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Why psychiatry should not get involved...by a psychiatrist

Discussion in 'General ME/CFS Discussion' started by brightonpiers, Jan 12, 2014.

  1. brightonpiers

    brightonpiers

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    Hello, I'm a long time listener, first time caller so to speak. As a UK ME sufferer of 6 years standing, I am particularly galled, as are many, that the psychiatric profession has any input in our illness, let alone the great authority it does have.
    I had been thinking of writing an essay on why they have involved themselves in this way, breaking so many ethical issues. It was going to be something along the lines of a declining branch of medicine (which it is) making a land grab for a significant patient group or order to maintain its waning influence. Whilst I do believe this to be true I couldn't find enough evidence to really make the theory stick.
    However, I did find a very interesting article, in a psychiatric journal no less, that explains with much more lucidity than I ever could, why psychiatry should never be involved here. If it's too heavy a read, the boxes throughout the text provide a useful summary.
    Of course I'm preaching to the choir, but it makes such an interesting and informative read, especially when what seems so obvious and ethical to one psychiatrist, has never occurred to White et al. At this point I'd like to say that I am of course not trying to engender sympathy for the psychiatric profession, but if anyone can produce a good argument as to why ME should not be considered a mental illness, it's a psychiatrist.

    Below is the final summary of the article, but it's well worth reading the rest, link is at the bottom.

    Reasons for thinking that CFS does not have psychological causation
    There are often no significant psychological problems

    Where psychological problems are present, they are often part of the illness or consequences of it

    The absence of a known physical cause does not imply psychological causation

    Where psychological factors are present, they are often not the predominant cause

    Patients report a flu-like illness from which they have never fully recovered

    There is evidence of biological abnormalities of the central nervous and immune systems

    The Department of Social Services regards patients’ problems in walking as generally not of psychological origin


    http://apt.rcpsych.org/content/8/5/351.full
    kafkaboots, Raindrop, beaker and 9 others like this.
  2. alex3619

    alex3619 Senior Member

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    Last edited: Jan 12, 2014
  3. brightonpiers

    brightonpiers

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    By using the psychogenic inference, psychiatry sets itself up as diagnosis by default, sweeping up the crumbs from under physical medicine's table. Where the cause is medically uncertain, they'll offer the last explanation, and as the final explanation, they won't accept contradiction. You'd think they'd have more professional self-respect.
    leela and PhoenixDown like this.
  4. alex3619

    alex3619 Senior Member

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    Doctors sometimes get the too hard cases. We are often called heart-sink patients, that is doctor's hearts sink when they see us as the docs cannot do anything. We are also problems from the doctor's not understanding what is wrong with us. Doctors are often taught to present confidence, the people who have the answers. With us they have no answers. I think that having a wastebasket diagnosis like somatization gives doctors an out. Here, its someone else's problem, not mine.

    Further if doctors acknowledged how baseless psychogenic disorders are, a huge chunk of psychiatry would disappear in a puff of logic, leaving them with millions of people sick and distressed and no answers. I think they often consider its a case of better a bad answer than no answer. Yet I think they would really be better off acknowledging uncertainty and treating patients with reason and compassion. If there really are no answers, don't make one up.

    There is a double standard here, or rather a raft of double standards. In the comments to the article in this thread, they talk about doing away with an artificial dichotomy between mental and physical illness, as mental illness is based on physical problems in the brain. Yet at the same time there is a real world difference in how the two are treated, both in terms of medical treatment and by relevant aspects of society, including insurance companies.

    There is also a conflict in attitude. Psychiatry is science, but oh no, its special science, the subject matter is so difficult that we need special provisions and different standards of evidence. Most of psychiatry is not science, but that does not mean it cannot be rigorous. The problem is that once its thought of as scientific its presumed that standard scientific practices are adhered to. To a large extent they aren't. All psychogenic illness are hypothetical. Treating them as more than that is probably unethical and immoral.

    Getting back to better a bad answer than no answer, this leads to an issue. Such patients need constant review of the cutting edge of science, and more priority in research funding. Doctors are busy, and this is an extra burden on them.

    There is also the issue that biomedical research into ME and CFS is considered unnecessary by many organizations and funding agencies once they think its psychiatric.

    So there IS a difference between treating a disorder as physical or mental. That difference is part of the medical and research world. It has real world consequences.

    I do agree with Peter White on one point though. Mental illness is probably all to do with physical problems in the brain, and some psychiatric therapies (yes, even talk therapy) have a beneficial impact. However in the march for legitimacy they push their claims way too far, like unfounded claims that CBT/GET can lead to 60% recovery rates in ME.

    As patients we have a right to dismiss such baseless and unscientific medical claims. We have a right to reject treatment, but agencies often force them on us, either as a requirement for compliance or through sectioning. We also have a right to object to such large research budgets for psychogenic medicine when many findings in the biomedical science cannot be replicated due to lack of funding. Its double standards all the way, and we don't have to take it.

    Psychogenic Medicine - Dismiss, Reject, Object.
    Tito likes this.
  5. brightonpiers

    brightonpiers

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    I agree with your comment about the baselessness of psychogenic disorders. It sounds like something that is taken more on faith than evidence. If anyone could explain in a convincing way how a right minded, healthy, ambitious person could simultaneously experience a debilitating condition, then I would be all ears, honestly.
    In fact I am very open minded, but the replies by White and Fulford to the original article I posted, suggest they are tangled up in their own conceptual frameworks.
    Roy S, leela and Woolie like this.
  6. IreneF

    IreneF Senior Member

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    The article explains why the physical/psychogenic debate is so much more intense in the UK: differing levels of disability compensation.

    My cat Brigid had a psychogenic disorder. It was quite painful for her--she was peeing blood. It cleared up when one of the other cats died. My theory is that Brigid was disturbed because the old cat was likely blind, deaf, and demented (like kitty Alheimer's) and behaved badly.

    I think people can have psychogenic disorders, at times, but we are also able to understand that "the old cat is sick" and we can learn how to de-stress.
  7. Helen

    Helen Senior Member

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    Finally I found a link to this, what I think excellent article also in English, by a Swedish psychiatrist. He sadly died too early in 2008, but before that he was a strong voice in the debate, I would quote @alex3619 , about "psychobabble".

    It is from another point of view - when somatic doctors tell that diseases and symptoms are psychiatric without scientific evidence
    http://art-bin.com/art/dalen_en.html
    Last edited: Jan 13, 2014
  8. alex3619

    alex3619 Senior Member

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    @Helen, thanks for that article. I am saying a lot of the same kinds of things, though my subject material I am using for examples is different. In particular he takes almost the same attitude as I do, the perspective he uses to draw conclusions. He gives an interesting history of Lyme disease perceived as a psychogenic illness, yet another failure for psychogenic medicine.
  9. Esther12

    Esther12 Senior Member

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    Weclome to the forum @brightonpiers .

    Always good to have new people reading and posting interesting papers.
    brightonpiers likes this.
  10. Jarod

    Jarod Senior Member

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    Hi,

    Couple thoughts on psychiatry.

    1) Most everybody in the health business knows psychiatry is problematic with it's overlap in to real diseases. The science spells it out, and the psychs will probably admit it if asked directly.

    2) The root problem with psychiatry is how the media, and health organizations use the science that exists. Do they select the legitimate papers and science to report, or do they use the bogus stuff?

    The bottom line? Psychiatry is a substitute. I think there is a logical reason(I've thought alot about this), but I don't think most people can grasp it so we are given psychiatry instead.

    Be interesting to see how this all works out in a few hundred years.
  11. Snowdrop

    Snowdrop Senior Member

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    I have a different take on poor Brigid kitty.
    Let's pretent that there was a third cat in the family and that #3 kitty didn't react in any way to Alzheimer kitty's bad behaviour.
    Why not?
    I think that what looks like a mental manifestation (Brigid's response by peeing blood) is a physical issue.
    Perhaps along the lines of Alzheimer kitty being the stressor but the response, let's say anxiety is a physical issue requiring chemical pathways to do certain things leading to the peeing blood.
    Maybe this is a tomato/tomato thing but I see the anxiety leading to peeing as just purely physical caused by an outside stimulus that doesn't happen to be physical like a virus let's say.
  12. IreneF

    IreneF Senior Member

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    There was a third cat who did not respond in the same way. He was the alpha cat.

    Miss B responds to stress by peeing on things, usually my bed.

    I think you and I are saying the same thing (tomato/tomahto).

    My point is that people have understanding and insight into their situations and can help themselves, unlike animals.

    Anyway, Brigid is currently monopolizing my lap. She orders me around.
  13. alex3619

    alex3619 Senior Member

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    Its actually worse than this, if you credit the discussion on DSM committees and how they work by whistleblowers such as Paula Caplan. They cherry pick data, ignoring stuff they do not like, and favouring stuff that is methodologically flawed if it says what they want, and even ignore their own internal reviews. Its only really tested for diagnostic consistency ... that is how many psychiatrists will get the same result on the same patients using the definition. The definitions are not tested for substantive validity, as to whether or not such a disorder can even validly be said to exist.

    Many disorders disappear. Many more new ones appear. They definitions and labels keep changing. This high rate of change, and lack of solid diagnostic markers, is strong evidence that the psychiatric definitions are not mature, and so are still highly hypothetical.

    Yes its a difficult area to do research in. This does NOT give them license to weaken scientific standards, which I see a lot. What is needed, instead, is MUCH more careful interpretation of the data, much better methodologies, and an understanding that much of it is sociology and not science, and deserves to be treated differently. Treating sociology as science is bad. It does not mean that sociology is not rigorous either ... but too much of the psychiatric sociology lacks rigor because they treat it as science when it isn't.

    In a century and half there has yet to be any credible scientific evidence that any psychogenic disease even exists. People get sick. That does not mean their thoughts make them sick. Sure people can behave in ways that make them sick, such as sharing contaminated needles, or even sharing communal bowls of salt, binge drinking etc. That's not thoughts making people sick though.

    There have been a huge list of diseases that were claimed as psychogenic, including Lyme disease, that are now known to be physical (though chronic Lyme disease is still often treated as psychogenic). There has not been even one in which a psychogenic disorder has been proved. Let me say it again: not even ONE. Psychogenic disease is a man made construct of no objective validity. Could there be any psychogenic diseases? Possibly, but they have to do much better than they have to be scientifically valid.
    Jarod likes this.
  14. Jarod

    Jarod Senior Member

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    planet earth
    ;)

    This is kind of along the lines of what I was trying to say. Who knows how many real diseases convieniently overlap with psychiatry. Why is that? I bet on deniability.

    The science only applies to the scientists. Otherwise, leave it up to the media to cherry pick their favorite articles and do a creative writing exercise job on us. Why is the media(and govenrment authorities) always side with the most marginal and bogus science?

    Rant over.
  15. Firestormm

    Firestormm Guest

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    If psychiatry merged with neurology would than make matters better or worse? :)
    Last edited: Jan 16, 2014
  16. alex3619

    alex3619 Senior Member

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    @Firestormm, both? Better for psychiatry, worse for neurology?

    Psychological counselling is here to stay. However medicalization of thought processes without corresponding neurological involvement is dubious.
  17. Firestormm

    Firestormm Guest

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    What's the history Alex. Didn't one split from the other?
  18. alex3619

    alex3619 Senior Member

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    Hmmm, not entirely sure Firestormm. Neurology goes back to Charcot, that father of modern neurology. So does psychobabble, but psychiatry in general I am less sure of. Psychiatry/psychology arose from philosophy of mind, whereas neurology arose from biology of the brain.

    Charcot is a unique figure as he is the originator of both modern neurology (I think, hmmmm, will have to check that) and modern hysteria. http://en.wikipedia.org/wiki/Jean-Martin_Charcot

    PS According to Wikipedia, not always a reliable source but easy to find, Charcot was one of the pioneers of neurology.

    Freud was one of Charcot's students.
    Firestormm likes this.
  19. IreneF

    IreneF Senior Member

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    Interesting article:
    What’s Next for Somatic Symptom Disorder?
    http://ajp.psychiatryonline.org/article.aspx?articleID=1787312

    "In the absence of abnormal thoughts, feelings, and behaviors, patients with irritable bowel syndrome, chronic fatigue, or fibromyalgia would not qualify for a diagnosis of somatic symptom disorder."
    roxie60 and Esther12 like this.
  20. Snowdrop

    Snowdrop Senior Member

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    I just had a look at what I said and I'm not sure that I was altogether clear. I'm having trouble organising my thoughts.
    Or perhaps I'm not understanding what you're saying.

    Can't argue with our having insight and understanding that kitty has no access to and that we can, using metacognition, alter a rising response by being aware of it.

    Are you saying kitty's non ability to alter her response with insight is the hallmark of what makes it psychogenic? Or the outside stressor?

    My thoughts are that even though we might be able to alter our response that doesn't alter the fact of it being physical.

    I think this is where the waters get muddy. What is the nature of mind. If something arises from the mind does that mean that It's 'all in our head'? Again, I think of mental phenomena as arising from some physical stimulus to our environment. Depending on our personal physical makeup that stimulus may lead us to ignore cranky kitty or become upset. Again, the difference being that we can think about that stimulus and (sometimes for some things) alter that response.

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