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"Medically Unexplained Symptoms, Somatisation and Bodily Distress"

Discussion in 'General ME/CFS News' started by ixchelkali, Aug 13, 2011.

  1. ixchelkali

    ixchelkali Senior Member

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    Brace yourselves. Sept 30th is the release date for the new textbook "Medically Unexplained Symptoms, Somatisation and Bodily Distress: Developing Better Clinical Services," edited by Francis Creed, Peter Henningsen, and Per Fink. There are chapters by our old pal Peter White, and lots of references to papers authored by Simon Wessely.

    Chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome get full play.


    A preview of the book is available at Amazon, by clicking on the cover, where it says "Click to look inside". Then you can do a search for chronic fatigue syndrome, if you like.
    http://www.amazon.com/Medically-Unexplained-Symptoms-Somatisation-Distress/dp/0521762235/ref=sr_1_1?s=books&ie=UTF8&qid=1313281276&sr=1-1#_

    Just think, we can look forward to a whole new generation of students learning that these illnesses are somataform disorders.

    And I suppose that means they can justify cutting "illness-related financial benefits" as therapeutic. It doesn't seem to occur to them that the more seriously ill might be more apt to be receiving disability benefits.

    Oye. I can hardly wait for the book reviews. The BBC should have a field day.
    Xandoff likes this.
  2. Dolphin

    Dolphin Senior Member

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    Thanks ixchelkali.
    I'm not an expert on Francis Creed but he's one of the psychologists/psychiatrists who has got a grant from the Medical Research Council (MRC) in the UK before:
  3. pamb

    pamb Senior Member

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    I feel like the vulture in the cartoon, thinking 'patience, patience'. When the various research going on to the physical side of ME finally reached critical mass, it will be a pleasure watch the response from these guys.

    We've just moved from France (all to close to England) back to Canada. In France the official line was somatization and all John's doc's would do was give him benzodiazapines for anxiety and narcotics for pain. Actually the subatex was good, but here they have put him on suboxone - related, but better for ME patients. The somatization people would have just kept him doped up so he was no trouble, until he died or killed himself. Lovely.
  4. Enid

    Enid Senior Member

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    Gosh these people bore don't they - completely out of touch with real medicine - forever building the imaginary - as another member described "gods of the gaps".

    Having been told when very ill by a psychiatrist "you are imagining it all" - fair comment to apply to them ! (no ME diagnosis and only eventually accepted by my GP through my own "research".).
  5. Firestormm

    Firestormm Senior Member

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    When my consultant - Professor of Clinical Immunology no less and NHS - told me that there is no 'magic bullet' it was a massive relief to hear after 10 years of 'boom and bust' and pushing myself unrealistically.

    It was hardly a case of me possessing a 'belief that would not improve, [my] failure to attribute the symptoms to a psychological cause [or] the receipt of illness-related financial benefits.'

    I have always undertaken 'psychological' interventions and have never been in receipt of 'illness-related' benefits. Following a confirmed viral infection of significant duration, I was diagnosed with viral encephalitis, was then merged into the myalgic encephalomyelits 'pot', then endured the change to the chronic fatigue syndrome, then epilepsy diagnosed in addition following unconsciousness and observed seizures (still validated), and now in the past few years - myalgic encephalopathy.

    This patient has never diagnosed himself. Doctors diagnose. And my many, many, doctors over the years have never attributed a psychological cause - ever. Not that I would have had a problem with it if they had - only ever wanted to get better or better manage my condition. Psychological interventions have helped at times and when called for in respect of the latter as they do with many other chronic conditions.

    Generalisations help nobody. I am not bitter - not anymore - and would like to read this 'book' when it is published.
  6. SilverbladeTE

    SilverbladeTE Senior Member

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    Somewhere near Glasgow, Scotland
    Since Irritable Bowel Syndrome has been proven to have a physical cause, and treatable, these people should be sued or prosecuted for quackery, fraud, bigotry (laws vary greatly across countries, but refusing to treat a patient based on bigotry is usually a serious crime), Grievous Bodily Harm, False Imprisonment, and perhaps even attempted murder or negligent homicide.

    And I'm not joking.
    Physicians refusing to treat people because of bigotry, and worse, encouraging other physicians to do the same, is a heinous act and usually one liable to criminal charges and certianly losing their medical licences.
    There is nothing of science in these assclowns' garbage.
    This garbage they spew is like saying "Oh, these illnesses are all made up in their heads because they are Black, Jews, Women or other untermensch"...which would normally get a doctor jumped on from a VERY high height by the legal authorities.

    And since M.E. *IS* a lethal disease, as I'm sure any competant lawyer in England could argue based on Sophia Mirza's death certificate, then, yes, they are contributing to the unecessary death and suffering of patients.
    Their own, written, published words will hang them one day (*), they should all face tiral in the Hague for Crimes Against Humanity, see the Doctor's Trial, Nuremberg, 1946 and subsequent accords on medical ethics.

    (*) not a death threat, though in some nations it could be the legal punishment handed down by a judge and jury for their actions.
  7. Esther12

    Esther12 Senior Member

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    I love this one.

    It has been shown that a failure to attribute symptoms to cancer predicts a poor response to chemotherapy.
    It has been shown that a failure to attribute symptoms to HIV predicts a poor response to ARVs.
    It has been shown that a failure to attribute symptoms to an allergy predicts a poor response to antihistamines.
    It has been shown that a failure to attribute symptoms to psychological causes predicts a poor response to psychological treatments.

    What a surprise!!

    Maybe, if we encourage all CFS patients to believe their symptoms are psychological in origin, that will make it so, and allow psychological treatments to be more effective!!
  8. biophile

    biophile Places I'd rather be.

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    Statistics over spin

    I'm not saying these supposed perpetuating factors in FSSs don't or can't exist, but they depend too much on arbitrary interpretations on behalf of psychiatrists etc. Above it claims these are all recognized in the context of "consequences" but I wouldn't be surprised if it lacks the context of "correlation does not equal causation". Patients who are suffering and impaired due to symptoms are naturally going to "worry about having a serious illness" and at what degree the worry becomes maladaptive is an opinion, hypervigilance and catastrophizing are again largely interpretations about what "should" be happening, and belief in a physical cause may correlate with the experience of patients with a undetected physical etiology within the heterogeneous ocean of MUPS.

    This sounds like it comes from Sharpe et al 2010:

    So for context, note that despite an odds ratio of about 2 (relatively "small") for each individual factor, all these factors combined only explained 13% of the variance in outcome over 1 year.

    They may argue that baseline characteristics such as symptoms and severity are essentially the same between groups. However MUPS is the ultimate wastebasket category and the lesson from "CFS" is that the symptoms are similar enough to a range of medical and psychiatric conditions that the presence and severity of vague symptom descriptions alone is not enough to distinguish which type of condition underlies them. MUPS is supposedly not adequately explained by current knowledge of medical and psychiatric conditions but it is still a mixed pot, and sometimes a dumping ground for incompetent or lazy physicians.

    Like many of these supposed psychosocial factors, "receiving disability benefits" doesn't tell us much without knowing more about the underlying condition, because it may indicate either a perpetuating factor in people that could rehabilitate (as the authors apparently presume) or a survival requirement for people with an underlying condition that does not respond to rehabilitation or spontaneously improve.
  9. In Vitro Infidelium

    In Vitro Infidelium Guest

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    12 months defines the effective cut off point of many employment based provisions - sick leave and an entitlement to return to work, and the correlated out of work State Benefit - so there are strong predisposing factors for why chronically ill patients will have a higher dependance upon disability benefits. The conclusion by the authors appears circular, effectively it says "Illness beliefs and [STRIKE]financial benefits [/STRIKE] being ill for over year are more useful in predicting [STRIKE]poor outcome[/STRIKE] being ill for over year than the number of symptoms, disability and distress."

    IVI
  10. Snow Leopard

    Snow Leopard Senior Member

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    Agreed. You wonder why they don't realise that it is a tautology..
    Xandoff likes this.
  11. Mark

    Mark Acting CEO

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    It beggars belief to try to imagine that the authors do not fully understand the nature of their reasoning here. Any intelligent person must surely question the integrity of the authors in the face of examples such as this - and this sort of reasoning is quite typical - because their primary motivation to manage the financial costs, rather than to care for patients, is clear for all to see. This is clear from their own reasoning, even before their links to the insurance industry are explored.
  12. alex3619

    alex3619 Senior Member

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  13. In Vitro Infidelium

    In Vitro Infidelium Guest

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    One can invoke motivations on the part of any researcher, but malign intent isn't usually necessary to explain failures of logic. In this case the researchers have chosen a measure (the award of Incapacity Benefit and/or DLA) by which to categorise participants in a study - as the study doesn't explore the process of awarding benefit, nor is any reference given for authority of the validity of the measure, it's reasonable to consider that the authors are ignorant of the implications that adopting the measure had for their study. This is rather typical of studies that cross boundaries of expertise - in this case psychiatry and sociology, where the researchers, content with their expertise in one field, assume competence in another field without seeking critique from anyone appropriately qualified in that second field. Peer review fails because it is applied only to the primary content of the paper. And for the authors, confirmation bias inhibits any self criticism, obfuscating what are to anyone on the outside, rather obvious failings.

    This particular study is doubly affected by confirmation bias because the core evidence (report of neurologist) is based on the validation by the diagnosing neurologist of his/her own pre given diagnosis; the only way of controlling for this core bias would have been to have blinded assessment of the study participants by an independent neurologist, and by a sociologist. The former to control for diagnositic error and negative physician/patient relationships, and the latter to carry out sociological assessment to ensure control for confounding social biases operative within both the diagnostic and research processes. Claim of disability benefits as a study measure is not comparable to basic demographic measures such as age, gender race and its inclusion in a study necessarily requires controls beyond those normally sufficientwhere basic demographic measures are used. Even in terms of the basic demographic measure of age this study has an obvious failing - the reported age exclusion was <16, yet Incapacity Benefit is not payable post retirement age (Female 60, Male 65) and would not anyway be claimable by anyone taking early retirement on health grounds whose Private Pension exceeded the qualifying income to claim benefit, or who held cash resources above a certain level. The authors could argue that to have controlled on an upper age limit would have actually reinforced their conclusion, however the matter of age would also have needed to be controlled for given that actual or interpreted age related neurological impairments may attract more sympathetic diagnosis than the presentation of similar symptoms in younger patients.

    IVI
  14. Esther12

    Esther12 Senior Member

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    I always cringe when I hear researchers talking about how sophisticated the biopsychosocial approach to illness is compared to the crude reductionism of old biomedical approaches.

    They really don't seem to realise just how challenging such an expansive model is to get right, how easily it can go wrong and harm patients, and how ignorant they are of so many important variables. I want my doctors to take a reductionist approach - it leaves less room for their personal prejudices to screw me over.
  15. alex3619

    alex3619 Senior Member

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    Hi Esther, as I see it the biopsychosocial model is inherently reductionist - they claim to an expansive multidimensional model, but in practice this appears to be achieved by ignoring nearly all of the data and only using data within very strict limits. Its reductionist, but claiming to be non-reductionist. To put it another way, their rhetoric is anti-reductionist, but their methods are a very biased form of reductionism. Bye, Alex
  16. eric_s

    eric_s Senior Member

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    In Switzerland, just as an example, an ME/CFS diagnosis will get you nothing, in almost all cases. I won't even bother with this drivel. It's time for these people's medically unexplained disappearance from the stage.
  17. eric_s

    eric_s Senior Member

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    Just to say, that was not a threat to their physical integrity, only to everything else, as far as the law allows :angel:
  18. Esther12

    Esther12 Senior Member

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    I wasn't very clear, but I agree. I had adopted their terminology for some of my post, but not all. I probably wasn't clear about the sort of reductionism I wanted either... what a mess of a post!
  19. In Vitro Infidelium

    In Vitro Infidelium Guest

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    The inherent problem with the model is that 'social', however one approaches it, is an artefact of perspective, and when BPS was first proposed it was in the context of an unspoken assumption that the operative social reference (the 'correct' reference) was standard North American WASP Although there have been some critical approaches in psychology which have challenge the lack of multiple perspectives (Racializing Mental Illness) , BPS is most frequently presented in terms of the expert interpretion of what is the correct 'biology', the correct 'psychology' and the correct 'sociology' - the expert acting as empowered arbiter of what is 'correct' in each case. Psychiatry is heavily driven by a 'compliance' paradigm - compliance with treatment regimes = relief of distress, compliance with thought regimes = relief distress, compliance with behaviour regimes = relief distress, in that context it is very difficult for the expert to even begin to approach a validation of the patient's social experience and application of the BPS model leads inevitably to a imposition of the expert's social perspective as the 'correct' reference for compliance. For the psychiatrist this leads to the inexorable position of "if only they would think and behave like me - they would be well".

    IVI
  20. Enid

    Enid Senior Member

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    I think "Medically Unexplained Symptoms" today sounds very chancey - they may be tomorrow's big medical discoveries as happens in medical research and advances in understanding. THe concept of medically unexplained is an admission of "we don't know" - shaky ground for Psyches "castles in the air".

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