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(not important) 2014 Wessely book's chapter on Somatization.

Discussion in 'Latest ME/CFS Research' started by Esther12, Jan 31, 2015.

  1. Esther12

    Esther12 Senior Member

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    I wanted a copy of this for myself, and thought I may as well put it up here too. Nothing particularly revelatory or interesting. Wessely is one of three editors, but considering his interests and the book's preface (included at end) it seems fair to assume that this section is not far from his views on this matter.

    From the new edition of The Maudsley Handbook of Practical Psychiatry

    upload_2015-2-1_5-23-10.png
     
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  2. barbc56

    barbc56 Senior Member

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    @Esther12
    Thanks for taking the time posting the chapter. I can't believe it was actually written in 2014!

    What a patronizing, and dismissive attitude towards patients. It just boggles my mind that anyone can think this type of treatment even comes close to meeting a patient's needs.

    The same old same old recycled crap.

    Barb
    ETA
    I am definitely bookmarking this! Again, thanks.
     
  3. Gingergrrl

    Gingergrrl Senior Member

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    I have to say after working as a social worker in mental health for 12 years this is the most horrifying and condescending piece of BS I have ever read. It is also patently wrong re: how you would assess a patient for suicidality.

    It is trying to teach by following a formula or using certain phrases vs. starting w/each person as an individual and conferring with their medical doctor re: medical tests to rule in or out NOT deciding on your own that these tests are not necessary. This is a textbook of vignettes of exactly what NOT to do!
     
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  4. A.B.

    A.B. Senior Member

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    I see no such explanation, only the assertion that such a phenomenon exists. Probably because it has as much scientific validity as the concept of demonic possession.
     
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  5. barbc56

    barbc56 Senior Member

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    My appendix is grumbling.:rofl:

    Barb
     
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  6. eafw

    eafw Senior Member

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    Remarkable that this is the state of the art in 2014, it's positively Victorian. It would be nice to see some reviews of the book on the Amazon page from some of the more up to date and reality-based readers.
     
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  7. Gingergrrl

    Gingergrrl Senior Member

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    It is not state of the art in the US, neither at my school, internships, jobs, licensing board, and entire career etc. I don't know why it is so vastly different in the UK?
     
  8. barbc56

    barbc56 Senior Member

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    I've wondered the same thing as my traing sounds similar to yours.

    Barb
     
  9. Bob

    Bob

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    Gosh, that's surprisingly candid; it doesn't leave much room for any doubt about their illness beliefs in relation to ME.
     
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  10. Snow Leopard

    Snow Leopard Hibernating

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    The real sad part is that they seem to accept the 'poor prognosis' and lack of cure, but think this is acceptable, rather than a dire need to develop better treatments.
     
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  11. zzz

    zzz Senior Member

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    This is an old and venerable technique in logic known as "proof by assertion", which is very popular in many nonscientific circles. :cool:

    But they're already giving the patients the best possible treatment - what more can they do? Especially when the patients don't want to help themselves. :cry:

    Besides, if they started working on better treatments, the patients might get the idea that they have a real illness. And what could possibly be worse than that? :jaw-drop:
     
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  12. eafw

    eafw Senior Member

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    My "state of the art" comment was slightly facetious but in reality there is a long history of this sort of backward thinking here, and many cultural reasons why it persists - even though I'm sure some psychiatrists in the UK may be trying to turn the profession into a more credible and vaguely useful one.

    Is it really that vastly different in the States ? You have a similar history of paternalistic attitudes towards patients and endemic abuse within psychiatric institutions. Have they turned the profession round in recent times ? Maybe in part because psychiatrists are more mainstream where you are and still rather fringe over here.
     
  13. Countrygirl

    Countrygirl ME is not MUS

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    Thank you Esther! That has enabled me to clarify a tentative conclusion that I have reached regarding the CFS clinic local to me, the head of whom is one of the creators of the Oxford criteria.

    For many years, I was the co-ordinator/chairperson of the county support group until ill health and deaths amongst the committee members meant that we had to put the group in abeyance.

    Just to wind back in time to shortly before we fell off our perches through ill-health or death, a certain document fell into my hands: it was the transcript of a talk given by a certain psychiatrist to a medical conference in the south of England. The speaker was the person I mentioned above. Clearly with the intention of entertaining his medical colleagues in the audience, his talk was peppered with mocking and derogatory statements about ME patients. I was shocked and dismayed to read how the seriously ill were regarded as a source of entertainment to those who were charged with their care. I was even more shocked to find that this person was a little later appointed as head of the then newly formed county 'CFS' clinic.

    As people call me enquiring about the provision of help for ME patients, I thought I had better do a little research. I phoned the CFS clinic and said I had been contacted by someone with a diagnosis of ' Myalgic Encephalomyelitis' and enquired whether it would it be appropriate for the patient to be referred to them for help. I assume I was speaking to a receptionist. Her response was immediate. 'No', she said, this clinic is just for those who have mental health problems. That (ME.....................she couldn't pronounce it.) sounds physical, so the patient must go to the main hospital, not here.

    To give one example: recently, I had a number of calls from someone who wanted to voice her frustration about her experience at the clinic. I asked if they had told her that they viewed her problem as psychiatric in any way. She assured me, no, they had not. However, when I listened to her tale, I really do not believe she had assessed the situation correctly. She told me the doctor let her rehearse all her difficulties without contradicting her interpretation of them as a physical illness, but she was confused by the outcome as the doctor was attempting to stealthily guide her down the psychiatric route. The above extract fits so well with her description of her appointments with the clinic. If asked outright I suspect they would deny their view as it would alienate the patients, so, in this case, I think it is the receptionist who more accurately reflects the doctors' (abnormal illness :whistle:) belief system in this case. It reminds me of those training videos for doctors and therapists we have seen by Dr Chalder and company whereby they are recommended not to challenge the patients' interpretation of their problems, so as not to spoil the therapist/patient relationship thus enabling the doctor to surreptitiously manipulate the patients' attribution of their condition.

    Just to add, however, that I do know to a limited extent one of the two doctors at the clinic and I think he would be kind and supportive if he had clear and accurate direction, so I do not hold him responsible for the above
     
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  14. Roy S

    Roy S former DC ME/CFS lobbyist

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    "The educational mission of the Maudsley is to provide an internationally renowned training in Psychiatry and for the South London and Maudsley NHS Foundation Trust and King’s College London School of Medicine to become the premier place to train for future psychiatrists"
    Tony David - Vice Dean for Academic Psychiatry
    Simon Wessely - Professor of Psychological Medicine
    http://www.maudsleytraining.com/

    There is a link to the above on
    http://www.simonwessely.com
     
  15. Sidereal

    Sidereal Senior Member

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    The dire prognosis couldn't possibly have anything to do with undiagnosed (or currently undiagnosable) underlying organic illness, that's just crazy talk, right? :rolleyes:

    Gotta love the preposterous examples of psychological disorder. Candida overgrowth in the gut is measurable by lab testing. "History of unusual allergies" = mast cell activation disorder. Feeling overwhelmed by bright neon lights and lots of conversation going on around you = shitty redox status in the eye, problems with sensory gating, glutamate excitotoxicity etc.

    This text could have been written 100 years ago and that is my main problem with psychiatry. There is NEVER any progress or new ideas; just more vehement assertions and entrenchment of old ideas. As new evidence comes in challenging the somatisation status quo, it is always dismissed as some mendacious money grubbing doctor - crazy patient collusion. The bar for proof of organic illness is set so high - evidence must be absolutely unassailable - that almost nothing can ever satisfy it, and when something does satisfy it occasionally, like MRI and multiple sclerosis lesions or H. pylori and stomach ulcers, it's just quietly dropped from the new editions of such textbooks and never mentioned again, never taught to psychiatry trainees as historical examples of misguided treatment and abuse of patients, nothing.
     
    Last edited: Feb 1, 2015
  16. eafw

    eafw Senior Member

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    Yes, those passages from the manual have very much informed the treatment at NHS "chronic fatigue" clinics right across the UK. I know a number of people who've been subject to the exact same thing: "we know the patient is mental but let's lie to them and pretend we're taking them seriously, meanwhile working our way round to tricking them into psych meds and pushing CBT/GET to counter the illness beliefs"

    It's not only physically harmful for the patient it's also massively unethical.

    Doctors are supposedly some of the most intelligent people in the country. They have more than enough evidence that their quackery is deeply flawed, and again the ethics of being that deceitful with patients ? However pleasant and nice they seem in ordinary conversation, even if they believe themselves to be well-meaning, they are still responsible for the farce that we have to deal with here.
     
  17. Countrygirl

    Countrygirl ME is not MUS

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    Reluctantly, I must agree with you eafw. We are responsible for our own actions and cannot justify inflicting harm and distress on others because those higher up the food chain order us to behave unethically. (I was trying to be generous in my interpretation of the situation as despite their usual delusions of superiority they are mere flawed mortals. We can't win them round if we are constantly flogging those with potential for their past and persistent sins..............probably that doesn't make sense................I know what I mean even though I am not expressing it well :meh:......so I'll shut up before I dig a deeper hole for myself.:bang-head: )
     
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  18. eafw

    eafw Senior Member

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    I think it is what happens when you have otherwise "nice ordinary" people working in any institutional setting, particularly closed and unaccountable ones with a large power imbalance across the hierarchies. Mix that in with the aspect of human social behaviour that says not to question and to compartmentalise - us and them - and this is very dangerous ground to be treading.

    Drs and nurses and other practitioners do not have to be horrible slavering monsters to do harm, to perpetrate harm. Most individuals working in mental health and in cfs units will be your "nice ordinary" people, they will think of themselves as good people. But they operate within a culture that enables them to mistreat and abuse and makes it easy for them to do so while deluding themselves that it is not happening, that if anything they are doing good.

    It does take someone with actual principles to stand up to it and sadly most humans seem to be a bit lacking in that sense. Ideally you would structure the institution itself differently, a cultural change and checks and balances would help a lot

    It's not just Drs/medics, many aspects of life you see the same patterns but it is particularly pronounced in medicine because of the power imbalances and the way the medical culture is currently organised.
     
  19. A.B.

    A.B. Senior Member

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    It is the belief in psychosomatic illness that legitimizes the abuse of patients. Unexplained symptoms are viewed as behavioral and attitude problem rather than as undiagnosed / undiagnosable disease. Psychosomatic diagnoses are a form of dehumanization.
     
  20. Simon

    Simon

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    I strongly agree with this: the usual answer, for someone with ME/CFS, is PEM and relapses.

    The worst thing for me personally is that I've had a relapse that tooks several years to come back from (and many lesser relapses), though I know others have fared worse. I would love to know how Simon Wessely and colleagues would respond to such an answer from a patient.

    While there is disagreement over the best definition to use, I think almost all researchers (beyond Oxford Criteria advocates) think PEM is a core part of the illness. We are not talking about feeling a bit stiff or tired a day after exercise - hey, we are all familiar with such feelings when healthy, or even recovering from earlier illnesses, but something rather more distinctive.

    If I could borrow from that:
    "If the doctor has a specific illness belief (such as 'ME is simply an illness belief'), do not question this, even if there is no corroborating evidence." Illness beliefs are very hard to shift, doctors beliefs about this illness in particular, and there are probably better ways to use your energy.
     
    Last edited: Feb 2, 2015
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