"The biopsychosocial approach: a note of caution" George Davey Smith (2005/2006)

Dolphin

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I post this on another thread http://forums.phoenixrising.me/inde...ewcastle-13th-14th-october.36515/#post-610609 but thought it deserved highlighting in its own thread:

George Davey Smith gave a talk at a meeting of biopsychosocialists, but it looks like what he said wasn't popular with some/many/most there.

Maxhead (presumably the same @Maxhead that's on Twitter) posted the full chapter of Davey Smith's talk online:
http://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”.
 

Kati

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Thank you @Dolphin it is very important as programs develop around the world.
A 'biopsychosocial' approach to ME and related illness is just a polite way to say no testing and no medical treatment for you. Instead we will send you on an everending goose chase on how to cope, how to live, how to think and definitely how to behave. It is definitely more cost efficient for health care systems to do it this way. They introduce the concept of sustainable health care. Because they could not handle another HIV/AIDS epidemic.

If you think I am exaggerating, I'm not. It's happening right now.

In my opinion there is no 'good' CBT. Give patients medical treatments. As they get better, their lives will improve all by itself.
 
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duncan

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I'd be curious to examine that trend list Wessely alludes to, i.e., once considered real diseases being revealed as psychiatric. Or am I simply misunderstanding his insinuation? I notice he didn't say "pantheon" or "list" when he talked about it; rather, he used "trend", which suggests (to me at least) something ongoing, as opposed to static.

I suspect he is talking about myths and wives' tales pertaining to illnesses that have been proven - in his mind at least - to be of psychiatric origin. I wonder though, even so, how many are really psychiatric vs. simply upended superstitions.

That's a list I'd like to see.
 
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A.B.

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That diseases are mistakenly framed as psychosomatic over and over again is a sign of a systematic error. Until that error is corrected, the same mistakes will continue to be made. And I think that error is uncritically accepting the claims of psychosomatic illness, even if today we know that the initial case reports of successful treating psychosomatic disease were lies and fraud (Freud).
 

jimells

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Proof Positive said:
...Professor Simon Wessely, who chaired the entire conference, Professor Michael Sharpe and Professor Trudie Chalder, others who have featured in the fate of those with ME include Professor Mansel Aylward, formerly of the Department of Works and Pensions ... and who is now at Cardiff as Professor and Director of Psychosocial Disability and Research at a new Centre funded by UnumProvident, the medical insurance giant that has a lengthy and disturbing track record of refusing to pay legitimate claims, especially to those with ME/CFS, to the extent that punitive damages have been awarded against it.
Here we see the unholy alliance of the psychobabblers, academia, government, and insurers in the UK. I am convinced the same unholy alliance also exists in the US, with some of the same players, including psychobabblers exported from the UK (Hey! We don't want them either!) I hope to live long enough to see these connections exposed. Americans love a good scandal. There are still good investigative journalists around - I wish they'd go after this.
 

SOC

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In my opinion there is no 'good' CBT. Give patients medical treatments. As they get better, their lives will improve all by itself.
Not sure I can entirely agree with this. Certainly CBT is not a treatment that will improve ME/CFS somatic symptoms, whether it is 'good' CBT or 'bad' CBT. To improve our health we need medical treatment, not psychology.

However, some people with ME/CFS don't naturally develop the coping skills they need in order to function with a disabling chronic disease. Those people might benefit from the type of CBT that helps the patient learn to live with extremely difficult situations. There are (sometimes) ways to deal with tragedy that can help you get through it. Good CBT can help you face reality and move on with life.

CBT makes not one iota of difference to somatic symptoms, nor does every patient need it. Plenty of patients manage to cope without therapy, just like some people cope with divorce without therapy, but others benefit from some counseling. CBT should never be considered a treatment for ME/CFS, nor should it be recommended for all patients any more than it is recommended for every cancer or MS patient.

That said, I wouldn't put a penny of donated or government money towards 'good' CBT until we have reliable, well-accepted medical treatments available to all patients. It's a matter of priorities.

As for BPS theories -- total BS. They have no solid evidence to support them and should be tossed into the pseudoscience trash bin.
 

jimells

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I just realized the psychobabblers have built a perpetual motion machine. They are brilliant and devious:

1. Convince public that patients are fakers.
2. Public treats patients badly, causing much damage, including psychological.
3. Offer patients talk therapy to cure damage caused in Step 2.
4. Invest profits and publicity into more Step 1.
 

Kyla

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I'd be curious to examine that trend list Wessely alludes to, i.e., once considered real diseases being revealed as psychiatric. Or am I simply misunderstanding his insinuation? I notice he didn't say "pantheon" or "list" when he talked about it; rather, he used "trend", which suggests (to me at least) something ongoing, as opposed to static.

I suspect he is talking about myths and wives' tales pertaining to illnesses that have been proven - in his mind at least - to be of psychiatric origin. I wonder though, even so, how many are really psychiatric vs. simply upended superstitions.

That's a list I'd like to see.
Here is the exact quote:
"You should remember that there is an opposite trend as well, which you didn't mention. You ignored the history of visceral proptosis, floating kidney, autointoxication, or focal sepsis, for example"

This list, of course, doesn't prove his point at all.
In order for it to be an "opposite trend", these would have to be distinct diseases presumed to be of somatic origin, which with the advance of knowledge were proved to be distinct diseases of psychosomatic origins.

In fact these were more theories that were popular (presumed) aetiological explanations for symptoms.

Focal sepsis might be he closest to almost fitting this model. Ironically (for Wesseley), it was psychiatrists who were pushing the theory that this was the cause of bipolar disorder and schizophrenia. Leading to some rather nasty experimenting on psychiatric patients. From Wikipedia:

"the director of the psychiatric asylum at Trenton State Hospital since 1907 was Henry Cotton.[51] Drawing influence from the medical popularity of focal infection theory,[20]Cotton identified focal infections as the main causes of dementia praecox (now schizophrenia) and manic depression (now bipolar disorder).[51] Cotton routinely prescribed surgery to clean the nasal sinuses and to extract the tonsils and dentition.[51] Yet, seeking to clean the entire body of focal infections, Cotton frequently prescribed surgical removal of the appendix, gall bladder, spleen, stomach, colon, cervix, ovaries, testicles, and thereby claimed up to 85% cure rate.[51]"

What makes this an especially bizarre comparison is that I don't believe ANYONE (even Wesseley?) would condone calling bipolar or schizophrenia a psychosomatic disorder. And, in fact, I would say these are the psychiatric illnesses where there is the CLEAREST evidence of an underlying biological / biochemical basis.
So really no one was mistaking a psychosomatic disorder for a somatic one. They were just wrong about the aetiology. (Very, very wrong).

In any case. His list holds no water. It is (at best) an illogical and intellectually dishonest argument.
 

Woolie

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I also got interested in Wessely's comment on this presentation, where he mentioned four diseases he believes were formerly thought to be "organic" and are now thought to be psychiatric (he rather cleverly uses the word psychiatric, not psychological, but he uses the example in a way that claims these illnesses are indeed now thought to be psychological in origin).

They are:

visceral proptosis, floating kidneys, autointoxication, focal sepsis.

The point he was trying to make is that its not always the case that illnesses once believed to be psychological turn out to have a biological basis. The opposite can occur too.

I did a little research into these conditions, to see what their presenting features are and what current views on them are. There is little information to be found in scientific journals on the first condition (visceral proptosis). The only places I found reference to it was when it was being listed to support arguments of Wessley himself or his coauthors (where the diseases above are often listed in the same order, almost as if copied and pasted from one article to the next).

But I had a bit more luck on floating kidneys, where it appears the "psychological" interpretation is still in dispute:

Barber, N. J., & Thompson, P. M. (2004). Nephroptosis and nephropexy—hung up on the past?. European urology, 46(4), 428-433. http://www.sciencedirect.com/science/article/pii/S0302283804001794
The label of ‘an ineffective treatment for an imaginary disease’ has largely been successfully stuck to the condition of nephroptosis and its surgical management, nephropexy. As a result, younger urologists, especially in the US and UK, have little knowledge of the condition nor why such accusations were made. In this review we explore the historical background to this statement, including descriptions of some of the more exotic surgical procedures employed in the past and visit the diagnosis again in the setting of the modern era, armed with more sophisticated diagnostic tools and less invasive and thus morbid surgical techniques. We aim to demonstrate that with appropriate diagnostic criteria, the diagnosis of symptomatic nephroptosis can be reliably made and that laparoscopic techniques provide an excellent approach in the successful surgical management of this condition.

So this example is incorrect.


Autointoxication is not a disease in its own right, but rather an early explanation for a condition we now would probably call schizophrenia. While the autointoxication theory has gone out, most current theories of schizophrenia focus on genetics and neurobiology as the primary causal factors, not psychology at all. Schizophrenia is not generally believed to be psychogenic in origin, nor is it considered to be a psychosomatic disease.

So this example is incorrect
.

Focal sepsis is also an explanation rather than a disease in its own right, and its not true to say that diseases once thought to be due to this cause are now considered to have a psychological cause. One of the diseases where focal sepsis was thought to play a causal role is in fact rheumatoid arthritis:
http://www.sciencedirect.com/science/article/pii/0277953682901356

So this example is incorrect.
 
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I also got interested in Wessely's comment on this presentation, where he mentioned four diseases he believes were formerly thought to be "organic" and are now thought to be psychiatric (he rather cleverly uses the word psychiatric, not psychological, but he uses the example in a way that claims these illnesses are indeed now thought to be psychological in origin).
Thanks for digging past the rhetoric!