What exactly *is* the biopsychosocial model of ME ? (Poll included)

[Art Vandelay]

What exactly is the biopsychosocial model of ME as advocated by Professor Peter White?

It is whatever White wants it to be. From my observation, it seems like the BPS crowd alter their model depending on the occasion, the audience, and whatever new evidence that comes to light.

It's deliberately amorphous so that they can change it whenever they need to. It's all designed so they can keep their particular gravy train going.

 

[snowathlete]

I'm not voting in the poll because it means whatever the creators what it to mean and it changes all the time. What they say it means changes depending on who is in the room, if they are "treating" patients, at a conference of colleagues, or a conference of other scientists, whether they are in the room with the SMC and other media, whether they are talking about it in a journal paper, or in reply to a response to their journal letter, at a tribunal hearing, or to people in government.

 

[Valentijn]

So, to follow your logic, psychological and social forces would impact disease in differing ways and to varying extents depending on the particular psychological and social force we're talking about and what the disease process is they're influencing.

I wouldn't say that social and psychological process have a particular relevance to disease, beyond the relevance they have upon the rest of life. I don't think it's accurate to say that such forces impact disease ... rather, they impact people. Obviously that impact will vary depending on the individuals involved and social perspectives of the specific diseases.

But psychological and social influences have such a universal impact in life that it doesn't make much sense to focus upon them as somehow being extra impactful upon disease. It would be like focusing on the impact of air or gravity upon disease. It has no special effect upon disease that it doesn't have on any other aspect of life.

 

[worldbackwards]

Perhaps the real biopsychosocial theory is the bullshit we accumulated along the way.

 

[alex3619]

For example LPS-induced mitochondrial dysfunction from intestinal dysbacteriosis could be caused by a medical culture of handing out antibiotics like sweets or perhaps due to a standard western diet driven by the fast food industry.

A case in point. Social practices, including refined wheat and sharing of food with fingers, have been implicated in transmitting H. pylori and hence leading to gastric ulcers. The problem is physical. The risk profile is physical and social.

 

[NL93]

Trudie chanlder talking nonsense:

They don't really seem to have 1 theory.
They will accept any explaination as long as it involves the patient doing something wrong that can be corrected. Doing too little activity, or doing too much. Too much rest, or too much stress. Maybe you are surpressing your emotions too much, but you might also be overdramatic. Sleeping too much might also cause your condition, as does sleeping too little.

If you have a relapse that can also be caused by any of those reasons.

Your perfectionism might also have something too do with your illness, but you also lack motivation.
And did your parents divorce 8 years before you got ill? Well, that can't be a coincidence.
Were you not doing good in school at the time you got ill? Oooo you had straight A's? In that case you burned yourself out.

It really depends on which psychobabbler you ask when. You will probably get a lot of wildly contradicting answers.

 

[Scarecrow]

Does anyone know who the interviewer is in the clip above? I think I recognise him from those GP trading videos Clare Gerada did.

 

[Cheshire]

Does anyone know who the interviewer is in the clip above? I think I recognise him from those GP trading videos Clare Gerada did.

It's Vincent Deary. He played the patient with Clare Gerada.
He's a psychologist. I think he's the one who coined the term persistent physical symptom.

He's the author of that article on cfs on King's College's site: http://www.kcl.ac.uk/innovation/groups/projects/cfs/health/index.aspx

Much has been made of the fact that when badly "administered", Cognitive Behavioural Therapy can be less than helpful in the management of Chronic Fatigue Syndrome. Indeed, despite now very strong evidence (see the recent JAMA review) that CBT is an effective intervention, there was a recent patient conducted survey which showed a high degree of dissatisfaction with implementation of this treatment.

However, we professionals would like to minimise this finding, we cannot ignore the fact that there is a very real problem. It would seem that for some sufferers, the key ingredient of best practice CBT - collaboration - is missing. The experience of this group of dissatisfied customers is that of treatment as rote prescription uniformly administered, a one sided exhortation to do more, exercise, sleep less. Coupled with this is the perception of a lack of empathy for very real pain, distress and disability.

The problem may well be that some of our treatments are too evidence based. Thoroughly convinced as were are by the evidence, we all too easily fall into a repetitive giving of advice, encouraging the patient to do the right, evidence based thing - do more, exercise, sleep less. What this fails to address as an approach, are the very real reasons why a client may be sceptical or anxious; their wariness of yet more professional advice; the complex reasons why the imposition of a routine on their current life feels nigh on impossible.

My bald

 

[Scarecrow]

Thanks @Cheshire. Always nice to be able to fit a name to a face and vice versa.

 

[Dolphin]

I'm sorry Dolphin, I'm not being intentionally obtuse or obdurate, I'm just trying to write a blog post explaining things to my friends and I need to know I've understood something if I'm going to object to it.

Why not write a blog on CBT and GET? Those are the therapies recommended by NICE. We have manuals for them from the PACE Trial.

 

[Dolphin]

If I could read Peter White's book for myself I would have started it by now.

For anyone interested, a chapter from this book by George Davey Smith can be downloaded from https://issuu.com/maxhead/docs/bps_caution_davey_smith

Here's a sample summary to help use decide if you want to read it: http://www.meactionuk.org.uk/PROOF_POSITIVE.htm

PROOF POSITIVE?

Evidence of the deliberate creation via social constructionism of “psychosocial” illness by cult indoctrination of State agencies, and the impact of this on social and welfare policy

Eileen Marshall Margaret Williams 30th August 2005

[..]

The one dissenting voice at the conference was that of George Davey Smith, Professor of Clinical Epidemiology, Department of Social Medicine, University of Bristol, who in a presentation called “The biopsychosocial approach: a note of caution” carried the torch for intellectual integrity. His contribution showed that bias can generate spurious findings and that when interventional studies to examine the efficacy of a psychosocial approach have been used, the results have been disappointing.

To quote from Davey Smith’s contribution: “Over the past 50 years many psychosocial factors have been proposed and accepted as important aetiological agents for particular diseases and then they have quietly been dropped from consideration and discussion”. The illustrations he cited included cholera, pellagra, asthma and peptic ulcer. He went on to quote Susan Sontag’s well-known dictum: “Theories that diseases are caused by mental state and can be cured by willpower are always an index of how much is not understood about the physical basis of the disease” (Illness as a metaphor. New York: Random House; 1978).

Davey Smith’s reasoned warning to brought to mind the validity of Susan Haark’s chapter “Concern for Truth: What it means, Why it matters” in “The Flight from Science and Reason”. (Eds) Paul R Gross, Norman Levitt and Martin W Lewis (New York Academy of Sciences, 1996; pp57-63), which finds that those who know only their own side of a case know very little of that, and that “sham reasoning” attempts not to get to the truth, but to make a case for the truth of some proposition to which one is already committed, a familiar phenomenon in contemporary academic life. “Sham reasoning” in the form of research bought and paid for by bodies with an interest in its turning out in a desired way, or motivated by political conviction, and “fake reasoning”, in the form of ‘scholarship’ that is in reality self-promotion, are all too common. Could this possibly apply to members of One-Health company?

In the discussion that followed Davey Smith’s presentation, Wessely appeared to be apoplectic: “That was a powerful and uncomfortable paper. There will undoubtedly be many people, including those who one might call CFS activists, who would have loved every word you were saying. There is a popular and seductive view of medical history in which we move implicitly from unknown diseases which are thought to be psychiatric, and as we become better, brighter scientists, they are finally accepted in the pantheon of real diseases. You should remember that there is an opposite trend as well, which you didn’t mention”.

Davey Smith’s response was succinct: he believed there is a need to distinguish association from actual causation: “My main point was about disease aetiology. As a disease epidemiologist I want to get the right answers about this. In my view, susceptibility has been overplayed and exposure has been under-appreciated in social epidemiology”.

The distinguishing between association and causation is a key issue: Wessely’s confusion, especially in relation to ME/CFS, of association with causality is a criticism that has long been directed at him and he has been reminded again and again that correlation is not the same as causation, and that he should not over-interpret results as having more practical importance than those results warrant. To do so is not only methodologically flawed, but contributes to the continued mis-perception of the disorder.

Nevertheless, and perhaps unsurprisingly, Professor Sir Michael Marmot sprang to support Wessely: “I would emphasize Simon Wessely’s point. It is easy to look back and say, ‘Gosh, how silly they were in the past to think all these silly thoughts; aren’t we clever now!’. Research has advanced beyond the examples you cite because there have been many advances in conceptualisation and measurement of psychosocial factors”, to which Davey Smith replied: “We can get more robust evidence from observational studies, but these approaches have not really been utilized in the psychosocial field”.

@Simon wrote a blog about it:

The biopsychosocial approach: a note of caution - George Davey Smith (Summary with comments)
http://forums.phoenixrising.me/inde...eorge-davey-smith-summary-with-comments.1805/

 

[Hip]

My three part blog on the author's book of the same name starts here: http://forums.phoenixrising.me/inde...e-and-fall-of-the-biopsychosocial-model.1075/

I do like this from your blog:

the BPS proponents are treating the model as reality on the one hand, and not taking it seriously on the other.

So little research goes into obtaining empirical evidence to support the BPS idea that psychological factors play a role in triggering or maintaining chronic disease states (ie, the BPS model not taken seriously on a scientific level).

Yet in government policy decisions and in insurance company policy the BPS model is assumed to be true (ie, treating the model as reality), despite the dearth of evidence for psychological factors playing a causal role in chronic disease.

This indicates that the BPS model was not intended to be a scientific one, but rather a political tool.

 

[Undisclosed]

RE: The question "What exactly is the biopsychosocial model of ME ?"

There isn't a biopsychosocial model of ME per se. What happened was the likes of Peter White took the biopsychosocial model and perverted to their own ends to the detriment of patients in the Uk -- and it makes it almost impossible to get proper treatment or get disability payments.

The biopsychosocial model (BPS) is actually just a broad view that came out of psychology that attributes disease causation or outcome to many factors that interact -- biological, psychological, and social. And these factors differ for every single person.

The biomedical model states that disease is caused by biological factors -- viruses, genes, problems within the body etc.

Taking cancer as an example -- BPS view looking at causation

Bio -- cause = normal cells changing to malignant from faulty genes, enviromental toxins etc
Psycho -- for example -- behaviour -- maybe smoking contributed to the cancer.
Social -- what factors might have contributed to the cancer.

Many doctors use this kind of approach to try to figure out risk factors for an individual, what might have caused the cancer etc.

As far as outcome with a cancer.

It's also part of a cancer treatment to look at how a patient is coping/not coping, the effect medications might be having on them, how the cancer is affecting their social life... .

I have absolutely no issues when the BPS model is used to help patients.

So what did White et al do. They took the BPS model and used it to harm not help patients.

Incorrect usage with ME:

Bio: caused by viruses, bacteria, who knows. They seem to agree it's biologically caused when pressed to say so.
Psycho: They don't look at individual patients. They just say that 'patients' are maintaining their illness with incorrect thinking thus the need for CBT to help them stop maintaining their nasty abnormal thinking patterns that keep them in the sick role. They have even perverted what CBT is meant to be used for which is to help people cope with their symptoms. Esther Crawley also supports the BPS in her support of lightning therapy which is another therapy that helps you correct your disordered thinking.
Social -- CBT would help us get back our social lives because most of us have poor or no social lives due to our maintaining our illness with our abnormal thinking patterns.

This is the manufactured BPS model of ME. Can you imagine if this model was used this way for Cancer patients. Yup, you have cancer and your cancer is maintained by your incorrect thinking and CBT is the main treatment offered for your cancerous tumour. Patently absurd and ridiculous.

A correct use of the BPS model for ME for example migh be:

bio -- a biological cause, treating the patient with meds, and other medical treatments to help decrease or alleviate symptoms etc
psycho -- how does having ME affect you, treatment provided would be counselling or other treatments that help with coping.
social -- what effect does having ME on the social life, help in this area would consist of tailoring the environment to meet individual needs, talking to family about it, things that help you cope in social situations.

 

[chipmunk1]

I propose:

E - A giant load of horse manure.

The BPS Model of Peter White is based on Engelian theory which is based on Freudian theory which is a huge fraud based on cocaine induced delusions.

 

[Wolfiness]

Why not write a blog on CBT and GET? Those are the therapies recommended by NICE. We have manuals for them from the PACE Trial.

Well, I avoid talking about the politics of ME as much as possible because it's bad for my health both mentally and physically and there are much better advocates out there. I cannot type too much so I am concentrating on a blog essentially explaining why I am at the point of not being able to get out of bed or communicate any more, and the direct impact of NICE treatment is a small part of it unless of course you count culpable neglect. Indirectly of course 15 years of ignorance and victim-blaming pressure does things to people.

I guess where I'm coming from is I have been open to brain-body hypotheses of the Gupta type, with the single objection that it just doesn't work for me. So when I see White authoring papers on elevated cytokines (http://niceguidelines.blogspot.co.uk/2011/03/pace-trials-prof-peter-white-exercise.html) I wonder - wrongly it seems - if the theory has moved on to something I could begin to accept.

My general impression is the same as yours - (psychiatric lobby = FAD = CBT/GET = BPS = as little biology as we can possibly concede). But bending over backwards to derive some benefit from available treatments because I have no other options except wait, I have had GAT (rather than GET) privately. I agree with our majority opinion on its uselessness but as I say, despite my better judgement I feel I have to justify my failure to improve through all non-pharmaceutical methods (including pacing, Gupta etc.).

My additional concern is the entirely unfair accusation that we PACE critics are a 'vocal minority' of 'extremists', and that we misunderstand and misconstrue the psychiatric lobby by thinking they think this illness is entirely psychological. So in starting this thread I wanted to make scrupulously sure I was being as fair to the psychiatric lobby as possible and I knew how much biology their view involves. I'm happy to accept the answer that there is no answer and I have always taken the view that given that I am adequately educated, open-minded and self-aware, the fact that I have such difficulty understanding what they're saying is their failure not mine.

 

[Hip]

I guess where I'm coming from is I have been open to brain-body hypotheses of the Gupta type, with the single objection that it just doesn't work for me.

I personally think that in a small minority of ME/CFS cases, there may be learned stress responses that plays a causal role in the disease. There has been one or two cases on this forum of ME/CFS being placed into near remission (though not without niggling persisting symptoms) as a result of becoming aware of one's stressful responses to stressors, and with the help of a therapist, re-educating the mind not to respond stressfully.

However, the fact that a very small minority appear to benefit from such de-stressing does not imply that a learned stress response plays a role in the vast majority of ME/CFS cases.

 

[Dolphin]

Why not write a blog on CBT and GET? Those are the therapies recommended by NICE. We have manuals for them from the PACE Trial.

Well, I avoid talking about the politics of ME as much as possible because it's bad for my health both mentally and physically and there are much better advocates out there. I cannot type too much so I am concentrating on a blog essentially explaining why I am at the point of not being able to get out of bed or communicate any more, and the direct impact of NICE treatment is a small part of it unless of course you count culpable neglect. Indirectly of course 15 years of ignorance and victim-blaming pressure does things to people.

I guess where I'm coming from is I have been open to brain-body hypotheses of the Gupta type, with the single objection that it just doesn't work for me. So when I see White authoring papers on elevated cytokines (http://niceguidelines.blogspot.co.uk/2011/03/pace-trials-prof-peter-white-exercise.html) I wonder - wrongly it seems - if the theory has moved on to something I could begin to accept.

My general impression is the same as yours - (psychiatric lobby = FAD = CBT/GET = BPS = as little biology as we can possibly concede). But bending over backwards to derive some benefit from available treatments because I have no other options except wait, I have had GAT (rather than GET) privately. I agree with our majority opinion on its uselessness but as I say, despite my better judgement I feel I have to justify my failure to improve through all non-pharmaceutical methods (including pacing, Gupta etc.).

My additional concern is the entirety unfair accusation that we PACE critics are a 'vocal minority', and that we misunderstand and misconstrue them by thinking they think this illness is entirely psychological. So in starting this thread I wanted to make scrupulously sure I was being as fair to the psychiatric lobby as possible and I knew how much biology their view involves. I'm happy to accept the answer that there is no answer and I have always taken the view that given that I am adequately educated, open-minded and self-aware, the fact that I have such difficulty understanding what they're saying then is their failure not mine.

Thanks for replying, @wolfita.

 

[Wolfiness]

I personally think that in a small minority of ME/CFS cases, there may be learned stress responses that plays a causal role in the disease. There has been one or two cases on this forum of ME/CFS being placed into near remission (though not without niggling persisting symptoms) as a result of becoming aware of one's stressful responses to stressors, and with the help of a therapist, re-educating the mind not to respond stressfully.

However, the fact that a very small minority appear to benefit from such de-stressing does not imply that a learned stress response plays a role in the vast majority of ME/CFS cases.

I know, yeah, I am fairly well-informed, but I'm just trying to get better by myself without being able to get out of bed so my options are limited . I did have a very anxious unsafe childhood of the kind that Jay Goldstein believes compromises the immune system. Of course the the fact that stress starts something doesn't mean that Iack of stress will undo the end result of it and Goldstein did not treat people with verbal therapies but with drugs, which are the only thing that has ever worked for me except for a) summertime and b) moving to a small flat instead of a house.

I did try your NAG and turmeric anxiety protocol few months ago, not because I am anxious, simply because I am the wired type and do not rest anywhere near enough. But I also have what is probably an irrational belief that some occult anxiety process I cannot consciously perceive is damaging me. This belief I would suggest is in fact a iatrogenic neurosis I've developed as a result of the prevailing UK atmosphere that makes me feel at fault for not having got better.


@Dolphin. No problem. It's sad that a matter of medicine has come down to taking sides, but it has, and we are on the same one.

 

[A.B.]

But I also have what is probably an irrational belief that some occult anxiety process I cannot consciously perceive is damaging me. This belief I would suggest is in fact a iatrogenic neurosis I've developed as a result of the prevailing UK atmosphere that makes me feel at fault for not having got better.

The dark side of this approach. It causes psychological damage to patients. And the therapists seem to be completely unaware of this.

 

[Hip]

@wolfita
My own hunch is that in a few cases, a learned habit of responding stressfully to the daily stressors of life could conceivably cause chronic immunosuppression, since under stress there is a natural shutdown of the immune system to a degree (in order to conserve energy for dealing with the stressful situation).

This immunosuppression may then make it harder to clear the underlying viral infections that may be causing your ME/CFS.

When we consider stress-induced immunosuppression, we tend to think of cortisol secretion under stress, since cortisol turns down the immune response.

However, in this study for example it mentions four pathways that mediate stress-induced immunosuppression:

Autonomic nervous system
Hypothalamic adrenal axis (cortisol response)
Extra-adrenal pathways involving neuropeptides
Neurotransmitters and neuroimmunological mediators

So conceivably a learned habit of responding stressfully to stressors could inhibit viral clearance by a number of immunosuppressive mechanisms.

The difficult thing to identify is the stressful habits that an individual might have, because those will be different for each person. And without uncovering them, presumably you will not be able to address them.

I'm just trying to get better by myself without being able to get out of bed so my options are limited

The Reverse Therapy therapist that @sueami used I think works though Skype (see @sueami's blog articles here and here), so that should be something you can do while still in bed.

Reverse Therapy seems relatively sensible, intelligent and down to Earth. By contrast, the Lightning Process seems like a bizarre happy-clappy cult religion.