(not important) 2014 Wessely book's chapter on Somatization.

[IreneF]

We're not talking about the diagnosis of serious mental disorders. We're talking about people who supposedly meet a set of criteria for a condition called somatization. Many of us had healthy and active lives before we got this disease and don't meet any of the criteria for somatization.

 

[Kati]

I don't think it is just Wessely who is writing this stuff, other adherents of somatization disorder are also pumping out similar nonsense. Wessely is the name we all know, but many other psychiatrists and professors are peddling such somatization garbage as well.

For example, the somatic symptom disorder DSM-5 working group, whose purpose it was to update the definition somatization disorder (it was redefined as somatic symptom disorder) for the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5), comprised the following members:


Presumably many of these guys above must be writing books on somatization disorder / somatic symptom disorder.

We also have one of these specimens that really should all be sent to Mars based in Toronto. I forgot her name.

 

[Kati]

A nice fantasy But more realistically, I expect that there will be wide-spread calls for their dismissal from clinics and universities, and large-scale retractions of the published papers making groundless and inflated claims.

And loss of knighthood status as well

 

[Valentijn]

I wonder how psychiatrists respond to patients who have ME or CFS symptoms but no evidence of somatization?

They interpret any physical symptoms as evidence of psychosomatic disorder. Hence every ME patient is somatizing, in their minds.

The Lelystad clinic in the Netherlands had me take the Dutch 4DSQ, among other questionnaires. Its purpose is too see if the presumed crazy patient has either a typical psychological disorder or a somatization disorder - there is no "sane but ill" option for interpreting it, unless there are very few physical symptoms.

I scored very low for the subscales on distress, depression, and anxiety, but 12 out of 32 points on somatization, with a score of 10-20 indicating "moderate elevation". Light-headedness, painful muscles, neck or back pain, headache, abdominal bloating, blurred vision/spots, shortness of breath, are all evidence of somatization on that scale.

So they probably quite happily assumed that I was somatizing, even though distress should theoretically be associated with it, and I had extremely low levels of distress.

So yeah ... "too many" symptoms = psychosomatic, as far as they're concerned. Even patients with better-understood biological multi-system illnesses have to beat the quacks off with a stick, due to the belief that these scales are meaningful and accurate.

 

[Valentijn]

Notice that all but the last of these experiments were done decades ago. Yet the process of mental illness diagnosis has not changed significantly in the interim, and the diagnoses by mental health professionals are generally assumed to be correct and scientifically based, despite much evidence to the contrary.

I would LOVE to see how "fatigue" clinics respond to undercover patients who are known to actually have MS, lupus, etc, and who report their symptoms truthfully. I bet they all would end up in CBT/GET with a CFS diagnosis.

 

[Cheshire]

As "nothing wrong" can be found with us, they just assume that somatization is the only thing that can explain our symptoms, and they will pathologize any sane behavior. We do too much, or too little, we have too much support or too little.

Whatever we do or think, if someone has decided it's pathological, well it will be. Because if we didn't have an abnormal mental health, we wouldn't be sick. That’s circular reasoning. They are so sure of themselves that they can’t even consider a not yet detectable disease. Especially when dealing with women, as we are so prone to mental health and irrationality!


We are supposed to be emotionaly unstable, so when facing a rational patient who does not fit their archetypal distressed somatizing patient, some psychiatrist have other justifications in store, so as to incorporate all the patients.


An example of this psychologization of a normal behavior can be found there.

http://www.google.fr/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0CCEQFjAA&url=http://global.oup.com/us/companion.websites/fdscontent/uscompanion/us/images/lamberty/lambertypresentation.ppt&ei=PS7PVLPhAcm5UeG_g5gO&usg=AFQjCNE1jO3MwHXTH1jv0S6uosWwmuW9aA&sig2=67_ZxUU-nZtIso5S15Az7A&bvm=bv.85076809,d.d24


p117 and following

Management

All practice settings are different, but I see two fairly distinct presentations where somatizing patients are concerned.

Stoic

- Typically referred by practitioners from various medical specialties like neurology, rheumatology, infectious disease, and cardiology, but also primary care (family practice, internal medicine) clinics, chiropractic practices, and concerned family members.

- These patients appear stoic and matter-of-fact in conveying their concerns, and they emphasize the objective and medical nature of their problems.

- It is often the case that there has been an event (an accident or injury) and the patient is simply not functioning at a level that is characteristic of them.

- While it is not universally true, the stoic patient tends to have had less overall contact with the medical system than the expressive patient.

-rigid and obsessive personality style

-often quite specific about when their difficulties started

-“world was turned upside down” and all difficulties follow that event difficult to sort through the reality of such assertions as the stoic patient will have incorporated the historical truth of their experience in a way that makes it unassailable in their mind

-In neuropsychology practices, the prototypical example of this presentation is the modal mild TBI case

- The dramatic and almost literary quality of “life changing in an instant” seems to be the main emotional hook for the stoic patient. To the extent that any emotion is shown, it is when discussing the event.

“I didn’t ask for this” or “this is not me” are oft-repeated themes that sometimes bring a brief, almost controlled outburst of emotions.

Another example with (Dutch) OoOps Belgian Van Houdenhove http://psycnet.apa.org/psycinfo/2012-28743-001/ (p 19):

This is often accompanied by so-called hypermentalization or mentalization “on the loose”, and clinicians may be easily led astray by what seem to be elaborate, differentiated, and largely accurate narrative.

Hopefully, Van Houdenhove is there to debunk these particularly hard to detect delusional patients!!

Several features distinguish such accounts from genuinely high levels of mentalizing, including

(a) the excessively lengthy, overly analytical, and repetitive nature of such narratives

(b) the overly cognitive nature of such accounts, out of touch of the underlying affective core of these experiences, or the affectively overwhelming nature of such accounts. […] (my comment: so if you are too emotional, that’s a sign of distress, but if you’re too rational, that’s the sign you’re pathologically dismissing your emotional problems!!)

(c) the inability to “switch perspectives” (my comments: or the inability to adopt the therapist’s view, which can be nothing but the truth, because youa re delusional…)

So we are trapped, they have settled a net that encompasses all behaviors, from “neurotic” to “normal”, so as to catch everyone…


I remember a social psychology study done with psychology students. Unfortunately, I don’t remember where I saw it, if someone’s got a reference, that would be great.

They showed a film displaying a normal person, behaving normally to two students groups. They said to one group, this guy is normal, please describe his behavior. Showed the same film to the other group saying this guy has a psychiatric issue, please find the clues. Guess what happened…




And I don’t think it’s a “psychiatry only” trend. This reasoning can be found throughout the medical system and is endorsed by the whole system. The first ones to adhere to it are the physicians who send us to psychiatrists. And not all psychiatrists agree with this.

 

[lansbergen]

Another example with Dutch Van Houdenhove

I thiink he is not dutch but from Belguim.

Hopefully, Van Houdenhove is there to debunk these particularly hard to detect delusional patients!!

Wasn't his approach a complete failure in Belgium?

 

[Cheshire]

I thiink he is not dutch but from Belguim.

Wasn't his approach a complete failure in Belgium?

Yes, sorry, he is not Dutch.


Yes, the CFS special centers' results mirror those of the PACE trial: improvements in subjective outcomes, but not in physical capacities. So the Belgian government closed those centers.

But CFS is still seen as a mental health problem, and the failure of the centers was not put to a wrong treatment choice, but to a not enough efficient treatment. As CBT didn't bring the hoped therapeutic success, Van Houdendove came with a brand new treatment: a mixture of CBT and psychoanalysis (that's why he talks about mentalization, which is a psychoanalytic concept)


To read more about the reopening of the Belgian centers, you can go to Johan Mares' blog: http://www.pugilator.com/awareness/the-new-multidisciplinary-diagnostic-centres-for-cfs-in-belgium/

 

[taniaaust1]

That's the kind of crap Ive had to put up with for years with some doctors. They lead me on, making out they believed when they didnt and were doing stuff behind my back like ignoring other of my doctors advice for treatments.

Its extremely cruel when one gets a doctor like this and wastes so much time and energy going to them over and over again thinking they are about to do something to help but they just delay eg they may tell you they will refer you soon when you ask when they will during a visit but do nothing at all.

They also will hide any abnormal tests results if say your specialist sent them some results and they are supposed to give them to you. They do all kinds of crap behind your back, including ringing any new doctors/specialists you get and try to turn them against believing you.

Another thing Ive found that sort did to me is to say things like "we'll focus on only one symptom an appointment".. this will then drag things on and on if one has lots of symptoms. Some do this so you dont pick up fast that in truth they arent willing to treat you with anything!! . Want sleep drugs.. they may nsist you keep sleep diary first and do 101 other useless things first... I spent over a year trying to get something for my sleep! (I was going DAYS without any sleep till I was hallucinating at times). It took 18mths or so before I got something for sleep (and it was from another doctor).

I wasted 2-3 years on such a doctor who I thought was looking into things to help me (he acted sympathetic and like he did want to help when he spoke) and thought my specialist had given up on me when nothing was happening.

Turned out all the advice my specialist was giving the other to give me was getting was hidden from me. This doctor finally showed his true colours when one day I was crying at an appointment due a horrfic collapse experience and this doctor turns to me and goes "You arent disabled".

I never went back to him and only after this found out about all the other stuff (by that time the specialist was no longer treating patients cause he'd had a stroke. My specialist never knew what the other did).

 

[cfsStevew]

I see no such explanation, only the assertion that such a phenomenon exists. Probably because it has as much scientific validity as the concept of demonic possession.

yes what are these machanisms pray tell!!

As far as I was aware they have no explanation for this proposed phenomenon?

 

[NK17]

It is not state of the art in the US, neither at my school, internships, jobs, licensing board, and entire career etc. I don't know why it is so vastly different in the UK?

I guess that in the UK the status quo has a strong hold on society.

Just think about the UK's inhumane homophobic laws (subject recently touched in the movie "The Imitation Game", about mathematician Alan Turing who decoded nazy Germany encription machine, used to send messages in WWII).

The fact that british decisions' makers decided to opt out of the Eurozone and keep the £ as the UK currency, also speeks about the will of remaining attached to the past (eventually by 2020 or soon after they'll will have to join as Denmark and Sweden will have to too).

And I'll stop here ...

 

[alex3619]

Opting out of the Euro I actually think was a good move for the UK. A single currency only works for a single country. When you peg the currency then countries doing well will do real well, and countries doing badly are in deep trouble. This is because you removed any chance of currency alterations fixing economic issues.

 

[NK17]

I would LOVE to see how "fatigue" clinics respond to undercover patients who are known to actually have MS, lupus, etc, and who report their symptoms truthfully. I bet they all would end up in CBT/GET with a CFS diagnosis.

I think that ME is where MS was about a 100 years ago.

 

[NK17]

Opting out of the Euro I actually think was a good move for the UK. A single currency only works for a single country. When you peg the currency then countries doing well will do real well, and countries doing badly are in deep trouble. This is because you removed any chance of currency alterations fixing economic issues.

Sure, I agree with you @alex3619, but was just trying to make my point about the British powers that be strong, atavistic and in the end anti-social resistance to changes for the greater good.
The adoption of the € by many European Countries, Greece above all, has been a true scourge.

 

[alex3619]

Hmm, could we organize a sting operation, obviously not in public like here? Or, lol, just advertise that we have and see what happened? Send a bunch of healthy people and people with other clear physical disorders into these clinics and see what happens? Then report on it, outing the ineptitude.

 

[NK17]

Hmm, could we organize a sting operation, obviously not in public like here? Or, lol, just advertise that we have and see what happened? Send a bunch of healthy people and people with other clear physical disorders into these clinics and see what happens? Then report on it, outing the ineptitude.

That would be such a wonderful sting operation!
Such a fine and brilliant idea!!

 

[alex3619]

Sure, I agree with you @alex3619, but was just trying to make my point about the British powers that be strong, atavistic and in the end anti-social resistance to changes for the greater good.

The UK is arguable tradition bound, with its internal processes veiled in secrecy, and not far removed from a police state. The issues leading to that are expounded in The Silent State. Transparency and accountability do not really exist for much of the public institutions, which leads to corruption and support of the status quo. Its a problem.

There are some counter movements going on, most of this secrecy has nothing to do with the general population, but until there is exposure of corruption and archaic processes there will not be much progress. The UK needs constitutional reform very badly, though I can argue most countries need it to some degree. The institutions were created for times gone by, and so were the constitutions, and need to be refreshed for the modern world.

In the coming century countries that cannot adapt are going to be very hard hit. Flexibility is important, as is robust and not efficient institutions and economies.

In this situation its very hard to fight entrenched old school networks in the medical system. The courts are not very helpful. The public institutional corrective mechanisms will fail. The media or government should step up, but journalistic media is failing and the current UK government is part of the problem.

The US has some of that but far less secrecy in its institutions. We are in danger of these issues here in Australia. In fact, the very nature of democracy is checks and balances in addition to popular vote, and this includes a robust investigative media who can report on quirks, ineptitude and corruption.

Its unclear whether citizen reporters can step up and cover the shortfall in media reporting. In depth investigations take time and resources most of the population do not have.

One thing that I think needs to be forced on the medical profession is a choice ... strip them of their rights, privileges and protections, or force them to axe the dead wood from the medical profession. It can reside in alternative medicine without, for example, the ability to use medical or legal coercion to force treatments on patients.

 

[barbc56]

I've been reading about pain and somatization. Poppycock!

Fibromyalgia has no test so you go by symptoms and medical history. Yet, I have never had any doctor tell me it is any form of somatization. When I was first diagnosed with FM there were certainly inferences of depression to the exclusion of medical reasons.

Now, at least generally in the medical community and specifically to my health care provider it's more accepted as a physical illness than previously. FM is recognized by the American College of Rheumatology.

I am truly blessed and realize that my health care is exceptional. I say this not to boast, I'm not sure if that's the correct word, but to show that there are places where you can get appropriate health care. Still not enough nor fast enough but at least there's some hope out there.

Barb

 

[Esther12]

Interpretation of them is not always the same, however, and some schools of thought (and many physicians) believe that there are numerous exceptions that can be made for the greater good of the patient (in their eyes). These exceptions tend to weaken the whole foundation of medical ethics, moving it toward a "whatever the doctor thinks is best" point of view, which allows virtually anything.

Thanks for that post.

I have to admit that a lot of the medical ethics I read seems to be trying to coming up with excuses to allow doctors to do what they want. I suspect that some of that may be because I'm drawn to titles/abstracts that look irritating though!

re the 1st Rosenhan experiment: I thought that a lot of them were diagnosed as having suffered from a psychotic episode, but now being in remission. Also, the participants were not behaving in a normal manner after being admitted, as sane people not attempting to be a part of such an experiment would want to inform the staff that they had faked psychotic symptoms in order to gain admission. While I'm sceptical of many on the claims of expertise coming from psychiatrists, the Rosenhan experiment doesn't really seem to show much.

 

[A.B.]

While I'm sceptical of many on the claims of expertise coming from psychiatrists, the Rosenhan experiment doesn't really seem to show much.

There was also a second experiment:

For this experiment, Rosenhan used a well-known research and teaching hospital, whose staff had heard of the results of the initial study but claimed that similar errors could not be made at their institution. Rosenhan arranged with them that during a three-month period, one or more pseudopatients would attempt to gain admission and the staff would rate every incoming patient as to the likelihood they were an impostor. Out of 193 patients, 41 were considered to be impostors and a further 42 were considered suspect. In reality, Rosenhan had sent no pseudopatients and all patients suspected as impostors by the hospital staff were ordinary patients.