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

[cfsStevew]

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.

yes it is this combined with the persons inherent cynicisms about life and others.

What is most apparent to me is the ease with which people are inclined to not believe other human beings when they say they are suffering. Those who have or have had struggles in their own life seem all too ready to believe that someone is underserving of sympathy - and if its a psychosomatic illness - that leaves an open goal for them to project their own frustrations into an abusive attitude to the patient. Its a double whammy - because people dont really buy psychosomatic illness as 'real' or deserving - even if they are psychiatrists who claim to.

 

[chipmunk1]

yes what are these machanisms pray tell!!

As far as I was aware they have no explanation for this proposed phenomenon?

i think the mechanisms are still freudian sometimes replaced with the more modern concept of fear avoidance or conditioning/reinforcement.

http://medicine.med.nyu.edu/conditions-we-treat/conditions/somatization-disorder#causes

Causes
The cause of somatization disorder is not known.

There is no medical illness to explain the symptoms, so the disorder is believed to be due to mental and emotional causes. Somatization disorder may also be due to brain processing.

Risk Factors
Somatization disorder is more common in American women, but incidence varies among different cultures. Other factors that may increase your chance of developing somatization disorder include:

Family history of somatization disorder
History of psychological trauma or early experiences with physical illness, hospitalization and medical treatment . Note: Childhood trauma?
Lower social class with little education - Note: The patients are riff-raff?
Individuals who may be extremely emotional (also known histrionic) Note: Histrionic is a psychoanalytic term
Individuals with antisocial personality disorder , substance abuse disorders, anxiety , depression , or panic disorders
Individuals who are unable to express their emotional distress through language (due to neurological disorders or intellectual disability ), or in cultures that discourage the communication of emotional distress Note: the idea that repressed emotions cause somatization is freudian

more at: http://medicine.med.nyu.edu/conditions-we-treat/conditions/somatization-disorder#causes

basically they are emotionally repressed, antisocial, hysterical, traumatized and uneducated troublemakers causing their own problems...

It is difficult not to draw the conclusion that, in formulating its criteria in this particular instance, the American Psychiatric Association did little more than take an old diagnostic error and give it a new name together with a new aura of respectability. Since the very concept of “conversion” is specifically psychoanalytic, and since it is historically indivisible from Freud’s own idiosyncratic theories of “hysteria”, it further seems that the creation of the category “conversion disorder” was a politically astute way of preserving the old concept of “hysteria” in euphemistic disguise.

Richard Webster

 

[Esther12]

There was also a second experiment:

Yeah, and that certainly seems to indicate that their diagnoses and views of their patients are affected by factors other than their patients.

 

[Snow Leopard]

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?

What could be worse? Patients recovering, getting medical degrees and stealing their jobs.

 

[Antares in NYC]

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.

I think it would be quite interesting if recordings, videos, or transcripts of that speech ended up online, you know, in the public interest.

As a matter of fact, it's not he first time I read about the disgusting comedy routine of that individual at the expense of ME/CFS patients. I understood he basically took his stand-up comedy show on the road, and did the same oh-so-hilarious number in several conferences and symposiums.

 

[Sean]

I think that transcript / recording clearly needs to be made public. Transparency is the key to holding the abuse of power to account.

 

[alex3619]

I think that ME is where MS was about a 100 years ago.

I put it about 40 years ago. Things were bad for MS patients in the early to mid 70s.

 

[alex3619]

Transparency is the key to holding the abuse of power to account.

Its the first half, the other half being mechanisms for accountability.

 

[taniaaust1]

Thanks for that post.

I have to admit that a lot of the medical ethics I read seems to be trying to coming up with excuses to allow doctors to do what they want. I suspect that some of that may be because I'm drawn to titles/abstracts that look irritating though!

re the 1st Rosenhan experiment: I thought that a lot of them were diagnosed as having suffered from a psychotic episode, but now being in remission. Also, the participants were not behaving in a normal manner after being admitted, as sane people not attempting to be a part of such an experiment would want to inform the staff that they had faked psychotic symptoms in order to gain admission. While I'm sceptical of many on the claims of expertise coming from psychiatrists, the Rosenhan experiment doesn't really seem to show much.

I hadnt heard of that experiment before thanks. http://en.wikipedia.org/wiki/Rosenhan_experiment . Its blown me away reading it as it confirms what Ive also thought and also they experienced some of the stuff I have too.

Hospital notes indicated that staff interpreted much of the pseudopatients' behavior in terms of mental illness. For example, one nurse labeled the note-taking of one pseudopatient as "writing behavior" and considered it pathological. The patients' normal biographies were recast in hospital records along the lines of what was expected of schizophrenics by the then-dominant theories of its etiology.

Ive had some of my history and family history too "recast" by doctors who want to see ME/CFS as a psychological illness. eg My history of a heap of cancer being in my family.. become all those family members had psychcological illness. Crazy mistakes in my medical notes which push towards the view trying to make ME/CFS a mental health thing.

Me taking notes at a medical appointment.. that has been turned against me too by at least one doctor.

 

[Woolie]

If anyone can get hold of the full paper, I think they talk about the conning people onto antidepressants here

http://www.ncbi.nlm.nih.gov/pubmed/11144910

Its is more disheartening than anything I've ever read on this topic (and that's a fair bit). Some pertinent excerpts about how to dupe the patients into going on antidepressants:

".... in the following extract the physician is attempting to coax a patient who remains insistent that she has a viral induced disorder, that her suffering can be interpreted in other ways.

129 D: What we’ve got to try and do is ignore everything that you believe it is or we believe it is and investigate you and say, ‘right what biological abnormality can we find in you’. My guess is, my guess is that you don’t have enough blood pressure to sustain you when you’re standing up.

133 P23: Yeah, with that I see what you’re saying, but I still find the same thing when I haven’t done it.

135 D: Right. The cause of that is a drop of serotonin, a chemical in the brain, which if we don’t have enough of that it will make everything go wrong, or some things and not others. Completely unpredictable…Simply because when we give people serotonin lot’s of these things, including the blood pressure problem disappears…
​

By enrolling serotonin as an ally, the physician opens up the possibility of prescribing, at a later point, anti-depressant drugs such as Paroxetine (Seroxat), Sertraline (Lustral), or Fluoxetine (Prozac). Further, it enables her or him to introduce psychological factors into the consultation in a physicalist rather than a psychiatric frame of thinking. That is to say, in a frame that would be more acceptable to patients."

Then later, what to say if the serotonin story doesn't fly:

"...

153 D: …I see you’ve tried Seroxat before.
154 P7: Yeah. I went to one of the doctors and she said it could be depression and so I give it a try and it made me feel worse to be honest.

156 D: But, guess what? Sometimes in some people the blood pressure responses are cured by that, so they’ll say, ‘well yeah it must have been depression then because I feel miles better on this’.
(...)
181 D: [addressing others present] …we know he’s not short of serotonin because he’stried Seroxat and that made him worse, so that moves us on then to acetylcholine as the other main culprit…"​

 

[Woolie]

But this from the same journal, shows a really different perspective. It examines transcripts of support groups' conversations:

Dumit, J. (2006). Illnesses you have to fight to get: facts as forces in uncertain, emergent illnesses. Social science & medicine, 62(3), 577-590.
http://www.academia.edu/download/30900373/medicalization.pdf

From the article:
"The experience of having terrible and terrifying symptoms, seeking medical attention and being turned down bureaucratically is quite commonly described by persons with CFS or MCS. Learning that because “there is no code” for one's condition, care cannot be provided is devastating psychologically and socially.......

"In addition, because social legitimacy depends upon maintaining a sick role, sufferers also have to work to convince friends, family and co-workers that their illness is real and legitimate....."

The article concludes:
" ... the networks of small groups, internet communities, and mass media sharing to make life more livable for sufferers. As a social movement, sufferers and others committed to helping them provide a community and offer alternative personal narratives, strategies for surviving, and emotional support. In the words of William Gamson, there is a big difference between individual resistance, and “being part of the Resistance.” (Gamson in Taylor, 1996, p. 15; see Dumit, 2005).

The resultant discussions form the basis of constant experimentation with strategies, tactics, identities, and relationships, as well as with the expected alternative therapies, referrals, and emotional support. The persistence of uncertain and contested illnesses like CFS and MCS as ‘emergent’ must be understood negatively as the continued existence of suffering that is not being treated, and positively as the ability of sufferers to creatively survive within the cracks of institutions arrayed against them."

 

[Antares in NYC]

If the medical establishment had spent as much energy and resources in research as they have spent on coaxing patients, devising strategies for dismissal, or building questionable academic constructs for denying us treatment... then we would have a cure by now!

It's sad and infuriating.

 

[Snow Leopard]

135 D: Right. The cause of that is a drop of serotonin, a chemical in the brain, which if we don’t have enough of that it will make everything go wrong, or some things and not others. Completely unpredictable…Simply because when we give people serotonin lot’s of these things, including the blood pressure problem disappears…​

​

Oh wow, doctors trying to push non-evidence based ideas.

Firstly, studies in CFS patients show increased serotonin pathway activity, in fact this has been hypothesized as a cause of the fatigue and, I mean specifically hypothesized in papers, including several that were co-authored by Wessely or Sharpe.

The second is that the evidence base (placebo controlled RCTs) show that SSRIs show no benefit for depression in CFS patients. (whereas other classes of anti depressants have shown an effect on lowering depression)

Lastly, long term impact of 5-HT can induce a depression blood pressure (see the conclusions):
http://www.bmj.com/content/315/7101/164.extract

 

[taniaaust1]

Transparency is the key to holding the abuse of power to account.

Its the first half, the other half being mechanisms for accountability.

I agree with alex, this also goes on due to they can get away with it even if discovered. Will Sir Wessely ever loose his knighthood? Probably not even when it is proved his views were so very wrong.
.....

the sad thing is that once someone is labeled with many of those mental health conditions or with Somatization.. you wont be believed if you try to report the bad stuff being done to you and the systems which are there to protect you when you complain, dont even bother investigating to find out what you are saying is true.

Then there is some cruel psychs who may purposely say things to ridicule and taunt you. (I came across a very bad one last time I was in hospital for suicide attempt and now refuse to ring the ambulance if I need to go.. I was actually not only disbelieved (Im used to that when it comes to ME symptoms) but he also really bullied me, the hospital psychriastrist.was really really nasty. I really wish I had been able to record how he spoke to me and the things he said.

 

[Sidereal]

I've heard of the odd case of neurally mediated hypotension doing better on an SSRI but more often these drugs make people with CFS feel awful.

 

[Sidereal]

​

Oh wow, doctors trying to push non-evidence based ideas.

Firstly, studies in CFS patients show increased serotonin pathway activity, in fact this has been hypothesized as a cause of the fatigue and, I mean specifically hypothesized in papers, including several that were co-authored by Wessely or Sharpe.

The second is that the evidence base (placebo controlled RCTs) show that SSRIs show no benefit for depression in CFS patients. (whereas other classes of anti depressants have shown an effect on lowering depression)

Lastly, long term impact of 5-HT can induce a depression blood pressure (see the conclusions):
http://www.bmj.com/content/315/7101/164.extract

Thank you for posting this. I am vaguely aware of this literature so was surprised to hear Dr Hornig at the recent P2P workshop talk about serotonin deficiency, kynurenine pathway etc. While this is true in depression/sickness behaviour, I don't think it's generally the case in CFS. Personally, tryptophan/5-HTP supplementation makes me feel very ill. I've not tried reuptake inhibitors.

From the Sharpe et al BMJ paper:

Our data show a significant rise in prolactin responses to D-fenfluramine in men with narrowly defined chronic fatigue syndrome in comparison to healthy controls. This finding supports some,1 2 but not all, previous neuroendocrine studies,4 5 and suggests that the chronic fatigue syndrome is associated with increased brain serotonin function. Though depressive symptoms are common in chronic fatigue syndrome, patients with major depression have unchanged or lowered prolactin responses to D-fenfluramine,2 making it unlikely that chronic fatigue syndrome and depression share a common pathophysiology.

We measured prolactin concentrations for only four hours after giving D-fenfluramine, whereas a five hour sampling period is customary. Another study that found increased prolactin responses to D-fenfluramine in chronic fatigue syndrome measured prolactin concentrations for five hours.2 Though we cannot exclude the possibility that patients with the chronic fatigue syndrome have greater prolactin responses to diverse pharmacological stimuli, not specifically those mediated by serotonin, the prolactin response to insulin hypoglycaemia is blunted in patients with chronic fatigue syndrome.4

Raised brain serotonin activity might explain the excessive fatigue experienced by patients with the chronic fatigue syndrome.3 Increased prolactin release mediated by serotonin in the chronic fatigue syndrome might, however, be a secondary consequence of behavioural changes such as prolonged inactivity or disturbance of the sleep-wake cycle.

Elevated serotonin and prolactin? Poor response to SSRIs? Sounds like a low dopamine situation to me which would only be worsened by serotonergic drugs.

 

[chipmunk1]

Ssris/5-htp made me worse. I don't need to feel worse than i already do.

The serotonin hypothesis is another very questionable idea from psychiatry. What is true is that serotonin (like many other chemicals and hormones) plays an important role in many physiological processes which possibly include mood regulation.

For some reason people who suffer from depression and some other related and unrelated conditions improve when taking SSRIs, it is not known why this happens. they're pretty much guessing.

now for some reason SSRI and serotonin have become the catch-all explanation and swiss army knife therapy for anything vague/subjective possibly psychogenic that can not be treated otherwise. There is probably only weak evidence or no real evidence for many of the SSRI uses. if you do respond even when it is just a little bit this is often seen as "proof" that your condition was psychological which is nonsensical as a medication is a physiical therapy not a psychological/psychosocial intervention.

they are not understanding what they are doing when they give a SSRI to someone yet they do believe they can interpret a response to it.

 

[Sidereal]

now for some reason SSRI and serotonin have become the catch-all explanation and swiss army knife therapy for anything vague/subjective possibly psychogenic that can not be treated otherwise.

So very true.

 

[eafw]

For some reason people who suffer from depression and some other related and unrelated conditions improve when taking SSRIs, it is not known why this happens. they're pretty much guessing.

The latest theory is that some SSRIs and other antidepressants affect inflammatory processes and microglia in the brain and this is why in some people an improvement is seen. Would also go some way to explaining why it often takes weeks for them to show the improvement.

 

[cfsStevew]

Will Sir Wessely ever loose his knighthood? Probably not even when it is proved his views were so very wrong..

slightly OT but briefly - was Wesselys work into GWS along similar lines as CFS - IE somatization based on psychological factors? And if so how could he have been given a knighthood?! I sat next to a ex-army General recently who told me how obviously physically ill some of his guys were - he described them as almost dead...its crazy if psychiatrists have been let loose on those guys...