Psychiatrists -- People with authority and PACE.

[ScottTriGuy]

Just want to echo that therapists are in positions of authority.

CBT in not harmless.

 

[Hip]

When you read those GET materials they use this type of authority to assert that up is down, that the scientific consensus is that there is no physical problem other than being deconditioned.

This is a strong abuse of authority

Not really the doctor's fault. Doctors rely on scientific research and medically established protocols. If you have research like the PACE trial purportedly showing that CBT/GET cures ME/CFS, and the CDC inventing diseases like CFS which, unlike ME, is not classified as neurological, then it is not surprising that doctors are going come to incorrect conclusions about the nature and treatment of ME/CFS.

 

[Esther12]

I think in the case of ME/CFS patients, who have a lot of frailty of mind and emotional hypersensitivity, a medical professional with a strong personality or adherence to a particular methodology can come over as an authority figure, even though to a healthy person the same doctor would seem quite normal and even quite empathetic.

...

So I think the emotional hypersensitivity may create the image of an authority figure in the ME/CFS patient's mind, when in fact there may be none there.

Nevertheless, even if this is just a perceived aura of authority, rather than a real one, it does have a very real effect on ME/CFS patients.

If you're in a medical appointment and the professional is telling you things, and claiming that they're based on good quality medical research, that is an assertion of power from a position of authority.

I don't think I've developed a form of 'emotional hypersensitivity' or 'frailty of mind', and would take the same view for medical professionals treating any condition. A doctor telling a cancer patient that treatment X will lead to Y and Z is in a position of authority and is asserting power. They have a responsibility to do so cautiously and reasonably.

 

[Hip]

Sorry, but I have to say something to this. CBT is not just offering a different explanation for your symptoms. CBT goes much further. CBT tries to change your maladaptive thinking, which usually leads to maladaptive behaviour. Or in other words, the therapist teaches you how to recondition your thoughts and tries to fix your cognitive distortions. CBT was and still is heavily influenced by the theories of conditioning.

That is not the way Simon Wessely sees ME/CFS etiology. Wessely posits that all the mental and physical symptoms of ME/CFS are caused by the patient having a belief that they are ill. His view is that if you can change or oust this belief that you are ill, and replace it with the belief that you are well, then ME/CFS will disappear.

So for the Wessely school, CBT is used in order to expel these illness believes that he thinks maintain the ME/CFS state. The fact that this sounds rather like the hocus pocus you find in religious exorcism has not stopped Wessely's theory from being published in scientific journals.

 

[Hip]

A doctor telling a cancer patient that treatment X will lead to Y and Z is in a position of authority and is asserting power.

That is not the normal meaning of the words authority or power. Authority would be where a doctor has the power to enforce their treatment. For children under 16, doctors do indeed have the authority to do that, but not in the case of adults. For adults they can legally only advise.

Though certainly a doctor is in a position of influence.

 

[Esther12]

That is not the normal meaning of the words authority or power. Authority would be where a doctor has the power to enforce their treatment.

I disagree. Could discuss the semantics if you'd like. Quick google for 'doctors authority' would seem to indicate that many in medical profession see themselves as being in positions of authority. If patients realise they are being manipulated/misled, they can walk-away, but this can take some time, and even then the claims of doctors can still go on affecting them.

 

[Kati]

Position of authority and paternalism is what is going on, unfortunately.

 

[EllenGB]

Just want to echo that therapists are in positions of authority.

CBT in not harmless.

It depends what type of CBT. The Chalder protocol is potentially harmful in that it aims to increase activity. For most other disorders, CBT is focused on resolving specific issues that en has e.g. depression. It is therapeutic. It can help or it has no effect.

 

[EllenGB]

That is not the way Simon Wessely sees ME/CFS etiology. Wessely posits that all the mental and physical symptoms of ME/CFS are caused by the patient having a belief that they are ill. His view is that if you can change or oust this belief that you are ill, and replace it with the belief that you are well, then ME/CFS will disappear.

So for the Wessely school, CBT is used in order to expel these illness believes that he thinks maintain the ME/CFS state. The fact that this sounds rather like the hocus pocus you find in religious exorcism has not stopped Wessely's theory from being published in scientific journals.

Good point. The CBT protocol for CFS is unusual and different to CBT for say, MS. Or depression. Which is why I don't like it. I have spent over 30 years challenging the CBT fanclub, as I call them.

 

[EllenGB]

I don't think I can add anymore to the discussion so am retiring from this debate. Best wishes and a healthier 2016 to you all.

 

[TiredSam]

Thanks for the interesting debate.

 

[alex3619]

Not really the doctor's fault

Fault as in blame? Agreed, its not their fault for the most part. Fault as in responsibility? They have the responsibility to do better.

 

[alex3619]

Authority would be where a doctor has the power to enforce their treatment.

This is a specialized use of the term. Authority can have many shades of meaning.

One of the things we face is confusion. There is a lack of knowledge early on, and our friends, family and doctors don't understand either (unless you are fortunate). Sometimes we have self doubt, peer pressure, and a list of doctors who have written us off. So when a doctor, armed with dangerous or false information, comes along and tells us he knows the issues, and has the treatment, we WANT to believe them. We are vulnerable and they seize power over us, though typically in their view of our best interests.

Authority also refers to citing of expertise or literature, or other authority figures, which is the behind much of bad medicine. Its why the evidence based movements are so powerful, in part. Doctors and other experts are often wrong.

Doctors often compound this by rejecting people who do not immediately follow their advice. "I am right, so if you reject my advice you are wrong." This mentality is a huge part of what is wrong in medicine, and is based on fallacy and power.

 

[Woolie]

@TiredSam, thanks for keeping us posted. Just wanted to add this: Dr. Ellen Goudsmit's tweets are closed except to followers (she has 47 followers).

Here's another, tweeted 19 hours ago: "Cyberbully has returned to diminish me (on Phoenix rising). Frustrated by psychiatrists, I'm the Prof. Wessely manqué. Bash bash."

I'm sorry to hear that someone has taken this view of our discussion here, whatever the rights and wrongs of it.

 

[Skippa]

It absolutely REQUIRES the authority of doctors to be given access to drugs.

It absolutely REQUIRES the authority of doctors to make available (for example) NHS resources for additional treatments.

 

[Scarecrow]

Oh, here's another, tweeted 19 hours ago: "Cyberbully has returned to diminish me (on Phoenix rising). Frustrated by psychiatrists, I'm the Prof. Wessely manqué. Bash bash."

So not because she's a woman, then?

 

[Valentijn]

Are you allowed to agree CBT is a complete waste of everybodys time?

Nope. When I did that (cancelled my upcoming therapist appointments at a fatigue center), they responded by removing their diagnosis of ME/CFS and replacing it with a diagnosis of obesity.

It's only a small minority of therapists who abuse their authority (outside of ME/CFS anyhow), but when they do, they have the capacity to do a lot of damage.

 

[Sidereal]

Nope. When I did that (cancelled my upcoming therapist appointments at a fatigue center), they responded by removing their diagnosis of ME/CFS and replacing it with a diagnosis of obesity.

 

[Valentijn]

I think it is the mental state of ME/CFS patients that makes medical professionals come over as authority figures.

Maybe for you. But I've never automatically viewed any doctor as a threatening source of authority, before or after becoming ill. I still get on well with my GP, but I actually see her as being disempowered by the medical system. She does the best she can in that framework, but can't force specialists to see an ME/CFS patient, or write certain prescriptions without the involvement of those specialists.

When I clash with a doctor, it is precisely because he or she is attempting to exert authority over me to force my cooperation. I implicitly reject that authority by asking for an explanation or disagreeing with their conclusions. And then some try to use their authority as a tool to force compliance or to at least justify their own opinions while ignoring mine.

 

[Sidereal]

Personally, I view doctors as something stuck to the bottom of my shoe but neither they nor society agree with me so they are still in a position of authority over me even if I don't agree or behave toward them in a subservient fashion. They are the only ones who are allowed to diagnose disease, dispense meds, write sick notes, determine disability status...