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Psychiatrists Invent health preoccupation disorder

Discussion in 'General ME/CFS News' started by energyoverload, Jul 11, 2012.

  1. user9876

    user9876 Senior Member

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    I believe the editor of the previous edition of the DSM manual has attacked the new version comming out.

    I think many mental health issues will turn out to have neurological causes which is why Peter White wants to take over neurology. Some of the research even comes from the psychatrists unfortunately there are those such as Wessely and White who won't let go of their disfunctional thinking.

    My feeling is over the next few years there could be considerable progress in mental health as scanning an monitoring techniques improve and allow for a much clearer model to develop of how the brain functions. Even things like eating disorders are being associated with disfunction in the insula cortex rather than social factors
    http://www.medical-hypotheses.com/article/S0306-9877(10)00451-2/abstract
    taniaaust1 likes this.
  2. alex3619

    alex3619 Senior Member

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    HI
    PhoenixDown, some of us know better now. The idea of mind-body dualism is deeply entrenched in society. Similarly it can be hidden. Wessely in some places seems to reject mind-body dualism for example, but its difficult to follow his line of reasoning without presuming he implicitly believes in mind-body dualism. Otherwise why ignore so much of the physical evidence? Why dwell on unprovable psychiatric theory rather than work toward objective evidence?

    Bye, Alex
    Enid likes this.
  3. biophile

    biophile Places I'd rather be.

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    I was first diagnosed by a GP physician who had a biopsychosocial view of CFS. He was the first doctor I went to about symptoms as an adult, I did not drift through a dozen other doctors before getting a diagnosis. Yes, he was "conservative" in some ways and his opinions led to overly-optimistic and sometimes inappropriate advice, but overall as a GP physician he was not forceful and was willing to help with basic tests, occasional scripts for symptoms, referrals to specialists, filling out medical forms etc, and all at minimal financial cost to me. He has since retired and the thought of finding another inexpensive doctor in the current climate is rather daunting.

    That said, having a biopsychosocial view of CFS probably did not make his care better. I guess I just wanted to say that doctors with such views aren't necessarily bad, although I did see other doctors that were less helpful and even dismissive because of assumptions that CFS was functional and biopsychosocial. I do despise how the biopsychosocial paradigm has abused CFS as a play thing, but doctors with a biomedical view of CFS aren't necessarily better either. While such doctors were more willing to try exotic tests and treatments, many such tests and treatments are very expensive and often quackery with significant adverse effects.

    Unless I read something really convincing online I'm not interested in engaging the ill-equipped medical profession about CFS treatment again. CFS has a reputation for being difficult to treat, because, well, it is difficult to treat. I still dream about being under the care of a highly competent physician with biomedical views on CFS who is well informed and up to date with access to effective treatments. But to be honest, I question whether such people even exist or at least accessible to me. I'm not interested anymore in seeing the supposed "super" doctors I read about online. Not only do I lack the money anyway, but I fear the further loss of function and none of them sound particularly impressive to me in terms of treatment (although extensive testing sounds rather nice).

    I've reached a point in my life where I'd rather continue to rot away with a relatively poor but manageable quality of life than risk life becoming literally intolerable due to some experimental treatment or therapy. The state of research funding is atrocious, there are good doctors working hard to help, but when one have been ill for nearly 20 years, notions of hope and improvement become abstract; replaced with acceptance, adaptation, making the most of it, safeguarding what remains.
  4. Sean

    Sean Senior Member

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    The previous TWO editors of the DSM, in fact. Which is pretty damning.
  5. Sean

    Sean Senior Member

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    Pretty much in the same place myself, BP. Don't find the medical profession has much to offer me, re ME/CFS. Try to keep contact to a minimum these days, the occasional script, standard monitoring stuff you start getting after hitting middle age, etc. Maybe average two visits a year now.
    Tito likes this.
  6. DaiWelsh

    DaiWelsh

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    ^ this ^

    I have three young children, If I can drag myself to their adulthood without becoming totally bedbound I will count that as a win. Of course would love a cure but I cannot take any more risks on things that may drop me down more notches towards the basement, I am as low as I can go and still call myself a parent right now.
  7. Don Quichotte

    Don Quichotte Don Quichotte

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    I disagree with that. In fact one of the biggest differences among other form of medical treatment and conventional medicine is that it constantly checks itself.
    The changes that have occurred since I was in med. school 20 years ago and now are enormous.
    Just to name a few: Beta-blockers were contraindicated in heart failure, and they are not an important part of treatment of this condition; ulcers were treated with antacids and surgery and are now mostly treated with antibiotics; Staging laparotomy was done in patients with Hodgkin's disease and this is now totally abandoned.

    In fact I think the problem is almost the opposite. Because of the fast-paced progress in the practice of medicine (that no human being can keep up with) it became technocratic and fragmented. It also became extremely expensive, in a way that made it nearly impossible for any country in the world to supply the medical needs of its population.

    The less precise the field of medicine the more it suffered the consequences of this technocratic revolution and the less it benefited from it.

    Psychiatrists and also neurologists require excellent clinical and humanistic skills. This is true to some extent for every physician, but it is easier to get away with not having them in other fields.
    You can be a very reasonable surgeon even if you have very limited communication skills.
    There is no way you can be a reasonable psychiatrist if you lack such skills.
  8. Don Quichotte

    Don Quichotte Don Quichotte

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    I think that a physician should use all his scientific and humane understanding in order to find the best way to help his/her patient have the best possible realistic outcome.
    The fact that some physicians use a certain approach as a way to dismiss their patients, doesn't make this approach wrong. It makes them wrong.
    I do not think you can take good care of a patient without knowing him as a person and without knowing his social situation, support systems etc.
    When one of my neurologists came to discuss with me the hardships of living with my illness, I was very glad and thought that he, like me, doesn't only treat the disease, but treats the patient.
    After I realized that this was not because he was truly interested in me as a person, but trying to find justifications for his ignorance, I looked for someone who will just be interested in my disease and treat it.
    This was a much worse disaster, because that neurologist didn't even bother to at least have some reasonable bed-side manners.
    I then realized that I gave up what I thought was essential for a proper physician-patient relationship, just because someone abused it.
    I now have a wonderful neurologist who does everything possible to make my life better. He has outstanding clinical and humanistic skills.





    I had the ability to reach the best "super" doctors. I have an illness with a reputation of being easy to treat.
    They mostly caused more harm than good, because for them I was a challenge, not a person who came to them for help.




    [/QUOTE]

    Some diseases are very hard to treat, some diseases may be easy to treat, but some patients with those diseases have refractory disease, which means they do not respond to those commonly used treatments.
    Acceptance, adaptation, making the most of it and safeguarding what remains is an excellent and very realistic approach. It can even lead to some improvement in your ability to function on a daily basis with realistic goals.
    At some point you realize that there are no "magic pills" and that with proper supportive treatment, tools and aids you can still lead a very reasonable life.
    Most physicians, unfortunately, have very little interest in taking care of patients who do not respond to their "miracle cures" and don't give them the narcissistic satisfaction of being such amazing physicians.
    I personally think that a true physician is seen by his/her ability to take care of such "frustrating" patients.
  9. alex3619

    alex3619 Senior Member

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    Hi Don Quichotte, if the medical system were self correcting then most medical oversight bodies would have come down against diagnoses like hysteria, mass hysteria and conversion disorder. None of these have validity, and that has been clear for over a century - yet nothing changes. ME would be routinely diagnosed and accepted. Psychiatric drugs would not be over-prescribed. Proliferation of dubious psychiatric diagnoses would be opposed. The medical profession, quite rightly, is highly anti quackery - unless its their quackery.

    Instead they allow individual aspects of medicine to correct themselves, without oversight. Its a failure of the profession and its oversight bodies, not the doctors. Its allowing government committees to make decisions based on policy not science. Its a failure to properly engage in the kind of oversight that would identify problems and correct them. It is, in my view, nothing short of a failure in design of the oversight organizations. Since these organizations are substantially run by and comprised of doctors, then the medical profession largely has itself to blame.

    There are self correcting mechanisms in medicine, just as there are in science. They just are not working consistently or in a timely fashion. The push for evidence based medicine and biopsychosocial methods are aimed at correcting some of the deficiencies, but they are failing.

    EBM fails because it is largely not based on the science nor strict scientific criteria - they have in some cases strict technical criteria but its applied as a blunt instrument. Its highly vulnerable to undue influences, giving rise to the term Zombie Science.

    BPS has been adopted by many who want to justify their own versions of eclectic psychiatry. They claim to be BPS based, but they practice bPs or just -P-.

    There is nothing wrong with the general idea of BPS, and I think it can evolve to something useful. Its the same with EBM. What is forgotten in EBM is it is heavily politically oriented. Managers decide too much, not scientists or appropriate medical specialists.

    In both cases, BPS and EBM, they need to return to the science.

    The essential elements of BPS involving understanding patient situations are not unique to BPS. Its been a key part of medicine for most of a century. In my current view modern high throughput medicine is its main enemy, the main problem. Most doctors do not want to know much about patients if they only have 7 minutes to diagnose and prescribe. In some of the material I am reading a simple increase to 15 minutes begins to correct this. The problem is fast medicine precludes involvement, and changes the way doctors practice medicine. As doctors change the way they practice it becomes entrenched.

    I suspect, but have not properly researched this, that managed medicine is its own worst enemy. Its designed to save money and increase efficiency. However I think long term outcomes decline, creating more problems, and leading to increased long term costs. Its a short term saving for which everyone pays and pays and pays. It does not matter if this is HMOs or nationalized medicine either.

    Personally I would like to see more direct control of medicine by doctors, and of the research by medical scientists. If they are not driving the system they risk become even more disconnected and less likely to be invested in corrected problems. We also need independent research bodies for EBM. They cannot be politically tied to government policy. They cannot be overly tied to large medical companies, whether management, insurance or research companies.

    BPS needs to go back to its roots. I think the failure is its just a restatement of business as usual, without real change, and without appropriate research. Doctors have long known that social situations and psychology is important, but they have no time and are not rewarded for taking this into account. BPS as a discipline needs to have its own research methodologies and not rely on importing ineffective research strategies from, for example, psychiatry. Most of the BPS approach needs to be done in research and provided to practitioners in a well developed form. Most of the factors used in BPS cannot be properly implemented in convetional medical practice, but they can go into research in properly designed studies, and doctors can read the outcomes and apply them - if they have the time and reward structure to do so.

    Bye, Alex
  10. Don Quichotte

    Don Quichotte Don Quichotte

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    No doubt that there is much to correct in the medical system.

    But, the problem does not lie in medicine itself.

    There are many excellent physicians that are unhappy with the way things are and try to correct the system. There many others who care, but are just not fighters in their nature.

    But, the system is part of the society and its structure.

    With regards to conversion/hysteria specifically:

    As you know, I too am trying to understand what is so attractive about the diagnosis of hysteria and why it did not find its place in the museum many years ago. And in fact it seems that the exact opposite it is being used more and more (under different names which all basically mean the same).
  11. alex3619

    alex3619 Senior Member

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    Hi Don Quichotte, I understand your concerns. Its one of the reasons I do not blame medical practitioners as individuals. Some are the cause of the problems, but quite a few are my heroes too, and most are simply overwhelmed by the system I think. It all depends on the person, not just the profession. I also understand just how hard it is to change the medical system. So often those who try are threatened or otherwise punished. That is in fact part of the problem. A decline in medical remuneration, plus a gradually decline in the time doctors have to do things is a big part of the problem. One of the issues would be that to correct this they might have to train more doctors - a problem in many countries. This might also increase medical costs in the short term, though I am yet to be convinced it would increase costs long term if done right.

    Bye, Alex

    PS Just to clarify, by medical system I do not mean just doctors but support systems including government agencies, foundations, oversight bodies etc. Its a lot more than just doctors.
    merylg likes this.
  12. LilacGardenia

    LilacGardenia

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    Everyone needs to read "White Coat, Black Hat: Adventures on the Dark Side of Medicine" by Carl Elliot.

    I also had issues with getting diagnosed with dysautonomia. When my parents took me to the doctor back when my symptoms started getting really bad (when I was 7/8-ish) the doctor right away thinks "ADHD" and wants to prescribe Ritalin and such. He didn't even do any kind of medical testing. I went for years as a "kid with ADHD". Being in this incorrect diagnosis for so many years, made my sympathy grow for people with such problems. Some of them have it just as bad as the people with ME being told it's all "in their head."

    Secondly, I can see psychiatry becoming obsolete in the upcoming years. More is being understood about actual psychiatric illnesses and the science behind them--as a result, much better and permenant treatments are underway. People tend to group mental illness into a category of its' own, but like other physical illnesses, it too shares similar causes as other diseases like cancer and AIDs. Genetics, exposure to certain viruses, and toxins in the environment have all been identified as causes of certain mental illnesses. You can't tell me all of the sudden, something goes wrong with someone's mind without some sort of cause. There is so much leftover stigma that people with mental illnesses are "mad" or "crazy" and like the "CFS/ME is all in the patients head" perspective, it's absoutely wrong.

    When there is a new disease and scientists can't appear to find the reasons behind it (like ME, mental illness in the past, and these mystery diseases given the title "mass hysteria") they pass it on to the psychology professionals. I call it their way of giving up, but not wanting to take credit for not being able to identify the causes behind such diseases, egoistically, it's so much easier to call it someone's work that's irrelevant to your specialty.

    Now there are some issues that are purely psychological that are best dealt with by a psychologist (not a psychiatrist.) Psychaitry was really a specialty created thanks to big pharma's perspectives on how to treat mental illness. It was a failure and a half.
    Merry and PhoenixDown like this.
  13. LilacGardenia

    LilacGardenia

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    I definitely agree that it isn't entirely the faults of doctors. They are tricked into believing incorrect information about some pharmaceuticals. The sales reps are literally trained to coax them Ito believing anything the company wants, because they have a product to sell. Medicine has become more of a business and the original intent of healing, has been pushed aside and below the priority of making $$$. Look at all the solutions (mostly drug-based that require continuous consumption thought one's lifespan) and the diseases being studied and taken under big pharmas wing (diseases that affect large amounts of people.
  14. jen1177

    jen1177

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    I totally agree. I just joined Daughters of Narcissistic Mothers and learned what "gas lighting" means. Have to watch the movie.... Anyway, I also just read the book "The Psychopath Test" by Jon Ronson and you might enjoy it. It's amazing how much power doctors and psychiatrists have over patients. My docs gas lighted me for about 4 years and having no support from my family either I became suicidal and was hospitalized twice. Wasn't until I was nearly dead of Graves' disease which was finally diagnosed in 2002 that I started to realize how dilusional doctors can be. Once I got the Graves diagnosis, the other diseases I had had started getting noticed and the diagnoses started rolling in over the years. Hashimoto's syndrome, endometriosis, celiac disease, migraines, IBS, and yes, CFS. I wasn't crazy. I was sick from multiple diagnosable diseases. Not one doctor ever apologized for nearly killing me by failing to diagnose me as anything other than a psych patient. I would never again be able to trust a doctor of any kind.
    Yep, absolutely sickening. Literally and figuratively.
    Arise likes this.
  15. Don Quichotte

    Don Quichotte Don Quichotte

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    I am trying to understand, why do doctors have the need to diagnose patients with a psychiatric problems, instead of admitting that they do not know what it is.
    I think that one of the reasons for that is that society expects physicians to know. When a physician says that he/she doesn't know they are seen as incompetent.
    Patients understandably want answers. They can be very demanding.
    They want to receive treatment which will make them better, but they do not want to have serious side-effects.
    I know that I myself, initially, felt much more comfortable with physicians who were very confident in what they thought and gave me clear answers. (It took me time to realize that it was not that they knew more or had better answers, but were just less capable of admitting that they don't know).
    Physicians are not allowed to make any mistakes. They are expected to be able to diagnose and properly treat every illness, including very rare ones they have never seen before. They are expected to always choose the right treatment and always warn their patients of possible side-effects and complications, even those which are very rare. If they make management decisions which are not based on strict evidence, they have to document that very clearly and give a very good and convincing explanation as to why they did so. The only mistakes they are allowed to make are those " caused" by their patients. They can miss a serious illness, if they prove that the patient was responsible for that. They can overlook a serious side-effect of a medication if the patient had a psychiatric problem that made it hard for them to evaluate his/her condition properly.
    heapsreal likes this.
  16. Don Quichotte

    Don Quichotte Don Quichotte

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    I recently saw a patient for consultation which exemplified this:

    He was referred by a neurologist, after he had very atypical neurological symptoms, but his lab tests were abnormal and consistent with APLA. (An autoimmune disease which leads to thrombotic complications).

    I told the patient that clinically his symptoms were very atypical, but could be APLA. I also told him that such lab tests could be in perfectly healthy people. I told him that I did not have enough data to decide if he does or does not have this disease and therefore could not make a confident decision regarding treatment.

    I suggested that we try treatment for APLA and see if it leads to any improvement in his symptoms. I also suggested that his neurologist will do further tests to better confirm the clinical picture.

    A few days later he called me and said that he is having horrible headaches and that there is no improvement in his symptoms. I suggested that he stop the medication, as there was no clear indication for it and he seemed to have significant side-effects. I also told him to go see his neurologist ASAP.

    The next day he called me and said that his neurologist was very angry that I told him to stop the medication and that he should go consult someone else, as I am incompetent.
    The neurologist said there was no need for any further testing, as his diagnosis is clear.
    He put him back on the medication I prescribed. This time the patient felt no adverse effects and said that he did notice some improvement.

    I repeated what I said before, and also told him that he is free to consult someone else. He decided he prefers to consult another neurologist. I referred him to someone I trust, who agreed with me that the diagnosis was not clear and suggested further studies. We both decided that as there is some subjective improvement with the medication, he should continue taking it until we finish the work-up.

    A few days ago, the patient calls me again. This time he went to see another physician for some unrelated problem. This physician told him he should stop taking the medication I prescribed , as there is no indication for it. He also gave him the name of an excellent physician to consult. He explained to him that this is a dangerous medication and he could suffer serious side-effects if he keeps on taking it.
    The patient followed his advice, but after 3 days he had more severe symptoms again, so returned to taking the medication and called me for advise.

    I told him that he is free to choose between the opinion of the first neurologist (who told him it was incompetence to let him stop taking this medication because he had symptoms which could remotely be a minor stroke), between the opinion of the other physician (who told him it was incompetence to treat him with this medication without clear evidence that he had a stroke) and between my opinion (which is that I don't know and am trying to find the best management approach with this uncertainty).

    But, I have to admit that at this point I was very glad for him to go consult someone else.
    I can understand how someone like that could raise the need to give him a psychiatric diagnosis.
    He wanted me to give him clear answers, where none existed. He was not ready to patiently wait so that we could gradually find together the best management approach, hopefully with minimal risks and maximal benefits. On the one hand he gave the impression that he trusts me and appreciates my honesty. On the other hand he kept on searching for someone who will give him definite answers. But, even when he did find someone like that, he didn't follow his advise but came back to me so that I will take the responsibility.

    The medical establishment includes also patients. Patients have much more power than it may appear. They can destroy the lives of excellent and dedicated physicians. They are seen as " clients" both for medical managements and for lawyers. Trust is a two-way road.

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