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Medically Unexplained Symptoms - Training for Psychiatrists

Discussion in 'General ME/CFS News' started by Bob, Mar 23, 2014.

  1. Bob

    Bob

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    This sort of thing has been discussed elsewhere on the forum, but this training document is an interesting insight into what the psychiatrists are being taught about CFS, Fibro, IBS etc. It seems that psychiatrists are taught that CFS, Fibro, IBS etc., all fall within the classification of Medically Unexplained Symptoms (MUS.)

    The training document discusses Medically Unexplained Symptoms and is part of an educational course for post-graduate psychiatry trainees for their MRCPsych exams.

    The document can be downloaded here:
    http://www.cambridgecourse.com/action/file/download?file_guid=821

    Main website:
    http://www.cambridgecourse.com/

    But I've taken the liberty of converting the document to a PDF document and have attached it to this post.

    I really don't recommend reading it, esp if feeling a bit low at the moment, unless you're in the right sort of mood for it. It may make your blood to boil. But it is very interesting from an information perspective.

    There's so much in the document that I could quote, and challenge, but I don't know where to begin!

    I wonder if any of them question any of this stuff?


    As far as my understanding goes, this training information seems to be standard for psychiatrists, and this particular training company describes itself as follows:
     

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    Last edited: Mar 23, 2014
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  2. A.B.

    A.B. Senior Member

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    The possibility that patients may be suffering from unrecognized illnesses is never considered. On what basis is this possibility denied? Purely on faith, it seems.
     
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  3. peggy-sue

    peggy-sue

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    I've read it.
    Quite apart from it being cra**y garbage from the outset...
    I would not trust a document which describes "heard sink" (when they mean heart-sink) or uses the sort of silly expression I quote below.

    "Reasonable in patients not improving with structured explanation, graded activity and a trail of antidepressants."

    I don't suppose they MEANT a trail of antidepressants, but that is what it seems like to a lot of us!

    Are they completely unable to proof read their work before publishing?

    What else in their "work" is equally slap-dash?
     
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  4. anciendaze

    anciendaze Senior Member

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    I have long asked if there was anyway to disqualify a psychiatric diagnosis within psychiatry. The very concept seems foreign. Psychiatric diagnoses are disputed, but this is generally in an attempt to introduce a different psychiatric diagnosis. The idea of detecting a non-psychiatric problem by careful psychiatric diagnosis doesn't gain much traction. In every case I know where such a rediagnosis has happened it has been the result of medical tests outside psychiatry.

    This provokes deep thoughts about whether or not the light is on when the refrigerator door is closed.

    On the subject of proofreading, I can contribute an anecdote which doesn't involve psychiatry or psychology, to show I am not simply attacking one field.

    Scientific terminology produces some unusual spellings. In one case where reports of research actually funded and performed were being described a spelling correction suggested by a word processing program converted Langmuir-Blodgett films to Lemur-Blodgett films. This term continued in use for several years, either indicating the documents in question were write-only, or that lemurs were playing a surprising new role in scientific research.
     
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  5. peggy-sue

    peggy-sue

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    Folk should check that their computers have done what they thought they had told them to do.

    I may have used a computer to do some stats, but I always worked some examples out long hand to check.

    It's far too easy with number crunching programmes for folk to shove things in wrong columns.
     
  6. anciendaze

    anciendaze Senior Member

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    The missing action in the cases I described is thought. Please note that no numerical mistakes were involved in the research reported to involve lemurs.
     
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  7. SOC

    SOC Senior Member

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    Well it's not science. :rolleyes: Maybe we need some new language for this crap -- faith-based medicine? :rofl:
     
  8. alex3619

    alex3619 Senior Member

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    This is a gross under-estimate in my view. I haven't read the study they base this on, or don't recall it, but in recent times its been emphasized to stop investigating after a MUS diagnosis, so the real cause may never be found unless its a lethal disease. Chronic disease will remain undiagnosed.

    This is definitely not science. Popper called it nonscience, and sometimes pseudoscience. It fulfills every major definition of pseudoscience I have read. Using pseudoscience in medicine can qualify as quackery. This is however institutionalized, strongly defended pseudoscience. This has to change. The ENTIRE medical profession, as a profession, must be regarded as in disrepute. Their failure to act to fix this, alone, is enough to say that.

    The problem is so very much of psychiatry, including nearly (?) all psychosomatic medicine, and a good chunk of other medical disciplines, fall prey to the same problem. I suspect its due, in part, to how doctors are taught to think. They learn to think in "maybes" and "mights", but then overly invest in them with certainty. They do this so much it becomes accepted practice, and critical/rational thinking is reserved for a subset of doctors, and these often have tertiary training independent of medicine.

    What is really annoying is this insistence of lack of evidence. First, do no proper investigations, just do routine ones. Then when they come out as negative, reassure the patient and refer for psychoactive drug or talking therapy. Where is the appropriate testing? For ME I would think you would have to, to claim you really investigated, include at least CPET (1 day, 2 day much better though) and a SPECT scan. In the not too distant future I expect that to expand to include other tests.

    This is not just nonscience, its highly irrational. We don't know what it is, ergo, it must be psychiatric. There is no recognition that science has not discovered very disease, or the full extent and pathophysiology of well-known diseases, nor that most genetic diseases are probably not found, and maybe most are not yet discovered.

    Yet its asserted/spoken about with certainty. As unsubstantiated hypotheses for research that is not usually a major issue, as proven science its pseudoscience.
     
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  9. alex3619

    alex3619 Senior Member

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    Thank you @Bob for converting the slides. PDF is much better.
     
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  10. NilaJones

    NilaJones Senior Member

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    In the US, the motivation for a psychiatric diagnosis is that health insurance does not cover talk therapy, only drugs. It is a way for the insurance companies to wash their hands of a patient. Give them some prozac and send them home.

    How does this work in other countries? Are people referred for talk therapy? Does the therapy continue indefinitely, until the patient gives up? What would be the motivation for this -- I have a hard time imagining it is cheaper than running proper blood tests. Is it to save on the cost of in home care and disability benefits?
     
  11. peggy-sue

    peggy-sue

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    In th UK, there is official discrimmination against those with mental health illnesses as opposed to "physical" illmesses.
    The benfits paid out are less for mental health problems - so there is a huge saving for the insurance companies the psychiatrists all have private, personal interests in.

    And the denial of GWS (or whatever they are currently calling the devastating illnesses many war vets get) saves the MoD money.

    As Sir Simon put it about - they don't have PSTD - they've just got drink problems. Their fault.
     
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  12. Nielk

    Nielk

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    The huge savings in the US with Psych illnesses is in disability payments. If eligible, max coverage is two years. Whereas for organic disease, disability could be lifetime. This translates into major payout for insurance companies.
     
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  13. alex3619

    alex3619 Senior Member

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    There is no question there are huge financial incentives for insurance and government in denying payment to psych disorders. For insurance it makes financial sense while at the same time being immoral.

    For government it has financial viability only by a trick of accounting. One department saves money, but other areas of society and government pay the cost, and according to the only study that ever looked at this (which was announced but I don't think ever published, here in Australia) the actual costs are higher. Its a way of looking like saving money while racking up the costs and debt if the budget is in deficit.

    Yet its a mistake to think finance is all that is going on. Lets look at insurance for an example. Insurance companies fund research that helps them make money. That's a valid economic pursuit. Yet there are strong arguments that one sided funding severely distorts science even without bias or fraud. The funding alone is enough, and this even influences government funding. It leads to something called Zombie Science, science by monetary influence and not evidence and reason.

    Even taking that into consideration, its not even close to the full story. We could attack the financial basis and win the battle, but we would still lose the war.

    Psychiatry in the last century, which was a huge improvement on the century before, still committed atrocities that put it right up their with Soviet Russia or Pol Pot. I can give details, its well documented. In these cases only a few dissenting voices ever spoke up in psychiatry, medicine or government. In the end when something major went public, people finally realized what was going on, then very quietly and without fanfare things change. There, said the psychiatric proponents, things are fixed.

    Why does the psychiatric profession not take action? Insurance had nothing to do with this. Why does the medical profession not take action? How can governments let this happen, given that almost inevitably its society and the government that bears the cost? This is about much more than money. It goes to the very foundations of society involving mental disorders.

    Once upon a time (Middle Ages to Renaissance, the Inquisition comes to mind) people who were different, especially older single females living far from everyone, they were tortured, or executed, such as the infamous burning at the stake. We don't do that any more, but I don't think society has evolved all that much. Different = bad. People with strange health problems, strange behavior are different. Is the attitude that its best to lock them away for the good of society. Or is it something more subtle?

    Why has psychogenic medicine been allowed scientific standing when its bad medicine and even worse science? Its claimed, repeatedly, that something is needed and this is the best we have. This is tantamount to accepting counter-factual, speculative, dangerous, immoral and experimental practices to be used on people who are different. Its obscene. Yet the medical world and government mostly turns a blind eye.

    Not all of this is about money. There are layers of complexity that are usually missed. These various factors interact, reinforcing each other. Attacking just one layer, even if successful at some things, may fail at changing it all.
     
  14. A.B.

    A.B. Senior Member

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    This is an extremely important and interesting point. If policy makers could be convinced that biomedical treatment for CFS and early diagnosis ultimately means a lower financial burden, then their attitude will change even in the absence of biomarkers and clear definitions.
     
  15. greebo

    greebo

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    One thing I find fascinating is that the concept of "normal" was only created in the nineteenth century. I will attempt to attach a PDF file with an article from Lennard J. Davis, called "Constructing Normalcy".

    It's scanned from a book and very difficult to read, but I think it shows at least one of those factors you mention.
     

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