This might be what you want Mark. It has just been released.
Mary Schwietzer was a university lecturer until she became ill and writes very incisive essays.
She says what I believe so much better than I could.
Mithriel
Mary Schwietzer was a university lecturer until she became ill and writes very incisive essays.
Cognitive Behaviour Therapy
(Re: CBT, an update)
By Mary Schweitzer
<marymsch@COMCAST. NET>
Carl Graham asks us whether CBT as a concept has
been sufficiently polluted in CFS research and clinical
use that it will have to be retired.
My answer is an unqualified "Yes."
The key is the association with ANOTHER
questionable concept in psychiatry:
"inappropriate illness beliefs."
"Inappropriate illness beliefs" is itself a type of
ideology, a type of belief system. It requires the
assumption that if there is no APPROVED objective
test for a medical condition, then the condition must
belong in the domain of psychiatry.
In the history of medicine, the reverse has always
been the case. Charcot's hysterics were epileptics
and victims of third-stage syphillis. Women with
hysterical paralysis turned out to have Multiple
Sclerosis. "Cold Mother Syndrome" is now called
autism.
I have no quarrel with psychiatry as a profession.
There is no doubt that the profession of psychiatry
has saved patients with such biological disorders as
bipolar syndrome and schizophrenia from myths of
demons or self-indulgence. And many who would
have dropped by the wayside have been saved by
the counseling they received from intelligent and
caring therapists.
But psychiatry as a profession is also a minefield
of confused and inappropriate diagnoses.
It is exceedingly ironic that White, Wessely, Sharpe,
and Chalder, the most visible psychiatrists pushing
this particular brand of sophistry on the public,
always open their presentations (in print or lecture)
with the claim that they are breaking down Cartesian
mind-body dualism. They then proceed with a
dualistic theory as to what is wrong with the patient
and how to fix it.
One has to reach back to the "four humors" to find
such a thoroughly theory-driven model of how the
body works.
Yet article after article is published, the "peer
reviewers" apparently losing all their critical
reasoning skills. The same research is repeated; the
authors all cite each other frequently. The result is
the appearance of scholarship with no scholarship.
Here is an example of the excesses to which the
theory of "cognitive behaviour therapy" coupled with
"inappropriate illness beliefs" has taken us, from the
King's College, London, website on CFS for
professionals:
( http://www.kcl. ac.uk/projects/ cfs/health/ )
"Many clients have built up an infrastructure of
support, a coping network, to help them manage
their illness. One of my clients had, over the years,
established a rota of friends and volunteers, who
visited two or three times daily to help her with
meals, washing, housework etc. Mostly she was in a
wheelchair, and walked only with crutches. She wore
a neck-collar to support her head.
For her, the road to recovery involved the gradual
dropping of each one of these props. To put it in her
words, she had to "wean herself of" her network of
support, her chair, her crutches, her collar.
"Each new reduction in her dependence was a step
into the unknown. This required enormous courage
and persistence. Each move back into (her words)
'real life' was potentially that step too far that would
send her into relapse. The spectre of the bed and
the wheelchair is never far from the mind of many
sufferers.
"This weaning is not quick. Two years later we carry
on the journey, though her strides are that much
firmer and more confident. Therapists used to
working with anxiety must acquaint themselves with
a far slower pace of change, much less spectacular
progress. They must acquire patience, and lower
their own unrealistic expectations of speedy
recovery. In short, we must fall into pace with the
client."
If these psychiatrists are wrong - if so-called
"chronic fatigue syndrome" really is caused by
biomedical phenomena - and if the vast majority
of patients with "CFS" who are confined to
wheelchairs are there because of medically
verifiable physical limitations, the scenario
described on the King's College website is
unspeakably cruel.
The reader is reminded of scenes from "Elmer
Gantry."
As long as that practice remains; as long as
patients are grossly mistreated in the name of a
false science; as long as insurance companies and
government institutions rely on such advice - how
can a thinking person take the chance of
dignifying such practices by promoting the phrase
"cognitive behaviour therapy"?
No matter how well meaning, in the end the author
risks having his/her own words used in an act of
unspeakable cruelty. Why would you take that
chance?
Psychiatry as a profession should be so embarassed
by this performance to assign the phrase "Cognitive
Behaviour Therapy" to the dustbin of history, along
with eugenics and phrenology (the belief that a
person's character can be assessed by looking at the
shape of his/her head).
Do not say it "could" mean something different.
A set of rogue psychiatrists has given a fixed
meaning to this concept, and it has been applied
to extend the suffering of patients with a severe
disease.
AND THE PROFESSION OF PSYCHIATRY
HAS DONE NOTHING TO STOP THIS.
Why the profession itself has not risen up in anger
against this false scholarship is, frankly, beyond
me.
Perhaps it has to do with the patient in the above
scenario almost always being a woman.
Neurasthenia, like hysteria, has historically been
considered a "woman's" disease - attributed by such
as Simon Wessely to men only when they fail in the
most manly of duties, warfare.
Perhaps lingering prejudices against women's
internal makeup have provided the loophole through
which these clearly absurd ideas have spread
unchecked.
But neurasthenia does not have the most
respectable history.
In the nineteenth century, it was paired with hysteria
to create the medical view that young women should
not be permitted to study science or math in high
school (if they were permitted to attend high school
at all).
Freud's version of "neurasthenia" came from the case
of Anna O, whom he concluded secretly wished to
have sexual relations with her father as a child.
Only the release of Freud's private papers showed
the opposite: Anna O herself had come to Freud
because her father HAD sexually abused her.
After extensive efforts to treat her, the good doctor
decided that her claim was too grotesque to be true.
Only then did he create the OTHER version of the
story - that she had imagined it because she wished
it to be so.
With such a history, I would think psychiatrists
would be doubly careful to police their profession
for such misguided theories.
We are not talking about something hidden away
in a corner. The CBT/GET pushers and proponents
of "biopsychosocial" medicine have been unusually
prolific - often publishing more than one paper on
the basis of a single study.
They cite each other frequently, so they would show
up on the citation index as highly regarded, too.
Highly regarded by themselves alone, perhaps, but
the citation index does not make these distinctions.
It simply counts the citations - the more, the
better, no matter why.
Do you really expect bureaucrats to make the fine
distinctions between one form of CBT and another?
They do not, as a rule, and the money is behind the
cruel version. Children and young people have been
taken from their families and placed in foster homes
or psychiatric institutions on the beliefs bolstered by
proponents of CBT and GET.
It has taken its time getting to the United States,
but with the help of Emory's psychiatry department
and Reeves' "empiric [sic]" questionnaires, the U.S.
has finally arrived at a purely psychiatric view of CFS.
As long as psychiatry refuses to clamp down on
the con artists of Cognitive Behaviour Therapy and
"CFS/ME" as they sometimes call it, a thinking
professional should run, not walk, from their
terminology. The dangers are too great: the risk
lies in legitimizing an inherently illegitimate activity.
Has CBT as a concept been sufficiently polluted in
CFS research and clinical use that it will have to be
retired?
My answer is an unqualified "Yes."
Mary M. Schweitzer, Ph.D
She says what I believe so much better than I could.
Mithriel
