Invest in ME Conference 12: First Class in Every Way
OverTheHills wraps up our series of articles on this year's 12th Invest in ME International Conference (IIMEC12) in London with some reflections on her experience as a patient attending the conference for the first time.
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What exactly *is* the biopsychosocial model of ME ? (Poll included)

Discussion in 'General ME/CFS Discussion' started by Wolfiness, May 26, 2016.

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What do you understand by "the biopsychosocial model of ME" ?

  1. A

    13 vote(s)
    65.0%
  2. B

    3 vote(s)
    15.0%
  3. C

    1 vote(s)
    5.0%
  4. D - something else

    4 vote(s)
    20.0%
Multiple votes are allowed.
  1. Wolfiness

    Wolfiness Activity Level 0

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    What exactly is the biopsychosocial model of ME as advocated by Professor Peter White? I don't want to start an anti-BPS thread, I would just like to know the theory so I know whether I agree or disagree with it. I'm also including a poll to see whether we all agree on what we think they think it is. You can vote for 2 options in case I haven't put any of them quite right and of course suggest your own.

    Is it something along the lines of:

    A) Normal tiredness or deconditioning which the patient mistakes for biological illness due to ignorance and overreaction? Like me misreading my bank statement and thinking I'm overdrawn when it doesn't say that.

    B) An abnormal fatigue perception due to biological causes e.g. elevated cytokines or neurological sensors overstating it, but which doesn't directly affect exercise capacity. Like my bank statement really does say I'm overdrawn but it's wrong, so I could in fact afford to go shopping if only I realised it.

    C) Abnormal fatigue perception due to biological causes (which possibly even stem partly from psychological causes as Gupta suggests) and this then causes exercise incapacity because, say, my brain prematurely curbs energy metabolism because it wrongly judges it's not viable, and this starts a vicious circle. Like my bank statement wrongly saying I'm overdrawn and the bank believes it and charges me for the overdraft and this genuinely does push me into the red, so I really can't afford to go shopping till the bank realises its mistake.

    Or what?
     
    Last edited: May 26, 2016
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  2. worldbackwards

    worldbackwards A unique snowflake

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    It changes with the seasons. It's perhaps better to consider it's practical applications. It used to be that ME was simply a belief that someone had ME, which could be drummed out of them by exercising them back to health.

    It now appears to be some kind of complex interplay between this idea and some undefined and hazy physical elements that probably have something to do with deconditioning, which can only be drummed out of patients very gradually with potential setbacks. These will always be the fault of the patient, who is expected to be able to increase activity at all times.

    The essential point is that psychiatrists must remain the gatekeepers of treatment at all times and make sure that the patient is blamed if it fails. This may be considered to be the biopsychosocial theory of ME, given that this is what it always boils down to.
     
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  3. A.B.

    A.B. Senior Member

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    The cognitive behavioural model of medically unexplained symptoms: A theoretical and empirical review

    http://www.kcl.ac.uk/innovation/groups/projects/cfs/publications/assets/2007/deary.pdf

    There isn't really a model, more like the belief that medically unexplained symptoms are primarily maintained by psychosocial factors (biological aspects are typically viewed as triggers only). The role of the therapist is to identify the psychosocial factors and understand how they result in illness. As a result, there are many different narratives. The most popular one seems to be seems to be that patients become deconditioned during the course of an infection, and then mistake the symptoms of deconditioning for the symptoms of a chronic illness. This would result in a sort of exercise phobia, with gradual exposure to exercise being the cure.

    My personal opinion is that they are working backwards from a conclusion, have no evidence that any of this is true, and have very weak evidence that the interventions they believe would be helpful are actually helpful. Ultimately the patient is blamed for the failure of the therapy which they fervently believe to be effective. They also ignore the biomedical aspects which contradict their narrative and only seem to want to hear positive feedback. The story telling aspects resemble astrology - it's about coming up with a nice story and not letting reality get in the way of it. If one closely examines these narratives they quickly fall apart, therefore they are usually kept vague and unspecific.
     
    Last edited: May 26, 2016
  4. Wolfiness

    Wolfiness Activity Level 0

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    Yes, my first impression is that the BPS model is working backwards from the fear-avoidance-deconditioning conclusion which first arose due to lack of biological evidence. It's having to concede more and more as the biological evidence mounts up, like a Creationist who's had to abandon the Garden of Eden and 4004 BC but is still sticking with the bacterium's flagellum and the God who put it there. But I can't make a judgement on that till I know what the BPS model is, and I'm afraid I'm too mentality exhausted at the moment to read through your link A.B., though I will try later. At the moment I think it's theory B or C.
     
    Last edited: May 26, 2016
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  5. Dolphin

    Dolphin Senior Member

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    Last edited: May 26, 2016
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  6. Hip

    Hip Senior Member

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    The biopsychosocial (BPS) model is best understood not in terms of its scientific merits (which are highly dubious anyway), but rather for the many $billions this model can save the disability insurance industry each year (at the cost of patients, whose rightful disability income is cut off as a result).

    The BPS model basically promotes the idea that biological diseases like ME/CFS are not just caused by physical factors such as infections, genetics, autoimmune responses, etc, and there are psychological and social factors involved in causing or maintaining such diseases.

    The evidence for psychological and social factors playing a causal role is extremely flimsy, but that's not the point, as the biopsychosocial model is about saving money, not about good science.

    The way the biopsychosocial model allows disability insurance companies to cut off the rightful disability payments to patients with diseases such as ME/CFS is by a clause present in the small print of many insurance policies. This clause stipulates that any disease which has a psychological causal component is not fully covered by the disability insurance policy. Disability insurance is also called income protection insurance.

    For diseases with a psychological etiology, the insurance company will only pay typically 2 years worth of disability payments, before cutting of payments. Whereas for diseases or conditions whose causes are purely biological or physical, insurance companies will cover disability payments for a lifetime if necessary.

    Thus for a highly disabling disease like ME/CFS, that can last for decades or a whole lifetime, income protection insurance companies can save many billions of dollars by making ME/CFS look as if it has a psychological component, and this is the basis of the biopsychosocial model of disease.


    Further reading:

    One of the architects of the biopsychosocial model in the UK is Professor Sir Mansel Aylward, who "has been attacked as giving academic credibility to the biopsychosocial model which was said to be the basis of the Cameron government’s disability benefits crackdown".

    Source: Mansel Aylward - Wikipedia

    Mansel Aylward is director of the UNUM Centre for Psychosocial Research, at Cardiff University, which was set up by the disability insurance company UNUM in 2004 to promote the biopsychosocial model. By doing this at a university, it lends an air of academic respectability to the biopsychosocial movement.


    More articles on UNUM insurance promoting the biopsychosocial model for its own money saving purposes:

    Private Eye In The Back: MUTUAL BENEFITS
    Cardiff University | downwithallthat
    UNUM’s UNACCEPATABLE influence in the Formulation of UK DWP-ATOS Disability Assessment Regime
    From the British Welfare State to Just Another American State
    Letters: Private firms' role in creation of disability assessment regime | Society | The Guardian
    The influence of the private insurance industry on the UK welfare reforms
    UNUM Is Still Doing It To the Disabled
    BBC News investigation in to UNUM
    Welfare Reform: The dread of things to come (free eBook) Editor(s): Jonathan Rutherford, Sally Davison
     
    Last edited: Jun 13, 2016
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  7. sarah darwins

    sarah darwins I told you I was ill

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    I've heard Simon Wessely explain what it isn't ("Whiggish Cartesian Dualism") but not what it is. Does that help?
     
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  8. Wolfiness

    Wolfiness Activity Level 0

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    The thing is, I have read Orla's thread, but that's the psychiatric model, not necessarily the BPS model. Is there a difference between what the psychiatrists say and what we patients *think* they're saying? (e.g. here: http://forums.phoenixrising.me/inde...ts-with-chronic-fatigue-syndrome.36659/page-4) Because I do see people talking as though Prof White is talking about plain hypochondria or psychosomatic symptoms when he's clearly not.
     
    Last edited: May 26, 2016
  9. Wolfiness

    Wolfiness Activity Level 0

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    No! Exactly! :) I know what they keep saying they don't think it is but not what they do think it is.
     
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  10. Skippa

    Skippa Anti-BS

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    Basically, you are living your life wrong and whinging when things don't feel right.

    So by re-programming you to think positive and get your life in order (sleep, diet, anxiety techniques, manning up) you will be magically cured 'cos the brain is so powerful it created all this stuff in the first place.
     
  11. Dolphin

    Dolphin Senior Member

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    Whatever way you want to describe Peter White's views and whatever way he wants to describe it himself, it is based on the idea that the problem is reversible with Graded Exercise Therapy.
     
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  12. Wolfiness

    Wolfiness Activity Level 0

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    But is it? He says in the PACE trial write up that GET didn't work for everyone and new treatments are needed. We can't effectively oppose something if we mischaracterise what it is.
     
  13. Dolphin

    Dolphin Senior Member

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    My reading of it was they may have been referring to variations of the same theme, that it wasn't necessarily that they believed totally new therapies were required.
     
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  14. cmt12

    cmt12 Senior Member

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    How about another option:

    You really are overdrawn at the bank. This causes an over-reaction from your financial advisor who puts in all sorts of safeguards to prevent spending, while at the same time charging high fees for his service and putting you deeper into debt.

    Is that a model that anyone proposes? That first says we actually are overdrawn?
     
  15. Hip

    Hip Senior Member

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    @wolfita
    In your question at the beginning of this thread, you may be mixing up two related things: the biopsychosocial model, and central sensitivity syndrome.

    As mentioned above, the biopsychosocial model is a means that major insurance corporates use to avoid paying of disability support to patients with severe diseases such as ME/CFS. The university departments promoting the biopsychosocial model are set up and paid for by disability insurance companies.

    Whereas central sensitivity syndrome (also called central sensitization syndrome) is a scientific idea that, as its name suggests, posits there is excessive sensitivity to sensory inputs into the brain, such that what a person experiences is far in excess of the sensory signal.

    So in the case of pain signals, for example, the idea of central sensitivity is that the pain signal from a minor pain in the body may be hugely amplified by some unknown pathological mechanism such that it now feels like very severe pain.

    There is not much scientific evidence to back up the concept of central sensitivity, but it is proposed as a conceptual framework for understanding diseases such as ME/CFS, fibromyalgia, irritable bowel syndrome, interstitial-cystitis.

    There is a thread on central sensitivity syndrome here, and a short introductory article here.

    To understand central sensitivity properly, you need to view it in the context of functional disorders and somatoform disorders, because central sensitivity provides a possible hypothesized explanation of functional disorders. A definition of functional disorders and somatoform disorders is given in this post.



    The relationship between the biopsychosocial model and central sensitivity syndrome is that the BPS people seems to want to incorporate central sensitivity into their model. Again, I expect this is because central sensitivity may lend an air of academic respectability to this biopsychosocial money-saving scam.
     
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  16. A.B.

    A.B. Senior Member

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    I have some interest in the topic and found this frustrating. I doubt you will find any clearly defined models. The "model" is actually a vague belief that psychosocial factors cause illness. That's all there is to it. An euphemism for psychosomatic.
     
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  17. Dolphin

    Dolphin Senior Member

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  18. Hip

    Hip Senior Member

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    Indeed. To refer to biopsychosocial ideas a "model" is giving it greater substance that it deserves. It is a very vague and undefined notion.

    A good article on BPS ideas is this one: The rise and fall of the biopsychosocial model. An excerpt:
     
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  19. Effi

    Effi Senior Member

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    What I've been hearing a lot from the BPS squad lately is that they believe it is a BIO trigger (e.g. EBV) that causes temporary fatigue. This fatigue is eternalized by PSYCHOLOGICAL and SOCIAL aspects in the life of the patient. This is why they focus solely on changing psychosocial aspects in the life of the patient, as the bio aspect in their eyes is a mere trigger, not the cause.
     
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  20. Wolfiness

    Wolfiness Activity Level 0

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    Yes, this is a good question. If someone finds a biological root cause for fatigue à la mitochondrial myopathy, does that invalidate BPS or merely relegate it to perpetuating factor?
     
    Last edited: May 26, 2016

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