alex3619
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Download the PDF. Its much better formatted.
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Created in 2008, Phoenix Rising is the largest and oldest forum dedicated to furthering the understanding of, and finding treatments for, complex chronic illnesses such as chronic fatigue syndrome (ME/CFS), fibromyalgia, long COVID, postural orthostatic tachycardia syndrome (POTS), mast cell activation syndrome (MCAS), and allied diseases.
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One of the most bizarre aspects of this whole farce is the accusation that patients are gaining some special and illegitimate advantage out of this disease. Nowhere do the accusers seriously consider the actual and often extreme losses against the alleged (but unproven) gains.Secondary gain is a huge pile of nonsense.
I think it is obvious who gains the most from such diagnoses.
Reality is stranger than fiction?You can't make this shit up.
Coca is a far more potent and far less harmful stimulant than alcohol, and its widespread utilization is hindered at present only by its high cost.
Long-term use of coca is further strongly recommended and allegedly has been tried with success – in all diseases which involve degeneration of the tissues...
1895 Freud has to have his nose opened up surgically because it was so congested from cocaine abuse that he was unable to breathe.
1895 Publishes "Studies on Hysteria" with Josef Breuer. Introduces the idea that the symptoms of hysteria were symbolic representations of traumatic memories, often of a sexual nature.
DR. HOWARD MARKEL: Freud loved the way cocaine made him feel. And he was very interested in its psychological components. For one, it did make him feel better when he was sad.
He also was amazed at how it made him talk about things endlessly that he thought were locked away in his brain. Sound familiar? That’s talk therapy, but without the toxic side effects of cocaine. But he got to like it a little bit too much.
BETTY ANN BOWSER: Did any of his writings, the dreams, the sense of euphoria, all the things that he got from using cocaine, did any of those lead to anything that we now see in psychiatry today?
DR. HOWARD MARKEL: Well, it did. It did. To begin with, the idea of talk therapy where you talk freely or free associate from one thing to another, may have been inspired by the cocaine unleashing his tongue or his repressed memories. But most importantly, cocaine haunts the pages of “The Interpretation of Dreams.”
MARKEL: Well, it's a complicated answer. It's yes and no. I mean, there are points in Freud's early cocaine abuse where he was amazed at how loquacious it made him, how it freed up ideas that he thought were locked within his mind. Sound familiar?
FLATOW: Yeah.
MARKEL: And of course, that's what - a safer version of that is free association, where you're simply talking about things and going from topic to topic, to try to delve what's in your unconscious or subconscious mind.
The notion that ME patients are all "doing" illness for secondary gains can be disposed of in an instant by reference to the activities of at least some PwME on forums like this one; if we were manipulators of others for secondary gain why would we spend not insignificant amounts of time on PR pushing for effective treatment? Why wouldn't we simply get on with the job of enjoying our little "ill-gotten" secondary gains in silence? This leaves aside the fact that some people, like myself, get no money at all that doesn't come from self-employment - no benefits, no insurance payments, nothing.It is so blatantly false an accusation and smear, with appalling consequences, yet they get away with it for decades.
I don't think it can even dignified with the label 'theorising'. It is just plain malicious propaganda, the sort of stuff that makes it clear they are really not in this game to help us.Yes, the idea that we're in it for secondary gain is one of the cruder bits of generally crude theorising bandied about...
Exactly.The accusation of secondary gains says far more about the accusers than the accused.
I don't think it can even dignified with the label 'theorising'. It is just plain malicious propaganda, the sort of stuff that makes it clear they are really not in this game to help us.
Exactly.
Gain is a psychoanalytic concept first noted and defined by Freud.
He described two types of gains from illness, primary and secondary.
To Freud, primary gain was a decrease in anxiety brought about through a defensive operation that had resulted in the production of the symptom of the illness. Primary gain was therefore an intrapsychic phenomenon. The right arm the becomes paralyzed via a conversion mechanism. He is therefore punished.
This results in decreased guilt and a reduction in intrapsychic conflict and decreased anxiety(i.e primary gain).
Freud went to define secondary gain as an interpersonal or social advantage, attained by the patient as a consequence of the illness.
Since Freud's time the psychiatric definitions for primary and secondary gain have remained essentially the same.
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Absolutely brilliant. I have been waiting for years to see a good scientific paper critical of psychogenic explanations of physical illness. I like these excerpts:
This is a key point: the fact that psychologists and psychiatrists who deal in psychogenic explanations have far lower standards of evidence compared to medical scientists who study biochemical mechanisms of disease.
Spot on. This in a nutshell is the fundamental flaw in psychogenic explanations: the erroneous and baseless assumption that because current medical technology cannot find very much physically wrong in the patients, their physical symptoms must be caused by psychological factors. This ridiculous assumption needs to be purged from medical science.
Thanks for posting this!.
The article itself is only 17 pages long, the 40 pages total is when you include the massive list of references.
Just wanted to mention in case folks are scared by the hefty article.
It's well worth reading.
Yea, I tend to think he did a lot of good stuff, and his bigotry needs to be seen in the context of the period he lived in. If we read back on the other crazy ideas that were about at the time, Freud doesn't particularly stand out. The problem here is that subsequent physicians and other persons have enshrined the guy as some sort of oracle of the truth, when in all those other areas, we have revised our views.Without Freud we would not have… Woody Allen movies! That's how important he was to mankind… (And perhaps we would not have Ingmar Bergman movies as well, an even greater loss)
Its fairly long and detailed with lots of descriptions of symptoms and scales. If you read the intro, the bit on theoretical and conceptual issues, then skip to the Discussion, you get the main gist of it pretty well (the results are summarised at the beginning of the Discussion).I gave up after I vagued out at page 4. I'll give it another go tonight.
I tend to think he did a lot of good stuff, and his bigotry needs to be seen in the context of the period he lived in. If we read back on the other crazy ideas that were about at the time, Freud doesn't particularly stand out.
Spot on. This in a nutshell is the fundamental flaw in psychogenic explanations: the erroneous and baseless assumption that because current medical technology cannot find very much physically wrong in the patients, their physical symptoms must be caused by psychological factors. This ridiculous assumption needs to be purged from medical science.
Other bad stuff around then: wasn't this about the time when it was being recommended that the "feeble minded" should be sterilised? And by feeble minded, they didn't mean severely intellectually handicapped, it seemed to cover anyone of the lowest classes with no education. It was the heyday of phrenology. It also was a time when blacks were believed in many quarters to have higher pain tolerance than whites, so no need of anaesthetic. Prostitutes were held morally culpable of death for spreading syphilis among men. And only a decade or so later, people were coming up with the idea of lobotomies.Maybe too OT: I'm not well informed on Freud, but I've always been pretty disgusted by what I've read from/about him. Was there any real 'good', or just 'a bit less bad than the other terrible stuff going on at the time'?
Good: I don't know whether you can entirely attribute this to Freud, but the idea that "holding in" extreme distress and anger is bad for you. That you need to express it, to "let it out".
This idea of mental health as a thing, something you should preserve/maximise, seems to have arisen around then. Okay, I suppose people around then understood things like pain and grief, but even then, you were supposed to get over these things after a respectable time.
Hell, never thought I'd hear myself supporting Freud's side on any argument! Its just that I put the blame much more on the blind followers. This appeal to Freud's authority, which you still see rampant in the psychogenic literature today.After this extensive discussion I feel I can safely conclude that Freud sucked.
Its just that I put the blame much more on the blind followers. This appeal to Freud's authority, which you still see rampant in the psychogenic literature today.
If your strongest argument in favour of an idea or theory is the identity of the person who proposed it, you got a serious problem. This goes against everything Science stands for.
Hell, never thought I'd hear myself supporting Freud's side on any argument!
Modifying behavioural components to fatigue
Significant central fatigue warrants lifestyle changes, which may include rest periods and reduced workloads (104,105). However, the maintenance of physical activity is of paramount importance. The natural inclination of patients with central fatigue is to decrease physical activity. However, decreased physical activity over time will lead to cardiovascular and muscular deconditioning, which then makes physical activity even more difficult (104,105). Therefore, all patients need to be counselled with regard to maintaining an appropriate level of activity. In addition, an increase in activity should be attempted through the institution of a graded exercise program (106).
In many patients with liver disease and central fatigue, the degree and perpetuation of fatigue may be directly related to and influenced by a complex interaction of physiological, emotional, cognitive, behavioural and social factors (107). A patient’s thoughts and beliefs (ie, cognitions) may contribute significantly to the maintenance of certain illness behaviours, including fatigue (107,108). This concept has received the greatest attention in the setting of central fatigue related to chronic fatigue syndrome (107,108). The idea is that psychological processes not only drive deleterious behavioural patterns, but also directly increase the perception of fatigue (108). Moreover, cognitive behavioural therapy is the only therapy of proven efficacy for patients with chronic fatigue syndrome (109). Therefore, cognitive behaviour therapy needs to be examined as a potential therapeutic modality for fatigue in patients with liver disease. Subjective sleep disturbance is commonly associated with fatigue in patients with liver disease (8,110). Therefore, all fatigued liver disease patients need to be counselled with regard to proper sleep habits.