them on FB currently. They are obviously meaningless, but when the say something nice, we all love to say how true they are . . .

    The psychiatrist rides piggyback on this. He looks at us and "knows" what is going on inside. And because we are conditioned by fiction to admire the mystic, so we think he may be right. Just one or two truths smattered in there, and we accept the rest.

    And other stories of old, take The Secret Garden, and so on, all imply that people are all to willing to take to their beds for no reason, and to recover when suitable motivation is given.

    It all builds a climate in which psychiatric psychobabble can flourish.

    Well that's one thought - there are other perpetuating factors of course. ;)
     
  19. alex3619

    alex3619 Senior Member

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    Storytelling has been mentioned twice by public figures as a factor recently to my knowledge. I don't think it can be ignored. We like stories, and psychobabblers tell good ones.

    I have a lot to say about intuition. It is provably severely fallible, but our intuition says otherwise. Ooops. Funny enough much of this research comes from modern behaviourist research. I think intuition underpins reason, and its why two reasonable people with different intuitive understanding cannot agree. Its not the reasoning that is at fault, its that reason is based on intuition, and intuition is associational. Reason is just a tool. I may blog on this.
     
  20. alex3619

    alex3619 Senior Member

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    Yes, but what if that takes a century? Two? How many will die or be harmed? Do we have time to wait? Science is not automatically self correcting, it corrects because someone asks hard questions and does the research. How do we make that happen faster?
     
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