Review: 'Through the Shadowlands’ describes Julie Rehmeyer's ME/CFS Odyssey
I should note at the outset that this review is based on an audio version of the galleys and the epilogue from the finished work. Julie Rehmeyer sent me the final version as a PDF, but for some reason my text to voice software (Kurzweil) had issues with it. I understand that it is...
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Metaphors and medically unexplained symptoms - Lancet

Discussion in 'General ME/CFS Discussion' started by Hutan, Aug 21, 2015.

  1. Hutan

    Hutan Senior Member

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    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)61530-6/fulltext
    The Lancet
    Metaphors and medically unexplained symptoms
    Eben S Schwartz

    Argh, waffle about deluded people with trivial psychomatic symptoms looking endlessly and in vain for significant biological causes.

    There is a valid point that normal human states are sometimes being pathologised (sadness equals depression; valid fearfulness and uncertainty equals anxiety disorder.

    Looking on the bright side, there is an air of defensiveness
     
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  2. GracieJ

    GracieJ Senior Member

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    E-mail address for the author is on the article.

    Hard to believe this is written today.

    His lab friend is describing early signs of migraines developing. I wonder...

    Go, team.
     
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  3. TiredSam

    TiredSam The wise nematode hibernates

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    My first GP estimated that 95% of his patients had stress-related symptoms that would go away when they realised what was causing the stress. He saw his job as mostly holding people's hand. He was a terribly nice chap, if a little vague. What was causing my stress was a 6-week headache and his attitude, so I never went back.

    How does he know that the patient has been sufficiently comforted? Because they don't come back? Feeling sufficiently comforted wasn't the reason I never went back to my doctor, but if he wants to chalk it up as another success that's up to him. Another example of the self-delusion of psychobabblers - "well no-one ever comes back so I must be curing them".

    I don't even know where to start with this. He is concerned that those who devised cruel labels for the parents of autistic children in the past may not approve of the phrase "chemical imbalance", which he thinks is a metaphor for the "unknowable"?

    I suspect it would suit him for the causes of many symptoms to remain "unknown" for as long as possible, so he can continue lazily applying metaphors, dismissing patients and feeding his ego instead of doing some real work. It'll be interesting to hear what his successors make of him and his views.

    Can't read any more of his flowery language and pseudo-philosophical ramblings. How on earth stuff like that get accepted for publication in the lancet is beyond me.
     
    Last edited: Aug 21, 2015
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  4. Scarecrow

    Scarecrow Annie Gsampel

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    Because he's taught that that will be the case if he does and says the right things.

    There's a line in my medical file the pretty much verbatim goes "I reassured the patient. The patient was reassured." The context was that my GP was reviewing my blood tests shortly after I'd had to withdraw from university on the grounds that I couldn't sustain any activity for more than half an hour and I could barely read. There was no sign of inflammation or any other abnormality in my bloods, ergo there was nothing seriously wrong and nothing for me to worry about. So if he reassures me of that, I will in turn be reassured and in no time at all I'll just jump up and get back to normal.

    My thoughts at the time were not "how reassuring" but "you're an idiot". I just kept it to myself.

    Edited to add: this whole stupid way of dealing with patients of course just increases or, indeed, causes anxiety. I'd say that I had every justification to be anxious about my condition before that consultation. How much more anxiety forming to know that there is something very badly wrong with you but for your doctor to not recognise it and dismiss it?
     
    Last edited: Aug 21, 2015
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  5. sarah darwins

    sarah darwins I told you I was ill

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    What's this doing in The Lancet? Even the title belongs in the International Journal of Cultural Studies (alongside this month's articles — Constructing a digital storycircle: Digital infrastructure and mutual recognition and The pain and pleasure of roller derby: Thinking through affect and subjectification).

    And while we're deconstructing our narratives, I demand metaphorical clarification: have we fallen down a rabbit hole or gone on a crusade? It can't be both. No one ever went on a crusade down a rabbit hole. Except maybe a ferret. Are we ferrets? Is this our 'abnormality'?

    And who's to say what's normalcy? Or even normality?

    And who the hell is Eben S Schwartz? Is that even knowable?

    Next week — Medically Unexplained Symptoms and the Semiology of Oblivion: An Existential Perspective.
     
    Last edited: Aug 21, 2015
  6. TiredSam

    TiredSam The wise nematode hibernates

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    It's Alice in Wonderland.
     
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  7. worldbackwards

    worldbackwards A unique snowflake

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    It's medically unexplained.
     
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  8. Scarecrow

    Scarecrow Annie Gsampel

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  9. sarah darwins

    sarah darwins I told you I was ill

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  10. jimells

    jimells Senior Member

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    I wonder how many of his patients "went away" because they died.
     
  11. jimells

    jimells Senior Member

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    It must be a satire. Certainly "a real doctor" would never write this kind of rubbish...:alien:
     
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  12. JaimeS

    JaimeS Senior Member

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    One for each of the inhabitants.
     
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  13. Snookum96

    Snookum96 Senior Member

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  14. Sidereal

    Sidereal Senior Member

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    Sounds like dysautonomia to me.
     
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  15. Esther12

    Esther12 Senior Member

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    One day there will be an article with a title like this that turns out to be really interesting. I'm pro-actively preparing for this day in order to protect from the psychosomatic breakdown that the shock would otherwise induce.
     
  16. alex3619

    alex3619 Senior Member

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    Normalcy cannot be defined. This has been attempted again and again, but all definitions are problematic.
     
  17. alex3619

    alex3619 Senior Member

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    When patients ask a doctor if it could be X, because of Y symptoms, they are looking for answers. The doctor often cannot provide. If the doctor is sceptical that it might be X, this may be appropriate. What is not appropriate is ignoring the Y symptoms.

    Take the case of ME. The IOM report, for all its limitations, did point out that the five primary symptom clusters are all objectively measurable. So any claim that ME or CFS or SEID is about medically unexplained symptoms is dubious at best, and absurd at worst. There is a confusion here. The disease is not explained, but the symptoms are indeed explained. MS, diabetes and a host of other diseases are not explained either. Yet we do not doubt the measurable physiology of those diseases.

    I think many MUSes are the same - real and measurable symptoms are ignored, but with primacy being given to the cause not the symptoms. The cause is unknown, so the symptoms are ignored.
     
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  18. sarah darwins

    sarah darwins I told you I was ill

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    Exactly. I thought part of that anecdote about the lab worker was rather alarming:

    I can't see that there's anything vague about nausea. It's something that warrants investigation, especially in someone who is working in a hospital pathology lab.
     
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  19. Valentijn

    Valentijn The Diabolic Logic

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    It sounds like something Lemmiwinks might do. So I vote for "gerbils".
     
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  20. Woolie

    Woolie Senior Member

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    I like this part:

    Looks like the writer truly believes in the power of placebo. I guess that's what they're taught about there. They don't realise that a large part (perhaps all?) of the placebo effect is a self-report artefact.

    Ditto for "the correlations between stress and immune function, wound healing, and heart disease". Granted, the writer might not be fully qualified to evaluate the (very poor) research on this topic, but then if you're writing an article like this, you need to know your own limits.
     
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