Professor Peter White reviews IOM report in Psychological Medicine

[chipmunk1]

They are referring to Cartesian dualism. (theoretical separation of mind and body)
https://en.wikipedia.org/wiki/Dualism_(philosophy_of_mind)

Monism :
https://en.wikipedia.org/wiki/Monism

Its a rich irony considering the fact that White et al consistently ignore all biological evidence and like to ascribe literally everything to behavioural/psych explanations

it's an old psychobabble trick. the concept of "mind" is vague and confusing and can not be studied directly. You can claim what you want and then hide behind nebulous concepts and word games.

You accuse the others of having an outdated dualistic model to distract from the fact that your model is irrelevant and outdated.

The biopsychosocial model was the response of a trained psychoanalyst(Engel) to the demands that psychiatry become a science and a real medical speciality.(1977)

They did not want to change and get rid of their superstitions(Psychoanalysis) and came up with the biopsychosocial model to explain why a purely physical view of illness would not be sufficient to understand and explain illness. They claimed that everything in the body interacted and that would include non-physical factors like character, emotions, social relationships etc.

Since the mind interacts with the body and vice-versa you can say that you have a non-dualistic model. Non-dualistic could include your thoughts causing cancer, AIDS all what you want. It could be totally removed from reality and still be non-dualistic.

Check out the original article from Engel.

http://www.lumsa.it/sites/default/files/UTENTI/u668/PSIC_HANDICAP_Engel 1977_modello_biopsicosociale.pdf

At a recent conference on psychiatric
education, many psychiatrists seemed to
be saying to medicine, “Please take us
back and we will never again deviate
from the ‘medical model.’ ” For, as one
critical psychiatrist put it, “Psychiatry
has become a hodgepodge of unscientific
opinions, assorted philosophies and
‘schools of thought,’ mixed metaphors,
role diffusion, propaganda, and politick-
ing for ‘mental health’ and other esoteric
goals” (1). In contrast, the rest of medi-
cine appears neat and tidy. it has a firm
base in the biological sciences, enor-
mous technologic resources at its com—
mand, and a record of astonishing
achievement in elucidating mechanisms
of disease and devising new treatments.
It would seem that psychiatry would do
well to emulate its sister medical dis~
ciplines by finally embracing once and
for all the medical model of disease.

Now what Engel replies

But I do not accept such a premise.
Rather, I contend that all medicine is in
crisis and, further, that medicine’s crisis
derives from the same basic fault as psy~
chiatry’s, namely, adherence to a model
of disease no longer adequate for the sci-
entific tasks and social responsibilities of
either medicine or psychiatry

 

[meadowlark]

They are referring to Cartesian dualism. (theoretical separation of mind and body)
https://en.wikipedia.org/wiki/Dualism_(philosophy_of_mind)

Monism :
https://en.wikipedia.org/wiki/Monism

Its a rich irony considering the fact that White et al consistently ignore all biological evidence and like to ascribe literally everything to behavioural/psych explanations

Thank you! The irony re White's view is so astounding that I thought I must have been misunderstanding both theories.

 

[soti]

Pretty much what I'd expect from someone who believes the root causes of this disease are in life events, stress, etc. The trouble is I'm not sure what evidence they would accept that would falsify that belief.

Putting the shoe on the other foot: What evidence would I accept as falsifying my belief that the root causes of my illness are not psychological? Well, if I tried, say, CBT or other psychological interventions and something worked, sure, that would be great and I would accept the falsification of my prior belief (and the ability to leave the house without having to count the cost). However, I've been down that road and always run into the physical brick wall of my condition. So I have every reason to believe that that my condition is not at root psychological.

Since researchers who don't have ME/CFS don't have this experience, they are at a bit of an epistemological disadvantage. Still, that's what science is for. And if you are a scientist, you have to play by the rules of science, despite any convictions you may hold. That's why science is, to misquote Barbie, hard.

They know they can't win.

I wouldn't bet on that.

 

[Large Donner]

Putting the shoe on the other foot: What evidence would I accept as falsifying my belief that the root causes of my illness are not psychological? Well, if I tried, say, CBT or other psychological interventions and something worked, sure, that would be great and I would accept the falsification of my prior belief (and the ability to leave the house without having to count the cost). However, I've been down that road and always run into the physical brick wall of my condition. So I have every reason to believe that that my condition is not at root psychological.

Yes quite. This is comparable to a pharmaceutical company claiming they have the medication to treat a condition but when everyone keeps telling them they get no improvement or they are infact made worse they claim, "ah well people must just be swallowing the pills wrong", at the same time as having zero evidence that their medication works.

Also they can always use the fall back of "x ,y or z has a psychological component. But thats such a vague concept. Everyone person alive healthy or not has "psychological components".

In reality its just a meaningless phrase which seeks to plant it into the understanding of the ill informed that the "psychological component" is automatically flawed and secondly that the person with such flawed components cannot themselves address such components.

This nonsense is so easy to push when the "behaviour" of a sick or diseased person has to change to accommodate a new situation.

Symptoms can be termed behaviours and hence the "connection" is made between mind and body nonsense and therefore "proves a psychological component".

 

[Esther12]

Strange that White, writing in Psych Med, chose not to respond to the Evidence Review describing PACE's post-hoc recovery criteria as 'contradictory'. Instead of trying to defend his spin, he came out with more tedious mind-body drivel. What a missed opportunity.

 

[meadowlark]

What it highlights in this context of MECFS is that due to the ever growing evidence of biological problems in MECFS White and others have been forced to abandon their long held claims that the disease is purely a psychological/social condition.

They know they can't win. But it's their income and status at stake so to hold on to that as much as possible and to slow true biological research as much as they can, they now argue the disease is a combination of biological AND psychological/social causes/perpetuation a. A dualist understanding.rhey don't want a monist understanding in favour of biological causes and perpetuation a as this would cut off their income and they'd go out of business.

Of course, for decades they didn't mind a monist view in their favour, yet despite their monopoly of research funding they have delivered nothing of value over all that time. A complete and utter failure, which is why the IOM report spoke little about his work, it added nothing of actual value.

Thanks--I see now that I am not adept enough at twisting myself into a 3-D pretzel. I will have to learn that before I attempt to follow Peter White's mindset again.

 

[meadowlark]

it's an old psychobabble trick. the concept of "mind" is vague and confusing and can not be studied directly. You can claim what you want and then hide behind nebulous concepts and word games....

Check out the original article from Engel.

http://www.lumsa.it/sites/default/files/UTENTI/u668/PSIC_HANDICAP_Engel 1977_modello_biopsicosociale.pdf[/

... Psychiatry
has become a hodgepodge of unscientific
opinions, assorted philosophies and
‘schools of thought,’ mixed metaphors,
role diffusion, propaganda, and politick-
ing for ‘mental health’ and other esoteric
goals”
QUOTE]

Hall of mirrors. I wonder how many are truly lost in this hall of their own creation and how many of them manipulate it quite cynically.

 

[Large Donner]

Hall of mirrors. I wonder how many are truly lost in this hall of their own creation and how many of them manipulate it quite cynically.

Interesting. The problem is when you add the two groups together it always comes to 100%.

 

[A.B.]

Symptoms can be termed behaviours and hence the "connection" is made between mind and body nonsense and therefore "proves a psychological component".

And they pretend that correlation equals causation and that absence of good biological explanations means that no good biological explanations exist, and finally conclude that these psychological components therefore constitute a psychosocial illness.

And they wonder why patients don't take them seriously.

 

[Aurator]

Really?? Looking at physical and objective aspects in a disease is bad? How can one overemphasize the physical components of a disease?

I'm getting so fed up with their attempts to discredit the legitimacy of our disease.

But then White doesn't see it as a disease:
"Calling CFS a disease implies that there is an established disease process".

He has a point, but at the same time conveniently ignores his own role in actively preventing research that might have discovered a disease process at work in the first place.

His choice of the analogy of depressive illness, his speculative and provocative use of the term "systemic emotion intolerance disease", and his dissatisfaction with the relative absence, in the IOM report, of discussion of "psychological and social aspects of the illness" show where his scientific prejudices (or are they merely emotional prejudices?) lie, but say nothing about why anyone should feel that the recommendations those prejudices cause him to make should be adopted.

As others have mentioned, there is evidence here of a slight shift from the strongly psychosocial position of a few years back. This may have less to do with a shift in his core beliefs than with a futile desire to retain credibility as potential new discoveries come to demonstrate the absurdity, not to mention the injustice, of his and his colleagues' decades-long pseudoscientific theorising.

 

[jimells]

I'm getting so fed up with their attempts to discredit the legitimacy of our disease.

I wonder if the IOM authors will respond to his review?

They can't respond with one voice, because the panel that wrote the report no longer exists.

 

[Jonathan Edwards]

Can someone explain the meaning of "dualistic understanding" in the context of ME/CFS, as well as the meaning of a "monist understanding"?

Signed, Clueless in Toronto.

Dear Clueless (or maybe not so clueless),
'Dualism' is what you call the other person's view when you do not like it (I learnt this in my philosophy MA I did after retirement for fun). It is often intended to imply that the other person believes in some spooky stuff called mind that does not fit within physics, like Descartes. The problem with that is that Descartes did think mind was part of physics, but not the bumping into sort - he was probably right it has to do with electromagnetic fields. White makes a typical dissing statement about 'Cartesian dualism' in this vein. Yet he then pops up with saying that we should focus on mind rather than physics, as if mental causes are not physical.

There is some sort of meaning lurking underneath what he is trying to say but the trouble is he does not realise that what he actually says, at least about Descartes, is gibberish. The fact that he does not realise this seems to indicate a certain arrogance about how much he actually understands. Moreover, as others have pointed out, there is little or no evidence to support his protestations. And even if childhood trauma did predispose to ME we would want to know the physical mechanism involved and try and see it on a PET scan.

 

[Jonathan Edwards]

Check out the original article from Engel.
But I do not accept such a premise.
Rather, I contend that all medicine is in
crisis and, further, that medicine’s crisis
derives from the same basic fault as psy~
chiatry’s, namely, adherence to a model
of disease no longer adequate for the sci-
entific tasks and social responsibilities of
either medicine or psychiatry

An interesting piece of history. How wrong is that? My wife is alive today because medicine was in crisis in 1977? - or was it because of the extraordinary physical skill of the best GI surgeon in England and some chemotherapy? Did I waste my career researching the physical basis of rheumatoid disease? Should I have spent more time considering the psychological impact of not being able to walk? Did I get prostate cancer because I did not realise that alcohol is carcinogenic or because of the psychology of my dependence on a glass of gin in the evening? I think if I had known the physical facts I would not have needed the operation and got used to cranberry tea.

What utter drivel. And to think people still use the phrase 'biopsychosocial'.

 

[sarah darwins]

I wonder if there's some way to send that penultimate paragraph to Rod Liddle with a note "Here's the 'science' you've been defending".

 

[Snowdrop]

My brain thinks about as well as a hamburger these days so correct or clarify as needed but it seems to me that there is (among other problems) one that is intractible in PDW's argument

If he accepts that ME as an illness has both physical and psychological components then it would look like any other illness (unless ME is in a special category all it's own)

The physical aspect of the illness needs to be homogenous that is to say that we all share the same disease process which is what makes us all fall into the same disease category and not some other illness. But by its very nature the psychological is not homogenous. There are ever so many ways to respond to one's environment. To say that we all share a common psychology doesn't make sense. Unless he interprets the psychology as causing the illness in which case how does he justify ME as being a special case? Or is he positing that that is how people come by getting cancer? If it applies to ME it has to apply to other illnesses. As if it does than it cannot apply with any more frequency than any other illness making it at best case a small subset of people (who would respond to his miracle cure).

If he's going down the road of people who have a poor attitude are the one's who don't recover from ME it would apply equally to cancer (for example) in which case he has definitely bit off more than he can chew if he's going to challenge cancer patients.

 

[Aurator]

Here's a presentation Professor White made in 2008. (I'm sure it's been posted before).

Most of what he says strikes me as pretty reasonable. He undermines that impression though by a number of statements (particularly towards the end) that show he's jumped to rash conclusions and is working on the blithe assumption that these assumptions are reasonable.

 

[adreno]

I can't stand listening to him. It's just so opinionated. He starts off by telling clinicians which criteria they should use for diagnosis, based on nothing but his opinion.

 

[A.B.]

I wonder if Engel would have been able to name some diseases were patients were worse off after perception of the illness shifted from psychological to biological.

My impression is that this has always been a positive thing, and is actually a sign of progress.

Peptic ulcer patients are a lot better off with treatment for helicobacter pylorii than with stress management and antacids. Just a random example that came to my mind.

 

[alex3619]

These psychological factors are not discussed because the evidence for their causative role in disease is weak and not credible.

Precisely. Though they claim to be evidence based, the evidence is so weak that it does not deserve mention. If EBM principles were properly used then CBT/GET would be given a very low evidence ranking because of the weak effects, reliance on subjective evidence, methodological and statistical flaws, and so on. Its most definitely not gold standard. I wonder if White realizes that a lot of ME or CFS evidence was passed over because it was not strong enough. I suspect he does.

 

[Kati]

What utter drivel. And to think people still use the phrase 'biopsychosocial'.

@Jonathan Edwards There is another thread for this (http://forums.phoenixrising.me/index.php?threads/vancouver-complex-chronic-diseases-explained.41797/)

but this physician who is a director of the Vancouver clinic wins the prize for disregarding science and branding us patients as bio-psycho-social-central sensitization BS.

Here he actually tells other physicians in BC how to treat patients of our kind. (Make sure to scroll all the way to the bottom, to the comments because he has more to add)

http://thischangedmypractice.com/hope-for-patients-with-fatigue-pain-and-unexplained-symptoms/

We people in British Columbia need and deserve more medicine and less psychosocial BS.
(Edit to add: all over the world... )