"Suzanne O'Sullivan's It's All in Your Head wins Wellcome Book Prize 2016"

[Kati]

I thought that he was not actually an MD but was some kind of self-proclaimed "social historian?"

You are correct, he is not a MD. But he works for the faculty of psychiatry at University of Toronto.
http://www.psychiatry.utoronto.ca/people/dr-edward-shorter/

 

[Art Vandelay]

Perhaps this deserves its own thread, but I thought this line of argument from Sonya Chowdhury's letter to be really effective:

What is not true, though, is the assertion by Ms O’Sullivan that M.E. is a psychosomatic illness. We would welcome the chance to see the evidence for this claim.

I've seen the "show me the scientific evidence that ME/CFS is psychosomatic" challenge used by someone else when it came to this book (unfortunately, I'm fairly brain fogged, so I can't recall where I saw it) and I've also seen it used effectively against trolls on various newspaper articles about ME/CFS.

Given that finding such evidence is an impossible task, this is a particularly effective tactic against those critics of ours who claim to be scientifically-minded and rational because it highlights the pseudo-scientific nature of the psychosomatic school of thought (and, indeed, the pseudo-scientific nature of psychiatry in general).

Perhaps a great way to get publicity, much in the way of sceptics on other issues, would be to offer a monetary prize for the first person to scientifically prove without a doubt that ME/CFS is psychosomatic?

 

[chipmunk1]

You are correct, he is not a MD. But he works for the faculty of psychiatry at University of Toronto.
http://www.psychiatry.utoronto.ca/people/dr-edward-shorter/

He is a spokesperson for his psych buddies who where trained in the sixties.

 

[chipmunk1]

Could be. But Shorter's stuff was blatantly condescending.

He has an unique way of explaining medically unexplained illness. I have to laugh every time I read it. It's priceless.

They are convinced they are organically ill! The only treatment, really, is the gift of time, letting the patients tell, and if necessary re-tell, their stories to a clinician who nods sympathetically while not necessarily endorsing the patients’ supposed etiologies

This has worked in about 100% of cases that I have known.

The patient’s subconscious may not have chosen the symptoms. It’s really the culture that choses them, and patients get from the culture an idea of what is medically “credible.” Patients strive to produce symptoms that are medically believable, that cannot be disproven, in other words.

Haha. CFS is NOT credible never has been! It's the least likely to be taken seriously.

Probably the reason why the people subconsciously choose to have diabetes and MS in the fifties because they know it was poorly understood.

Also what about the pseudoseizure patients? Didn't our culture tell them about EEGs?

Somatisation disorder is often diagnosed precisly because the symptoms are so bizarre and nonsensical and unexplained and not credible.

 

[A.B.]

The only treatment, really, is the gift of time

Sounds like he is attributing the improvement from regression to the mean to the (non) treatment. A classical fallacy.

 

[chipmunk1]

Sounds like he is attributing the improvement from regression to the mean to the (non) treatment. A classical fallacy.

When you don't have a clue or an effective treatment, time is the only thing that you can offer.

 

[JaimeS]

When you don't have a clue or an effective treatment, time is the only thing that you can offer.

I really do think that at least a reasonable chunk of the popularity of this theory is due to the fact that it completely removes the onus from the physician to do anything meaningful. I think to physicians who were struggling with the cognitive dissonance of a real lack of understanding of this illness, and feeling helpless at their inability to help clearly suffering patients, it offers quite a few attractive features:

• You don't have to feel bad that you can't help -- the patient's illness is the patient's doing. Instead, offer a paternal ear... that sounds reasonable and kindly.
  
• You don't have to learn anything new -- there is nothing there to learn about. What you know now -- how to be a good listener -- is more than enough. To the physician overwhelmed with new information every day, this probably feels like a blessing!
  
• You don't have to fight an uphill battle with other physicians. (No, really. I don't care if you 'believe' in CFS, he needs a CAT scan as of yesterday.) You get to nod wisely with other mainstream physicians instead of being that guy on the fringes (who was sued, twice.)
  
• You don't have to struggle with the cognitive dissonance of knowing you should be the expert and yet being almost entirely unable to help a patient with an illness so common you and every doctor you know has a patient suffering from it.

I think the psychosomatic theory is so hard to uproot not only because it's 'cost-effective' but because it's so emotionally attractive to physicians. It lets them off the hook, lets them feel superior, and gets rid of the discomfort they feel because of their lack of knowledge. The psychosomatic model says:

It's fine you don't know -- there's nothing you have to know -- you already know everything you need to know.

And most importantly of all,

...you're still in charge, here.

A little more cynical than my usual, guys, but I think that from a psychological standpoint, people don't continue to exhibit a purely behavioral reaction unless it holds some kind of emotional reward.

-J

 

[eafw]

Here's an article from Edward Shorter from last year, showing his contempt for people with ME.

https://archive.is/j8QN0

Why is Coyne giving this guy a platform ?

 

[Valentijn]

I think the psychosomatic theory is so hard to uproot not only because it's 'cost-effective' but because it's so emotionally attractive to physicians.

I'd add one more factor which I've seen in a few cases. Specialists who are very diligent and compassionate in treating their "real" patients sometimes need to have a group of "unworthy" patients to contrast them with. I can't say I fully understand the mentality in these cases though ... is it the need to uphold the narrative of a horde of lazy weaklings exploiting welfare benefits while helping their own handful of patients get the same benefits? Or a need to provide a contrast to show how hard-working, honest, and long-suffering their "real" patients are, and therefore how important they are as doctors?

Regardless, those doctors need some serious therapy to deal with their issues

 

[Valentijn]

Why is Coyne giving this guy a platform ?

To allow a public platform for reasonable responses which show how ridiculous Shorter's statements are?

 

[JaimeS]

Here's an article from Edward Shorter from last year, showing his contempt for people with ME.

https://archive.is/j8QN0

Why is Coyne giving this guy a platform ?

Anyone who is willing to discredit O'Sullivan... strange bedfellows, I guess.

 

[JaimeS]

Specialists who are very diligent and compassionate in treating their "real" patients sometimes need to have a group of "unworthy" patients to contrast them with.

Ugh, the 'us-and-them' mentality that I always find so abhorrent.

Perhaps it's simply difficult to believe that nearly everyone is serious about their illness and not making things up. At least in the US, there is a persistent and prevalent narrative about welfare 'queens' and people who take terrible advantage of the system. Then there is the real concern of drug addicts coming to physicians and hospitals for their next fix. So those people do exist, but I think we as a society haven't done any meaningful digging into what percentage of patients these represent. O'Sullivan's claim that 40% are malingerers (please correct me if I'm wrong) is pretty wild and probably entirely in her imagination.

 

[ScottTriGuy]

Here's an article from Edward Shorter from last year, showing his contempt for people with ME.

https://archive.is/j8QN0

Wow, he's quite the piece of work - his writing exposes his lack of empathy and arrogance in refusal to acknowledge overwhelming biological evidence - and his hostility toward ME patients borders on pathological - he's sort of like a poster boy for hostile psychobabblers shoring up their own careers on the back of sick patients - soon history will judge him for the harm he has done, and it won't be soon enough.

 

[TiredSam]

Here's an article from Edward Shorter from last year, showing his contempt for people with ME.

https://archive.is/j8QN0

Why is Coyne giving this guy a platform ?

I would wildly speculate that Coyne is still on a learning curve and wasn't aware of how highly inappropriate it is to refer to Shorter as an "expert" in the title of an article about ME.

Shorter's tirade of filth has been brought to his attention in the latest comment, interesting to see how he responds.

Edit: Coyne seems to have preferred to think harmful BPS psychobabble is a British thing, and has not reacted well to criticism of the psych brigade from the other side of the pond. Shorter is a Harvard educated social historian, specialising in medical sociology, which presumably gives him a licence to babble all the shit he wants. Very much looking forward to seeing how Coyne handles this opportunity for growth, let's hope he gets it right this time.

 

[worldbackwards]

Very much looking forward to seeing how Coyne handles this opportunity for growth, let's hope he gets it right this time.

Chortle.

 

[A.B.]

Poor Coyne finds out the whole thing is even worse than he could have imagined.

 

[worldbackwards]

Poor Coyne finds out the whole thing is even worse than he could have imagined.

But I can comfortably predict that he'll lash out at any criticism and make a twat of himself. Again.

 

[Mrs Sowester]

I would wildly speculate that Coyne is still on a learning curve and wasn't aware of how highly inappropriate it is to refer to Shorter as an "expert" in the title of an article about ME.

Shorter's tirade of filth has been brought to his attention in the latest comment, interesting to see how he responds.

Edit: Coyne seems to have preferred to think harmful BPS psychobabble is a British thing, and has not reacted well to criticism of the psych brigade from the other side of the pond. Shorter is a Harvard educated social historian, specialising in medical sociology, which presumably gives him a licence to babble all the shit he wants. Very much looking forward to seeing how Coyne handles this opportunity for growth, let's hope he gets it right this time.

This is his facebook comment of 45mins ago
"It is not very useful to be continue this discussion at the level of "psychosomatic condition" or even "chronic fatigue syndrome" because of much of the disagreement is about what we mean and in what context"
https://www.facebook.com/james.c.coyne?fref=nf&pnref=story

 

[TiredSam]

But I can comfortably predict that he'll lash out at any criticism and make a twat of himself. Again.

I'd put it at 50:50, although it looks like he's going for irrelevant waffle and distraction this time. From his FB page as mentioned by @Mrs Sowester :

 

[Aurator]

I see the publishers have just changed the title of the book. It now reads It's All in Your Head: Stories from the Frontline of Psychosomatic Illness.
It's arguably worse.