'A postmodernist theory of medicine: "CFS/ME" and the PACE trials' (by Mary Schweitzer) (Dec 13)

[Dolphin]

'A postmodernist theory of medicine: "CFS/ME" and the PACE trials' (by Mary Schweitzer PhD)
http://slightlyalive.blogspot.com/2015/12/a-postmodernist-theory-of-medicine.html
(Dec 13, 2015)

 

[Tom Kindlon]

I don't know much about postmodernism but the last sentence here:

Postmodernism and medicine are not a happy coupling. The effort to join them must undergo even more scrutiny than usual, because what is being tried here is most unusual.

It is highly unlikely that the authors of the study willingly would allow that data to see the light of day, because so far the evidence suggests the data cannot support the conclusions - and too much is riding on those conclusions.

If the most basic rules of scholarship are permitted to be broken here, where then will they be enforced? CFS/ME is merely perception. Global warming is just biased statistics. “Fracking” has no effect on the environment. That may be your “view”, but my “view” is just as important.

made me think of Humpty Dumpty and how the PACE Trial authors define "recovery":

'And only one for birthday presents, you know. There's glory for you!'

'I don't know what you mean by "glory",' Alice said.

Humpty Dumpty smiled contemptuously. 'Of course you don't — till I tell you. I meant "there's a nice knock-down argument for you!"'

'But "glory" doesn't mean "a nice knock-down argument",' Alice objected.

'When I use a word,' Humpty Dumpty said, in rather a scornful tone, 'it means just what I choose it to mean — neither more nor less.'

'The question is,' said Alice, 'whether you can make words mean so many different things.'

'The question is,' said Humpty Dumpty, 'which is to be master — that's all.'
http://sabian.org/looking_glass6.php

 

[Tom Kindlon]

This piece criticises the biopsychosocial approach (and MUS, etc.) generally; it's not just about the PACE Trial.

 

[TiredSam]

I thought postmodernism was old-fashioned. Isn't it time for a post-postmodernism post?

EDIT: Sorry, I intended the above to be merely fatuous, but I just realised I may have been post-ironic by mistake. I apologise for any confusion.

 

[worldbackwards]

I thought postmodernism was old-fashioned.

That's just one opinion. But there are many narratives here, all with their own unique and equally valuable meaning.

 

[SOC]

I don't know much about postmodernism but the last sentence here:


made me think of Humpty Dumpty and how the PACE Trial authors define "recovery":

I'm finding there's a lot of Through the Looking Glass about PACE, and BPS hypotheses, research, and researchers.

 

[sarah darwins]

'A postmodernist theory of medicine: "CFS/ME" and the PACE trials' (by Mary Schweitzer PhD)
http://slightlyalive.blogspot.com/2015/12/a-postmodernist-theory-of-medicine.html
(Dec 13, 2015)

That's great work, and so important. And timely. Only a few days ago we were treated to Peter White, a man who manages to exert considerable influence on health policy in the UK, dismissing the IOM report as hardly worth reading on the grounds that it failed to address the "sterile dualism" of orthodox medicine. It's worth thinking about what that means — he's saying that a comprehensive survey of the best available medical evidence relating to a serious and widespread illness, carried out by a panel of some of the best scientific minds in the United States, was a "missed opportunity" because it paid no attention to metaphysical considerations; it was just dull old medicine. That, to be polite, is nuts.

I know I've said it before, but I don't believe the politicians who hold the purse strings have the faintest idea of what it is they're endorsing when they allow theories of illness from this quarter to shape health policy. Media commentators are equally clueless about what they perceive as "the science". It's not science. It is, as Mary Schweitzer says, philosophy. And while philosophy is a fine thing, it's not what I'm hoping to hear when I visit my doctor ... "You have a urinary tract infection, Sarah. I'm putting you on a short course of hermeneutics."

The challenge is how to get this distinction across to the policy makers who are unwittingly encouraging all this stuff. They hear the polysyllabic circumlocutions of BPS merchants and they assume they're listening to something very important. It's very clever, for sure, but clever is a long way from important. Or useful.

 

[TiredSam]

That's great work, and so important.

Yes it is. Initially the title put me off, but it's excellent.

 

[dancer]

"You have a urinary tract infection, Sarah. I'm putting you on a short course of hermeneutics."

Yes! This! Thank you for a great laugh this morning. I just heard the weird unscientific "happiness psychology" thinking the other day. A friend's husband is battling cancer and another friend said, "Well, we know he'll beat it because he's such a fighter." (so my other friend who died wasn't?) I understand it's said to be encouraging and offer hope, but it is philosophy not science and puts undue pressures on those who are ill to be ill "the right way" or cure themselves with mind over matter.

 

[Woolie]

I don't know much about postmodernism either, but the article is quite interesting. I was drawn to this bit, which the author argues is a central aspect of postmodernism:

Rejection of the modernist concept of progressivism - that knowledge improves over time

Some might remember that George Davey-Smith once gave a talk at a biopsychosocial medicine conference about the dangers of assuming a psychosocial cause for every illness we don't understand (he focused particularly on gastric ulcers, and how this theory delayed the discovery of a bacterial connection).

During question time, Simon Wessely described Davey Smith's view as "Whiggish". As I understand it, "Whiggish" refers to the idea that progress is incremental, that the more we discover, the closer we get to the truth. He seems to think this is not the case. So postmodernist elements there?

Maybe someone who knows more might comment?

 

[sarah darwins]

Maybe someone who knows more might comment?

I've spent a couple of decades trying to forget most of this, but I do recall hearing "Whiggish" a good deal at college. It comes up a lot in historiography. Here's the Wiki primer on science and Whiggishness:

https://en.wikipedia.org/wiki/Whig_history#In_the_history_of_science

I suspect Wessely would sneer at "Whiggishness" since it is an outlook that tends towards the making of value judgments about past theories and their proponents.

As far as I can see, all intellectual movements in psychology and psychiatry end up being abandoned (which tells you something about these disciplines). But "Freud was wrong" is mere Whiggishness (how banal, how very plebeian). To the enlightened, Freud's thinking may now be better understood in a non-Freudian light. Freud was not wrong, just wrong about the ways in which he thought he was right.

You might see SW's contempt for Whiggishness as a preemptive attempt to save biopsychosocial theory from joining every other historical psychological school in the trashcan.

 

[sarah darwins]

Further .. re George Davey-Smith and gastric ulcers. The enlightened postmodern view is that all those who maintained that such ulcers were the result of stress were not wrong. They were simply working with incomplete data. To say that their insights into the stress levels of ulcer sufferers were 'wrong' would be the worst kind of dualism. One should attempt to reconceptualise their insights in the light of what is now known about h.pylori. Perhaps h.pylori thrives in conditions of psychological stress? Further work is needed (preferably by a large, well-funded psychology department).

 

[Cheshire]

There's an attempt to get rid of time and evolution in postmodernism thinking. To parallel this thinking with psychosomatic theory kind of make some sense to me, whereas I'm not really able to articulate that clearly.

The fact for example that lots of proponents of psychosomatic theory often trace back "hysteria" to antiquity has always puzzled me. Hysteria discribes illnesses for which no organic dysfunction can be found, but most of these hysterical cases would be medical now. You can try to find historic cases of schyzophrenia or depression. But hysteria is definetly dependent of the medical science of a time. Refering to antic hysteria is really a negation of time and context. It's as if hysteria could only work in a timeless space. Maybe that's the sense of Simon Wessely describing Davey Smith's view as "Whiggish".

 

[sarah darwins]

One last thing … I think we’ve seen Wessely preparing the ground in just this way re Rituxan. He and the other bps capos want to create a climate in which clear findings from the Rituximab trials won’t invalidate bps theories (Cartesian dualism … tut tut). Rather, the bps crowd will welcome such findings as an opportunity to re-understand their own insights into the psychological aspects of me/cfs. Further research (ideally publicly funded) certainly needed.

 

[Woolie]

Very nice exposition,@sarah darwins! So a whiggish view is one where current scientists might judge previous scientists on the basis knowledge the original researchers might not have had (we now know the disease A is caused by X, but they didn't have that information at the time and did their best)? So not fair because they have the advantage of hindsight, sort of?

But sometimes those earlier researchers didn't do their best even with the knowledge they had, they collectively made a mess of it for reasons that are largely societal (appeal to religion, appeal to authority - remember Galen, how long did it take to shift that?). And we still have much learn from their mistakes here, lest we commit them again.

 

[Woolie]

e and the other bps capos want to create a climate in which clear findings from the Rituximab trials won’t invalidate bps theories (Cartesian dualism … tut tut). Rather, the bps crowd will welcome such findings as an opportunity to re-understand their own insights into the psychological aspects of me/cfs

There seems to be a lot of this circulatory thinking going on:

no biological markers of disease
-> must be psychogenic
-> biological markers found
-> still psychogenic, because the bad thinking causes the biological abnormalities in the first place.

In this scenario, the lack of biomarkers was the main strand of evidence supporting the original conclusion. BUt when these are found, the goal posts are shifted so that the old conclusion can still be preserved.

Concrete examples? I'm thinking of recent models suggesting inflammatory cytokines might not be causal in depression, but caused by the depression itself. Therefore, even if reliable markers of inflammation are found for MECFS, they could easily be attributed to psychological causes by the BPSers.

Scary thought!

 

[sarah darwins]

So not fair because they have the advantage of hindsight, sort of?

I think the postmodern perspective goes a lot further, dismissing right and wrong, this or that, as fundamentally untruthful concepts. There are views, all of which have a reality and contribute to the construction of a truth at any given time. That sort of guff.

This is why Sokal's famous spoof paper (which of course was published by a learned journal) appealed so much to everyone caught up in this stuff. He even got the subject matter just right: Transgressing the Boundaries: Towards a Transformative Hermeneutics of Quantum Gravity

Postmodernists in all disciplines love quantum mechanics (which they know nothing about) because they think it allows for a world in which nothing is real and everything is real, in which science is no different to, say, a marxian analysis of representations of social stratification in the nineteenth century novel or a Banksy mural .. like that.

Perhaps this is why so much bps research is so dodgy. I'm not sure they think data is all that important. It's just data. Let's talk about the perspective.

Such views are everywhere in the social sciences, and mostly harmless. But it's alarming to see how far they've found their way into a self-proclaimed branch of 'medicine'.

 

[worldbackwards]

Perhaps this is why so much bps research is so dodgy. I'm not sure they think data is all that important. It's just data. Let's talk about the perspective.

But surely this "data" which you speak of is simply an unconscionable restraint on the storyteller and his ability to weave counter-narratives. Such work unrestrained could potentially reveal a wealth of important and challenging dimensions to us about the medical "motif" of CFS, the "meme" if you will, greatly enhancing our potential subjective determinings on the matter in hand.

In painful contrast, these restrictions tell of a mind closed to the myriad paths and destinations that such an approach offers to academia, and possibly patients as well. Instead, you attempt to hobble this potentially dazzling field with such dreary, reductive and outmoded concepts as "truth" and "science", in the process showing up the unimaginative and meagre limits of your so-called "thought processes".

Pah! You, with your "facts" and your "data"...

 

[anciendaze]

There seems to be a lot of this circulatory thinking going on:...

Careful there, you mean circular reasoning, not circulatory.

I have been struck by the ability of BPS researchers to ignore circulatory problems in patients who can demonstrate objective measures of orthostatic intolerance. If your heart rate goes sky high, you have good reason for panic attacks. There is plenty of clinical data on psychological results of tachycardia, separate from psychological causes. Likewise, there is clinical evidence that poorly regulated blood pressure can lead to syncope causing injury or death when pulse pressure drops too low. I have seen considerable BPS verbiage concerning patients "catastrophizing" which totally ignored taking any measurements that might have shown these same patients were suffering from postural changes in blood pressure that might lead to vasovagal syncope.

I am a rare case with an implanted vagus nerve stimulator. I doubt the condition is rare, only correct diagnosis and effective treatment.

 

[sarah darwins]

@worldbackwards - lol. Busted! Does this mean I don't get invited to the Postmodernists' Ball (which is of course a Cube)?