Dr David Tuller: More on the BMJ Opinion Piece from the Psychobabblers

[Countrygirl]

Trial By Error: More on the BMJ Opinion Piece from the Psychobabblers



And do read the comments.


https://virology.ws/2025/05/24/tria...l2bcwBdMpUVrBZ2jWg_aem_CQYE8XZ0iMk38YDZtz1tQg

3 Comments /



24 May 2025

By David Tuller,

When it comes to ME and ME/CFS, The BMJ—formerly called The British Medical Journal but now, like the food franchise once known as Kentucky Fried Chicken, officially reduced to a mere acronym—is a long-time champion of the “biopsychosocial” ideological brigades. (I use the “scare quotes” because the term is a misnomer, given that these experts focus pretty much exclusively on the “psycho” and “social” while largely ignoring the “bio” part of the equation.) So it should not surprise anyone that The BMJ recently published yet another ignorant and misguided screed from this crew—a commissioned opinion piece titled “Patients with severe ME/CFS need hope and expert multidisciplinary care,” from Miller et al. (I first posted about this propaganda piece a few days ago.)

Indeed, The BMJ, and the many other titles under the BMJ publishing umbrella, have for decades provided opportunities for the GET/CBT zealots to air their theories about deconditioning and problematic illness beliefs as causal factors for ME/CFS—theories now extended to Long Covid. A 1989 letter written by Dr Melvin Ramsey, an early ME researcher, reveals the historical nature of this prejudicial and biased approach.



Dr. Ramsey investigated the 1950s disease outbreak at London’s Royal Free Hospital, the event that subsequently gave rise to the name “myalgic encephalomyelitis.” In 2021, an invaluable Twitter (now X) account, Royal Free 1955, which has released an impressive archive of relevant documents, posted Dr. Ramsey’s letter. In the letter, addressed to someone named Edith, Dr. Ramsey discussed the challenges he was confronting in trying to publish ME-related research. Here’s the key section:

“For many months we have been in difficulty by the influence exerted by a psychiatrist, Dr. Simon Wessly [sic] who has secured for himself the position of referee to the BMJ whose Assistant Editor has been strongly anti-ME and we cannot get anything published in British medical journals in our favor. Simon Wessly cuts right across my fundamental tenet of “rest” for chronic M.E. cases and tries to get them admitted to Psychiatric Units where they are immediately put on vigorous exercise.”

 

[Countrygirl]

In case you missed the piece in the BMJ by Miller and Garner, here it is:

https://www.bmj.com/content/389/bmj.r977
Do read the responses.

Papers

Randomised controlled trial of graded exercise in patients with the chronic fatigue syndrome​

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7095.1647 (Published 07 June 1997)Cite this as: BMJ 1997;314:1647

Reframing beliefs about illness, along with specialist rehabilitation, can help recovery in people with severe ME/CFS, write Alastair Miller, Fiona Symington, Paul Garner, and Maria Pedersen
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) affects around 250 000 people in the UK. Symptoms include fatigue, cognitive difficulties, pain, autonomic disturbances, disturbed sleep, and gastrointestinal upset. The National Institute for Health and Care Excellence (NICE) estimates that 25% of people with ME/CFS experience higher symptom levels and reduced function.1 These disabilities, and the patients’ belief that they won’t recover, can harm their mental wellbeing.2

Recovery is possible, but patients need help to find their path. A constructive starting point requires experienced practitioners to recognise that the evolved biological control systems responsible for maintaining safety can sometimes become dysregulated.34 This perspective offers patients a coherent explanatory model and, for some, a foundation for meaningful therapeutic progress.56

Guidance from NICE in 2021 on managing ME/CFS states that “recovery” may be only “a long period of remission” and that “many will need to adapt to living with ME/CFS.”7 For severe and very severe ME/CFS, the guidance states that patients may be in bed all day; may be unable to eat or digest; and may require a low stimulus environment in a dark, quiet room with little or no interaction because of hypersensitivity to light, sound, touch, movement, and smells.1 A government consultation with charities and patients about implementing the NICE guidance concluded that doctors must understand that people with severe symptoms need palliative care.7

Death directly from ME/CFS is unlikely. Neither somatic pathology nor specific physiological disturbance has been reliably and consistently identified.6 However, functional impairment may lead to malnutrition and dehydration—described as the cause of death of Maeve Boothby O’Neill, who died in 2021 at age 27.8 The coroner at her inquest highlighted that the NHS had no specialist units for severe ME/CFS.9 However, several specialist regional services for ME/CFS diagnose and treat mild and moderate presentations.

One specialist unit in the UK is at the Leeds National Inpatient Centre for Psychological Medicine. Some of the patients admitted have severe and complex ME/CFS. The Leeds centre delivers multidisciplinary inpatient care based on a biopsychosocial approach. This underpins much general practice in the UK, where symptoms and illness are considered not just in terms of the biology of a disease but also psychological (the influence of thoughts and emotions) and social dimensions (a person’s family, relationships, and societal beliefs).10

The Leeds unit employs highly trained and experienced staff in nursing, liaison psychiatry, occupational therapy, physiotherapy, cognitive behavioural therapy, dietetics, and pharmacy.11 Although their numbers are small, the improvements are seen across all groups of patients and are consistent. In nine of the past 10 years, everyone discharged had shown improvement, with over 50% each year reporting a major improvement, and the Care Quality Commission rated the service as “outstanding” on effectiveness and praised its holistic approach.12

Philosophical approach​

An advantage of the Leeds model is that it avoids continuous sensory deprivation and total bed rest, both of which are likely to harm health.13 A literature review by the Norwegian Institute of Public Health found no evidence that shielding patients from sensory stimuli benefited those with severe fatigue.14 A large international group of specialists in chronic fatigue conditions state that inactivity, bed rest, isolation, and sensory deprivation risk worsening symptoms and disability. They explain that fatigue after activity doesn’t necessarily mean that this is dangerous or indicate “a lack of energy in the body.” A gradual, controlled approach to increasing activity is an important part of rehabilitation.6

The philosophical approach behind the Leeds centre and the Oslo Chronic Fatigue Consortium’s statement overcomes the longstanding problem of separating “mental” and ”physical” illness.615 Specialists researching and treating these conditions view chronic fatigue conditions as a dysfunctional biological response orchestrated in the brain, influenced by expectations and conditioned responses.161718
Recent advances in neuroscience have enhanced our understanding of the link between the brain and physiologically based symptoms.181920 Subtle biological changes—such as increased sympathetic activity, decreased parasympathetic activity, reduced cortisol responsiveness to stress, and an activated immune system—can be attributed to a shift in the brain’s interpretation of the body’s condition.321 Emerging evidence suggests that psychoeducation about the stress response can help reduce hypervigilance and accentuation of the dysfunctional biological response.422

This approach across a range of conditions has been described for many years,23 underpinning national service planning in some countries. The Danish Health Care System for functional illness manages specialty specific functional somatic syndromes with common cognitive behavioural treatments, and patients can become self-supporting.24 In contrast, the UK is following an outdated model, leading NICE to disallow cognitive approaches to help recovery or bespoke programmes designed to increase activity.7

Inspiring hope, and changing the illness narrative, is helpful.25 The unproved narrative of a disease with no cure, improvement, or recovery can be harmful and is erroneous.6 Multidisciplinary, tailored approaches based on a biopsychosocial understanding can help patients and are urgently needed. Constructive dialogue between recovered and symptomatic patients, carers, and clinicians can help identify practical approaches to recovery.2627 Above all, we must remind patients, their relatives, and doctors that even those with severe ME/CFS can recover.25

Footnotes​

• Competing interests: None to declare.

 

[Rufous McKinney]

Neither somatic pathology nor specific physiological disturbance has been reliably and consistently identified.

yup, because when you do not go looking, you do not find anything.

However, some people do go looking and typically they find something. Those somethings are never mentioned it seems like, in the Literature Reviews here.

A constructive starting point requires experienced practitioners to recognise that the evolved biological control systems responsible for maintaining safety can sometimes become dysregulated.34

As a person who published science papers, and did peer review, what shocks me is the BPS psych advocates entirely ignore a huge body of actually valid science based studies with double blind, null hypothesis testing.

so they cite TWO papers to support this statement. Both of which are more of this same psych opinions. I don 't understand how these papers get through valid peer review. They would get an D- in my college courses, had they turned this stuff in.

- that sentence refers to our safety, Most of us know what this is inferring.

And yes, if I am out on the street, there is no safety. That part is super real. I can't do much if three robbers show up with a gun, which happened a block from here, two days ago.

This illness means I am NOT SAFE. I am woozy in public. I have issues standing up very long. My daughter tells me I can't be acting like this on a public street. It might attract robbers.

 

[southwestforests]

The philosophical approach behind the Leeds centre and the Oslo Chronic Fatigue Consortium’s statement overcomes the longstanding problem of separating “mental” and ”physical” illness.

Countrygirl herself didn't say that, the people she quoted did.

Well there ya go, its a religion not a science.
Perhaps a bit of hyperbole there, but, hey, I'm a writer, we do that from time to time ya know, anyhow, I'm suspecting they have a pre-established paradigm/philosophy, and work to make the illness fit their philosophy.