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CBT/GET potentially harmful to ME/CFS patients

Discussion in 'Latest ME/CFS Research' started by _Kim_, Nov 3, 2009.

  1. Dolphin

    Dolphin Senior Member

    It is not absurd. For a start, it is not at all clear that Peter White has dropped muscle pain from his vocabulary.

    Secondly, he may not know or accept the symptoms that patients face and why they might stop exercising. So he may not see fatigue as encompassing all the other symptoms.

    Thirdly, as most people in this thread agree, fatigue is not an adequate term to describe the symptoms people with M.E. feel when they over-exert themselves so whatever meaning he has in his head for fatigue doesn't mean that we can't challenge it (when he is describing the illness to other professionals) to say that it does not adequately describe what people experience. And why they may stop exercising.

    You have shown little interest in criticising his ideas. When I see you criticising one of his papers, I might think you care about this issue.
  2. Dolphin

    Dolphin Senior Member

    As Ellen Goudsmit has pointed out e.g. , the message has gone out from some of those pushing GET and CBT based on GET that we are wimps scared of a little fatigue.

    This is why it is important to challenge claims and wordings which do not get across the extent of the symptoms we feel when we over-exert.
  3. Alice Band

    Alice Band PWME - ME by Ramsay

    Maybe Esther would like to explain to us why she has this particular and prolonged interest in discussing GET?

    That may help people here to understand one another a little better.

    From my position I'm always interested in GET discussions because I have experienced a program.

    Esther, maybe tell us a little about your self and why you would spend so much time on a thread on GET?
  4. Esther12

    Esther12 Senior Member

    The answer was in the post you quoted:

    "If GET is criticised for claiming that patients only suffer fatigue and not muscle pain and cognitive difficulties, then anyone who knows that the term 'fatigue' being used is intended to include these difficulties will be able to rightly dismiss your complaints as (what would be more polite thing to put here? I really can't think of a better way to put it)."

    When you're criticising someone's arguments, it's good practice to attack the interpretation of their case which is the most resilient to attack. If your criticism is based upon a particular interpretation of a word, when another interpretation would invalidate your point, it can be dismissed as just straw-manning your opposition. This is especially the case seeing as you've now acknowledged that Peter White is likely to be using 'fatigue' in a different sense to your own.

    Right: They should be clearer. That was the point I made back on page one (really - go check if you want to see how far weve progressed since then).

    That's a different criticism to the claim that saying GET may result in 'fatigue' is somehow the same as claim GET will not result in muscle pain, cognitive difficulties, etc.

    1) No one's claiming he has.
    2) He may not. No-ones claimed otherwise. Equally - he may.
    3) You're free to challenge the use people make of the word 'fatigue'. You go for it if you want. But it's strange to act as if others are using your own definition of the word, even when you have good reason to believe they are not.

    I don't think it's an interesting issue. I think it's important for people with CFS, but intellectually, it bores me senseless. The evidence and theories surrounding GET all seem deeply doubtful, murky and contradictory to me; and it seems to attract those happy to talk with misplaced certainty about complicated and uncertain matters.

    Ive spoken repeatedly within this thread of the problems with GET and CBT, the way theyre promoted, and the way the medical community treats those with CFS. Ive probably reduced the amount Ive mentioned this as the thread has gone on because no-one disagrees with these points, so theres no reason to go on bringing them up.

    I have little interest in talking about GET. But Ive not been on a CFS forum before, so maybe the first few posts and replies were interesting for getting the perspective of other patients and clarifying my own ideas. More recently, I find it difficult not to reply to criticisms of my posts.

    For myself:

    I tried sort-of GET for my first year of being ill (really though it was just pushing myself and trying not to act like I was too ill). Then I did a year of pushing myself when I needed to, but taking more time to rest too. Then I did two years of pretty good GET. None of it made me feel any better, although I was never able to really enter any prolonged period of increasing exertion levels without a worsening of symptoms.

    Since then for about 4 years I've done more pacing and resting.

    I went to a GET clinic five years back, and the people there seemed like morons. They couldn't answer any of my questions, and seemed to resent me for asking them. It's possible they were trying to follow a CBT script, but were just very poorly trained.

    I think its possible GET and CBT could be useful, but are just very poorly applied to most patients. I dont know though. Currently Im not interested in giving them another go, but if further credible research is released which indicates they are likely to be of use, I might give them another go.

    I think Ive already provided all of this information, and it shouldnt matter anyway - my posts are my posts, and its just basic courtesy to respond to them as they are. The string of maybe you dont have real M.E., maybe you should just do some exercise then, maybe youre bonkers type inferences were just tedious. Whatever my personal experiences, they should be of little significance to a topic like this a sample of one is rarely compelling evidence of anything.
  5. Alice Band

    Alice Band PWME - ME by Ramsay

    Thank you very much for your reply Esther and talking about your experience at the clinics.

    I'm genuinely curious to know how GET could be applied better to any patients with genuine CFS or ME.

    Like yourself my condition worsened.

    Initially by experimenting to see where my levels were, then by trying to maintain a baseline and of course by increasing my activity. I went from being able to work a little bit sometimes, to being unable to bathe.

    Even the simple physical exertion needed to go to the clinic led to a downturn in my health.

    If one accepts that people with ME and CFS have post exertional symptoms, then I can't see how GET can be applied at all.

    Obviously, there will be a subgroup of people at the clinics who have recovered from a viral or fatiguing illness and can now increase their activity so that's not the group I am thinking about.

    Any ideas anyone?
  6. flybro

    flybro Senior Member

    Nancy Klimas says

    Nancy Klimas says
    5 minutes of some activity, followed by 5 minutes of no activity,

    so 5 on, 5 off, 5 on, 5 off,

    So if you were bed bound doing nothing, un able to abide noise, or light, or unable to sit up,

    perhaps a slight raised angle of 5 degress of the back of the bed for five minutes, may be raise the blinds a couple of millimetres, maybe turn a radio on very very low for a 5 minutes.

    I am pretty sure her intention would be that before patients try to re-condition that they have been on the supplements she recomends, and would be having regular NK cell tests, and watching for viral lode.

    Unfortunately, it does appear that in the UK CBT & GET seems to be run by individuals who are perhaps unaware of the immune/neuro/endocrine dysfunstion and needs of PWME/CFS.

    Also in the UK the research funding has mainly gone to the psych lobby's, which means that PWME are sick of having treatments to 'heal their minds', or 'recondition their bodies', when they are not offred anything that offers them support for viral lode, POTS, inflamation. Or blood tests that will check for bio-markers and the physiologilcal state of the endocrine/neuro/immune/cardio/vascular and give the PWME and indicator of wellness.

    It is hard to accept the psych lobby's findings because, the MRC has not been equal with bio-medical research funds.

    When so much scitific data has been ignored, why are we getting the supplements that work, why can't the NHS of USA insurances prescribe these.

    Whys is there no MRC research into the evidence of others biomedical research.

    If both sides, the bio-medical and 'sports/psych mind-body' research had been equally funded, perhaps more patients would have been able to benefit from CBT & GET, becuase they would have been made well enough by medicine to progress from illness to wellness and then perhaps to progressivly fitter.

    Just my 2 penneth.

    I for one was infuriated by my CFS expert.
  7. Dolphin

    Dolphin Senior Member

    Lucky for you that can sit back and not feel any responsibility on the issue.

    I'm grateful for the people who try to challenge him.

    For anyone reading this thread, here are some of his views which influenced the final NICE Guidelines:

    If you have sensitivies to chemicals, make sure to look at part (viii) including the references.

    It's a message I sent to Co-Cure around 2 years ago.

    I previously highlighted some points made by the Association of
    British Neurologists during the NICE process: i.e.

    and highlighted that one can read further submissions at:

    "Chronic fatigue syndrome / Myalgic encephalomyelitis: stakeholders
    comments and GDG responses":
    [AOL: <a href="">Here</a>]

    However this is a huge mass of information and going back and
    comparing it to the original is a lot of work. So I imagine most
    people will not do it.

    So I thought I'd highlight some comments by St Bartholomew's Hospital
    Chronic Fatigue Services. I have done this on a couple of UK lists
    and people have been fascinated by what was said.

    St Bartholomew's Hospital is often shortened to Barts - this is not a
    derogatory abbreviation.

    The Barts service is led by the psychiatrist, Prof. Peter White.
    Peter White is a major person in the CFS world. He has done much work
    in the US in recent years including with the CDC so I thought people
    around the world might be interested in some of the points they made.

    I have not put comments so people can judge the comments themselves.




    (i) On Disability aids and equipment:

    [TK: A blue badge is a disabled parking badge to allow somebody park
    in a disabled parking space]

    Draft text: For adults and children with moderate or severe symptoms,
    provision of equipment and adaptations (for example, a wheelchair,
    blue badge or stairlift) to allow individuals to improve their
    independence and quality of life should be considered, if
    appropriate and as part of an overall management plan.

    SH St Bartholomew's Hospital Chronic Fatigue Services
    69 FULL 183
    "…equipment and adaptations (for
    example, a wheelchair, blue badge or
    We disagree with this recommendation.
    Why should someone who is only
    moderately disabled require any such
    equipment? Where is the warning about
    dependence being encouraged and
    expectation of recovery being damaged
    by the message that is given in this
    intervention? We are in no doubt that it
    is a powerful message for a therapist of
    any sort to provide such aids. Our view
    is that such aids should only be
    considered by a multi-disciplinary
    therapeutic team as a whole, and
    usually in the context of providing a
    temporary means for a patient to
    ncrease their activity levels. An
    example would be providing a wheelchair
    for a bed-bound patient as part of
    their active rehabilitation programme. In
    our opinion, such aids should never be
    seen as a permanent solution to
    disability in this illness.

    We have recommended such
    equipment only if appropriate, and
    as part of an overall management
    plan and as an aid to independence.

    Another quote along these lines:
    In reply to (Draft NICE text): For adults and children with moderate or severe symptoms,
    provision of equipment and adaptations (for example, a wheelchair,
    blue badge or stairlift) to allow individuals to improve their
    independence and quality of life should be considered, if
    appropriate and as part of an overall management plan.

    Barts wrote:
    Equipment and aids may hinder
    recovery as much as help it, and their
    prescription needs to consider both
    outcomes. We believe disability aids
    can help a patient towards recovery if
    their use encourages a widening and
    increase in their own activities, on a
    temporary basis, as a means of
    supporting a rehabilitation
    programme. They should rarely if
    ever be used for patients with only
    moderate disabilities.


    (ii) On making information available on audio tape:

    SH St Bartholomew's Hospital Chronic Fatigue Services
    91 FULL 260 13

    Why should anyone with concentration difficulties find it easier to
    use audiovisual technology, which by your implication does not involve
    reading, more than reading itself (from either a book or computer
    screen)? Would it not be more effective to negotiate a simple graded
    programme of reading to help such a patient improve their reading
    ability, along with helping to improve their cognitive capacity
    through improving sleep and mood? What might be effective advice is to
    encourage the use of voice-activated software in someone who finds
    typing using a keyboard physical tiring, and needs to meet a deadline
    in their job or studies.

    Noted and removed – we consider that the text on including cognitive
    activities addresses these points.


    (iii) On Weight loss in CFS/ME

    SH St Bartholomew's Hospital Chronic Fatigue Services
    88 FULL 248

    "Adults or children who experience
    severe weight loss should be referred
    to a dietitian for assessment, advice
    and nutritional support, which in
    extreme cases may include tube
    This is alarming and arguably negligent
    advice, which we strongly condemn.
    Any patient who experiences severe
    weight loss should be referred for
    appropriate assessment, not by a
    dietician alone, but by an appropriate
    specialist doctor (gastro-enterologist or
    psychiatrist) so a diagnosis can be
    made. We do not know of any reliable
    or replicated evidence that severe
    weight loss, in deed any weight loss at
    all, is a part of CFS/ME. Whereas we
    are aware of patients referred to our
    service with a diagnostic label of
    CFS/ME who on assessment have an
    alternative diagnosis, most commonly
    anorexia nervosa (sometimes
    presenting atypically without a body
    image disorder, which is well described
    in the anorexia nervosa literature), but,
    on occasion, malabsorption.

    This recommendation has been


    (iv) On Neuropathetic pain and Gabapentin:

    Draft Text:
    Gabapentin: The GDG noted that the wider survey was supportive of
    gabapentin in severe CFS/ME sufferers. The GDG was uncertain why
    this was the case. Because of its side effects, the GDG did not
    think that it should be used for mild pain but there will be certain
    individual cases when it might be considered despite a relatively
    high side-effect profile. The GDG decided not to make a positive or
    negative recommendation.

    SH St Bartholomew's Hospital Chronic Fatigue Services
    87 FULL 233 1

    The GDG noted the survey support of
    the use of gabapentin in CFS/ME.
    However this drug is licensed for
    neuropathic pain. There is no evidence
    that patients with CFS/ME have a
    neuropathy and we would not
    recommend the use of this drug,
    particularly as one of its significant side
    effects is sedation, without empirical
    evidence for its support, which is
    currently lacking. It would be surprising
    if NICE gave guidance based on
    anecdotal evidence, an inaccurate
    indication, for a drug, which has
    significant adverse effects.

    NICE Response:
    Noted and we have recommended
    that people should be referred for
    specialist pain management if

    (v) Bowel symptoms and CFS/ME:

    Draft text: Prescribing of gut anti-spasmodics (such as mebeverine,
    alverine, and peppermint oil) should be considered for adults and
    children with bowel symptoms, such as cramp or bloating.

    SH St Bartholomew's Hospital Chronic Fatigue Services
    85 FULL 229
    "..gut anti-spasmodics.." are not
    treatments of CFS/ME since bowel
    symptoms are not part of CFS/ME. You
    should make it explicit that this
    treatment might be indicated for the
    treatment of IBS, if present comorbidly.
    Alternatively, and perhaps more wisely,
    you could suggest that IBS, if present,
    should be treated in the light of the best
    available evidence, and refer readers to
    appropriate guidance, which may or
    may not include considering
    antispasmodics as the treatment of
    choice for "bloating", although we would
    doubt it. You do mention IBS on page
    233, line 12.

    We have revised this
    recommendation and referred to the
    NICE IBS guideline – currently in

    (vi) On Drug Intolerance and CFS/ME:

    Draft text: Adults and children with CFS/ME may experience greater
    intolerance and more severe adverse/side effects from drug
    treatment. Where appropriate, drug treatment used for symptom
    control should therefore be initiated at a lower dose than in usual
    clinical practice, and should be increased gradually.

    SH St Bartholomew's Hospital Chronic FatigueServices
    84 FULL 229
    We are not aware of any reliable and
    replicated evidence to support the
    statement that patients with CFS/ME
    are more intolerant or have more
    severe adverse effects; and "more
    intolerant" than whom? We do not
    agree that drug treatment should be
    initiated at lower dose than in usual
    clinical practice. This possible myth is
    repeated within the guideline at various
    points, and is important since it may
    make doctors more likely to prescribe
    sub-therapeutic doses. If you are going
    to keep this included, you should make
    sure that the anecdotal level of
    evidence for this is explicitly stated. We
    would suggest changing to "..drug
    treatment at lower doses may be


    (vii) On Recovery times:

    Draft text: When planning a programme of GET the healthcare
    professional should:
    • discuss with the patient ultimate goals with the patient that are
    important and relevant to them. This may be, for example a 2 x 15
    minutes daily brisk walk to the shop, a return to previous active
    hobby such as cycling or gardening, or, if more severely affected,
    sitting up in bed to eat a meal.
    • recognise that it may take weeks, months, or even years to achieve
    goals, and it is essential that the therapy
    structure takes this pace of progress into account.

    SH St Bartholomew's Hospital Chronic Fatigue Services
    75 FULL 188

    These goals should include recovery,
    not just exercise and activity goals.
    If it takes "years" to achieve goals, then
    either the goals are wrong or the
    therapy is wrong. What other treatment
    in medicine would take years to work?
    We suggest "or even years" is deleted.
    If a therapy is not helping within a few
    months, either the therapy or the
    diagnosis or both should be reviewed
    and changes considered. We suggest
    that this advice is pertinent to all
    treatment approaches, not just for GET.

    The statistics indicate that total
    recovery is relatively rare and the
    GDG felt that to include recovery as
    a goal may lead to disappointment.
    As the goals are patient derived
    they may be long term. Interim
    goals would be developed.


    (viii) on Multiple Chemical Sensitivity (MCS):

    Draft text (this is in a section on severe CFS/ME):
    "Family life may also be affected as people with severe CFS/ME are
    often sensitive to sounds and smell. For example, the person may be
    unable to tolerate light or cleaning products whilst they are often
    unable to control their body temperature, thus impacting on the living
    "..Those caring for an individual with severe CFS/ME professionally
    need an understanding of the illness and the needs of the individual
    to meet the challenges of, for example, cooking or cleaning for an
    individual who is sensitive to the smell of food or of cleaning
    materials or bathing an individual who finds touch painful. Therefore
    proper training should be given about the condition with the
    involvement of the patient for any particular problems."

    SH St Bartholomew's Hospital Chronic Fatigue Services
    92 FULL 261 3 +

    A patient with increased sensitivity to the smell of various
    chemicals may be suffering from multiple chemical sensitivity, but
    you would be making a dubious assumption to state this is part of or
    even characteristic of severely disabling CFS/ME. MCS is a
    potentially remediable condition through a graded exposure programme
    on the basis that the underlying pathophysiology is a conditioned
    response. It should not be considered as a part of CFS/ME.

    (See: Staudenmayer H, Binkley KE, Leznoff A, Phillips S. Idiopathic
    environmental intolerance: Part 2: A causation analysis applying
    Bradford Hill's criteria to the psychogenic theory. Toxicological
    Reviews 2003;22:247-61.

    Bornschein S, Hausteiner C, Zilker T, Forstl H. Van den Bergh O,
    Devriese S, Winters W, Veulemans H, Nemery B, Eelen P, Van de
    Woestijne KP. Acquiring symptoms in response to odors: a learning
    perspective on multiple chemical sensitivity. Annals of the New York
    Academy of Sciences 2001;933:278-90.

    Otto T, Giardino ND. Pavlovian conditioning of emotional responses
    to olfactory and contextual stimuli: a potential model for the
    development and expression of chemical intolerance. Annals of the
    New York Academy of Sciences 2001;933:291-309.)

    NICE response:
    This section has been removed.


    (ix) Point about whether CFS/ME is an incurable chronic disease or not:

    Draft text: The objectives of the individualised programme are to:
    • sustain or gradually extend, if possible, the person's physical,
    emotional and cognitive capacity
    • manage the physical and emotional impact of their symptoms.

    SH St Bartholomew's Hospital Chronic Fatigue Services
    103 NICE 18

    The emphasis here would be
    appropriate for someone suffering
    from an incurable chronic disease,
    which CFS/ME is most often not. The
    aim of an individualised programme
    should be to help the patient recover,
    or, if this is not possible, to help the
    patient improve their quality of life and
    minimise disability. The expectation of
    both the patient and the practitioner is
    vitally important in determining
    outcome, and these current aims are
    too conservative, and inconsistent
    with the best available evidence.

    NICE Response:
    The Guideline Development Group had
    to balance a positive outlook with the
    recognition that some people will not


    (x) On liasing with employers:

    Draft text:
    • Healthcare professionals should be proactive in advising about
    fitness for work and education, and recommend adjustments or
    adaptations to work or studies to enable rehabilitation of adults and
    children with CFS/ME. This includes liasing (with the person's
    consent) with employers, education providers and support services e.g:
    occupational health services

    St Bartholomew's Hospital Chronic Fatigue Services
    FULL 23 22 thru 27
    Sometimes acting as an intermediary
    between patient and employer may
    encourage dependence rather than
    fostering recovery via empowerment.
    We therefore suggest adding the
    word "may" on line 24 to read, "This
    may include…"

  8. Esther12

    Esther12 Senior Member

    I think this is a good example of the problems we've been having in this discussion.

    What I write seems to have no bearing on what you read.

    I wrote: "I don't think it's an interesting issue. I think it's important for people with CFS, but intellectually, it bores me senseless" and you took that to mean that I think I have no responsibility towards this issue. Even when in another reply to you I wrote:

    I don't think there's anything more I can do about this.
  9. Dolphin

    Dolphin Senior Member

    It's not the same question. You haven't said he makes false and exagerated claims - you're refering to hypothetical claims that are not necessarily the claims he makes. The question is whether you are grateful to the people who challenge him and whether you feel any responsibility to challenge him.
  10. Mark

    Mark Former CEO

    Sofa, UK
    This just seems to me like a really nasty, insulting and misguided post. The accusations of sarcastic tone, seeing what you want to, and considering oneself to be THE authority, all seem to me to apply to some other people's reactions on this thread, but not to Esther12 based on anything I've read.

    And by the way, just because I'm trying to stand up for reasonable debate and reasonable behaviour here, doesn't mean I believe in CBT/GET. I don't. I hate it, and I want to campaign against it, OK? My interest here is in finding good quality, succinct, reasoned resources; arguments against it that I can use. I'm still looking for those.

    I don't fully understand why the following quote of Esther's was moderated earlier, it seems to me it may have been misinterpreted as an ad hominem attack (grammatically, it isn't, in my view), so a bit harsh to moderate it, but probably technically correct I suppose; I'm going to have to be really careful to avoid slips like this though:

    "If GET is criticised for claiming that patients only suffer fatigue and not muscle pain and cognitive difficulties, then anyone who knows that the term 'fatigue' being used is intended to include these difficulties will be able to rightly dismiss your complaints as ignorant ramblings."

    But as for I Wanna be Well's post, what can be said in its defence re: the guidelines on personal attacks? It seems a horrible way to treat a fellow PWC.
  11. Esther12

    Esther12 Senior Member

    No, it's not the same. It wasn't a question either.

    I was replying to your belief that I'd said I felt I had no responsibility on this issue. A strange interpretation of my word either way, made especially amusing by the fact I'd quite clearly said the opposite eariler in this thread. You seem to have avoided responding to that.

    I'm sure Peter White has made false and misleading claims, but I'm not familiar enough with his work to dismiss him outright as a fraud and quack. I'm not very good with names, but I have a vague sense that he tends to be more cautious than other members of the psychological lobby for CFS. This could just be a desire to make his own views seem more presentable and respectable or it could be if is genuinely aware of the uncertainty that surrounds CFS, or it could be I've just not read any of the worse pieces of his work.

    Lets think back.

    For the first point, I was responding to your assertion that people needed to have evidence of a damaged mitochondria and other known abnormalities to be classed as having CFS, and that if I did not, I was misdiagnosed.

    I can't remember if I have evidence of a damaged mitochondria or not, but I do know that whatever abnormalities were identified with me, they played no role in my diagnosis, other than excluding other potential causes. I don't know of a diagnosis criteria for CFS that does require evidence of mitochondria damage, and certainly wouldn't feel comfortable telling those without it that they have been misdiagnosed. That you should do so, and then go on to accuse me of acting like THE authority on CFS strikes me as rather amusing, and may explain my sarcastic tone. The fact that you keep insinuating that I'm some undercover psychologist out to spread dissent in the ranks makes it even more difficult to take you seriously.

    Secondly, I was responding to your assertion that, because the fatigue associated with CFS is different to the mild fatigue it is normal for healthy people to occasionally feel, this must mean that the word 'fatigue' cannot be used to refer to CFS fatigue. I pointed out that the word 'fatigue' is already used to describe a very wide range of experiences.

    Hi Mark.

    I really don't mind the jabs, although I thought the moderation seemed a little one sided too.

    ps: sorry for not responding to people's more contructive comments, but I'm only really sticking with this thread out of some peculiar compulsion. I think I've said my piece, and don't have the knowledge to add any more. I'm just responding to misinterpretations of what I have said.
  12. Dolphin

    Dolphin Senior Member

    I want us to critique Peter White's GET program on this thread (it was posted earlier). It is going to lead to a lot of acrimony if you are going to behave like you have done in recent posts e.g. yesterday. That's why I wanted to get you to say you felt some responsibility on the issue (of challenging him) and were grateful to the people who try to challenge him.

    The statement:
    is pretty meaningless. "False and exaggerated claims" could be that everyone will get better within a month. It isn't well-defined. Peter White or somebody in his team could say it.

    Given your contributions on this and other threads I have my suspicions you are not who you say you are.
  13. Dolphin

    Dolphin Senior Member

    You can read some of his views in an earlier post in the thread:
    If you start critiquing some of them, I might start believing who you say you are.

    While if you say you are a patient living in the UK and have no major problems with them, I find it very odd.
  14. fresh_eyes

    fresh_eyes happy to be here

    mountains of north carolina
    Hi folks. I have not kept up with this long thread, so forgive me if this isn't relevant or I've missed things.

    Hi TomK. I wanted to say that I appreciate your efforts on this thread, particularly posting the White NICE guidelines. I am in the US and don't have much specific knowledge about your situation over there, though I continue to be shocked and horrified. I think it would be very fruitful to hammer out precise, well-reasoned objections to each item. (I couldn't tell - are those guidelines still in use?)

    Hi Esther12. Would it be safe to say that you don't think the NICE guidelines are necessarily so bad? If so, fair enough. I hope you can understand that others feel differently and want to discuss what they would like to see changed, without having to defend themselves at every step.

    It's a challenge to wade through all the argument to get to the information here. Perhaps TomK could start a new thread for those who want to work together to critique White's NICE guidelines. I would like to read such a thread.
  15. Esther12

    Esther12 Senior Member

    You said "You haven't said he makes false and exaggerated claims".... and then when I do so you say that such a claim is meaningless. Why did you care about it in the first place then? I thought it was quite meaningless too, but it seemed of some import to you.

    Anyway, I was replying to your belief that I'd said I felt I had no responsibility on this issue. A strange interpretation of my word either way, made especially amusing by the fact I'd quite clearly said the opposite earlier in this thread. You seem to have avoided responding to that.

    That you're suspicions of my claim to be a CFS patient shows more about the workings of your mind than it does about my posts. Maybe CBT would help you deal with these problems.

    I've not said I have no major problems with 'them' (depending on what the 'them' refers to - I didn't look through the information you posted, so gave no opinion on them way or the other).

    Just now I was unable to find the St Bartholomew's Hospital Chronic Fatigue Services' comments on the NICE website, and I don't really feel terribly interested in spending much more time looking. Most of the ones you posted seemed more cautiously expressed than the psychological CFS work I have the most trouble with.

    I don't think I'm likely to progress the debate about CBT and GET for CFS within the medical community. I don't have the skills or energy to do so.

    If there's a particular medical paper White has written which you think is especially damning, I'd be happy to read it. I certainly understand that the psychological lobby has distorted the discussion of CFS, and think they're drawn to overblown and misleading statement about the nature of CFS and the efficacy of treatments like CBT and GET. On an emotional level I feel a fair amount of resentment and hatred towards them, but I also try not to let that affect my judgements. I also resent the rather childish, tribalist way in which some on this forum seem to think you need to fall into line behind particular beliefs or emotional responses before your comments or illness can be somehow validated. It seems like a hypocritical reflection of the way many in the psychological lobby treat CFS patients.

    If you start critiquing some of them, I might start believing who you say you are.

    How very generous of you. What if I decide Id rather not? What if I end up agreeing with some of Whites claims? What if Peter Whites miraculous treatments lead me to a full and complete recovery?

    I think one of the dangers of internet forums is that they lead to people with very similar beliefs and experiences congregating and then never being exposed to alternative ideas. What a stale form of discourse that would be. It seems to be what some people want though.

    I did read the NICE guidelines recently, and didn't think they were that bad. The draft ones were absurd. I didn't think the NICE guidelines were that good, but it really depends upon what you expect. I started reading them after having read how unhappy most patients were with them, and maybe expected the worst; but I think that most of the contact I'd had with doctors prior to these guidelines was worse than what you'd expect from a doctor trying to follow the guidelines. Flawed as they are, I still think they're an improvement.

    I understand that others can feel all sorts of things. Thats really not a problem.

    If you look back through this thread, you'll see that I did not start this discussion by insisting that others defend themselves against me. My first post was not aimed at anyone in particular, but just an expression of my own ideas.
  16. Dolphin

    Dolphin Senior Member

    What you said in the last post was:
    That's not the same thing. There's no commitment in that. You are telling people you don't know much about him.

    When you say things like giving people disability benefits can impair their chances of recovery and mention psychobabble with regard to other conditions as you have done in other threads, I like others can wonder whether you are a patient who is out of work.

    You can find them in the following files:

    Open up any one and do a little search.
  17. Cort

    Cort Phoenix Rising Founder

    Lets keep this post on track. Its a difficult subject for many, for sure. There have been only a couple of blowups - almost all of which have concerned CBT. In each case someone starting questioning someones identity -and things went south quickly from there.

    We're coming up with some guidelines for the forums. We haven't delivered them so no ones aware of them. One of them, however, is going to be not questioning someone affiliation or identity. It doesn't matter if Peter White himself comes on board as someone else and touts his case. Our focus, hopefully, is on the issue at hand - not at who's delivering it.

    We're trying to get away from these kinds of statements

    so we can focus on the most critical part of the discussion - the information.
  18. Esther12

    Esther12 Senior Member

    You really don't seem to think there's any problem with quote mining. You're quite happy to do it on a forum, to posts people will have just read, or be able to search for. You didn't even feel the need to put '...' after "dismiss him". It's surreal to watch.

    re this sort of statement: so what was the 'them' which you think I said I have no major problem with? I really don't know.

    re NICE guidelines: I did look through the table of comments, and couldn't see them.
  19. Dolphin

    Dolphin Senior Member

    I restrained myself up to now in this thread. Then you started suggesting I need psychological help for wondering whether you are the person you say you are. So combining that with your rudeness in this thread, I felt it was justified.

    I misread your post and edited the post which must have been at the time you were replying.

    The table of contents one is at: - search for "bart" as in "St Bartholomew's Hospital Chronic Fatigue Services"
  20. Mithriel

    Mithriel Senior Member

    Tom, you are a great asset to the ME community. Your activism and especially your ability to explain the deranged statistics of the weasels is marvellous. Your explanations of the empiric definition's shortcomings were admirable. I would rather have you posting about something relevant to us not this endless debate.

    I am tired of reading someone's internal musings. I cannot follow it all with the cognitive problems we have in this disease. I agree with Fresh Eyes. Let's start a thread about CBT with people who have followed all the literature and know what they are talking about.

    By all means carry on this thread amongst yourselves anybody who wants to do so.


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