"Treatment of neurotic disorders" by Simon Wessely (2008 presentation)

[Valentijn]

Maybe we should make a chart of all of the (contradictory) claims which various psychobabblers have made regarding ME/CFS. Could be interesting. Or at least entertaining

 

[chipmunk1]

PS: that hypermentalization crap was talked to me too by the psychiatrist who claimed that my repetitive stating how poorly I felt and what was happening was pathological

[satire]Perfectly reasonable. It is well known that people with physical illness don't feel poorly and don't complain.
Complaining is always a sign of the absence of physiological pathology.
[/satire]

 

[misskatniss]

@Valentijn nooo we should do it AND not do it at the same time, like we seem to do / not do everything at the same time! I guess we are like Schrödinger´s cat huh? ^^

 

[biophile]

Maybe we should make a chart of all of the (contradictory) claims which various psychobabblers have made regarding ME/CFS. Could be interesting. Or at least entertaining

Here is an unrelated topic which sounds uncannily similar to problems we face with the psychologisation of CFS:

http://www.theage.com.au/business/economists-and-the-clash-of-theories-20141017-117i2w.html

Economists may be bad at forecasting - even at foreseeing something as momentous as the global financial crisis - but that doesn't stop them arguing about events long after the rest of us have moved on.

That's good. Economists need to be sure they understand why disasters occurred so we can avoid repeating mistakes. They need to check the usefulness of their various models and whether they need modifying.

One thing that causes these debates to go for so long is that that economics - particularly academic economics - is based more on theories than evidence. Some theories clash, so empirical evidence ought to be used to determine which hold water.

But economists aren't true scientists. They pick the rival theories they like best and become more attached to them as they get older. They'll try to talk their way around evidence that seems to contradict the predictions of their model.

This leaves plenty of room for ideology, for individuals to pick those theories that fit more easily with their political philosophy.

 

[meandthecat]

ME and CFS patients can develop real ongoing shame and embarrassment in reporting their symptoms to health care professionals that they fear will be dismissed as evidence of neurotic behavioral patterns.

I have a great relationship with my GP, I don't mention ME and she doesn't ask.
How many elephants fit into a doctors office....as many as they choose not to see!

I have just gone through surgery for prostate cancer, it's taken four years but hey what's the rush.. as I was in recovery I started to feel bad, well bad'er and desperate to lie flat had to battle with the staff nurse who wanted me sitting up. Finally got help from another nurse only to be rounded on by the staffy again but having had a few minutes lying flat I could think again and said 'I have ME', she changed, she accepted the reality of my statement in a way that no doctor has; 'no one told me' she said. I had told the anaesthetist on the 'final walk' to theatre and felt the change in his attitude, which always makes me nervous as he will control my life for the next few hours.
I had mentioned it to the admitting doctor but under my breathe so that he could pretend to ignore it.
I have gone back to work and it is now ME rather than post surgical recovery that is knocking me out but my doctor is only to happy to give me a sick note saying prostate surgery.

I manage the condition well, but it ravages my life. People know I have ME but I downplay it and most only see the active 'me'. I live a lie.

 

[Sean]

I live a lie.

Having to live a lie, especially long term, is one of the most stressful, degrading, and destructive things you can force a human to do.

I wonder if Wessely and Co factor into their beautiful model the necessity for patients to do that, due to misdiagnosis and mistreatment by the medical system, and the general social hostility we face as a result?

The problem for them is that everything they say is a psychopathology in us could be explained as secondary consequences of both the disease process itself, and especially the consequences of their inappropriate behaviour towards us.

It's bizarre. They set up a situation that is predictably going to cause serious psychological distress and harm, then say, 'see, we told you, they are psychologically troubled'. Gee, no shit, Einstein?

Where do I get a job like that?

Besides serious physical pain, the real suffering from ill health is from the way society treats you over it.

 

[chipmunk1]

Here is an unrelated topic which sounds uncannily similar to problems we face with the psychologisation of CFS:

http://www.theage.com.au/business/economists-and-the-clash-of-theories-20141017-117i2w.html

Economists and weather forecasters are at least sometimes right.

Have the psychobabblers ever been right?

MS, Graves Disease, Hypothyroidism, Asthma, Cancer, Peptic ulcers, Diabetes, Arthritis, Movement disorders.

Is there any condition that Psychobabble can CURE?

Oh i forgot. It can cure any psychogenic illness it's just that the sufferers are too lazy, to anxious or want to remain ill.

 

[Sidereal]

Psychosomatic medicine is quite literally the only branch of medicine that is always - invariably - proven to be wrong once enough data are in about the pathophysiology of any disease claimed to be caused by mental states.

 

[ukxmrv]

Does anyone know what year this video was taken? The MD is nice but completely out of touch with CFS.

I think that the video was from 2010 and part if a series directed at UK GP's. The woman shown in that particular part is the real life wife of Professor Simon Wessley, Clare Geralda. She is a London GP and for a year was head of the UK GP group the RCGP.

This may go part of the way to understanding her unhelpful beliefs about CFS but who knows. It could be a folie a deux or she could have even started him off on his path.

I can't see any sign of these attitudes changing in GP's sadly. This video would have made things even worse for those of us seeing a GP in the UK.

 

[chipmunk1]

I think that the video was from 2010 and part if a series directed at UK GP's. The woman shown in that particular part is the real life wife of Professor Simon Wessley, Clare Geralda. She is a London GP and for a year was head of the UK GP group the RCGP.

This may go part of the way to understanding her unhelpful beliefs about CFS but who knows. It could be a folie a deux or she could have even started him off on his path.

I can't see any sign of these attitudes changing in GP's sadly. This video would have made things even worse for those of us seeing a GP in the UK.

but he says CFS is caused by deconditioning and exercise phobia and she seems to suggest "enormous bursts of activity" cause symptoms.

 

[Countrygirl]

I have only just stumbled across this thread and it is a real blast from the past for me . I had no idea that Wessely was hiking around a picture of my bedroom for his presentation. WoW! That was a shock! Cheeky tyke! I recall that mantelpiece and the woman in the wheelchair, not to mention the cat now long dead.

it will take me a while to recover from the shock.

Thanks for the memories, Simon.

 

[Snow Leopard]

We lack insight in our condition but the "researchers" don't.
It is important that we develop a consistent approach:

http://bit.do/TnhP

Does anyone still believe this BS?

No.

The reason why we should be sceptical because the sensitivity and specificity of these associations are not even mentioned in the above studies, let alone tested.

For example, a claim, that say, 50% of CFS patients have ongoing depression cannot be used to explain CFS in general, because that is a very low sensitivity. It also has a low specificity - almost all people with depression do not have CFS. But yet, discussion of the sensitivity and specificity of such associations is never mentioned.

 

[chipmunk1]

here are some facts that suggest that GET is a huge scam, unethical and outright dishonest:

http://bit.do/TnhP

Listen carefully to what the she says:

It is important that we break the association between activity and symptoms

The word association is often used in that context in classical conditioning.

So i would say she seems to believe that the negative effects of activity are due conditioning if she is talking about associations.

http://en.wikipedia.org/wiki/Classical_conditioning

Conditioned suppression[edit]
This is one of the most common ways to measure the strength of learning in classical conditioning. A typical example of this procedure is as follows: a rat first learns to press a lever through operant conditioning. Then, in a series of trials, the rat is exposed to a CS, a light or a noise, followed by the US, a mild electric shock. An association between the CS and US develops, and the rat slows or stops its lever pressing when the CS comes on. The rate of pressing during the CS measures the strength of classical conditioning; that is, the slower the rat presses, the stronger the association of the CS and the US. (Slow pressing indicates a "fear" conditioned response, and it is an example of a conditioned emotional response, see section below.)

The concept is of course used for various psychotherapies.

Behavioral therapies[edit]
Main article: Behavior therapy
Some therapies associated with classical conditioning are aversion therapy, systematic desensitization and flooding. Aversion therapy is a type of behavior therapy designed to make patients give up an undesirable habit by causing them to associate it with an unpleasant effect.[32] Systematic desensitization is a treatment for phobias in which the patient is trained to relax while being exposed to progressively more anxiety-provoking stimuli(e.g. angry words).[33] Flooding attempts to eliminate an unwanted CR. This type of behavior therapy is a form of desensitization for treating phobias and anxieties by repeated exposure to highly distressing stimuli until the lack of reinforcement of the anxiety response causes its extinction.[34] It is usually with actual exposure to the stimuli, with implosion used for imagined exposure, but the two terms are sometimes used synonymously. operant conditioning.

Interestingly some psychs have stated that CFS sufferers have exercise phobia. For phobias systematic desensitization is often used..

http://en.wikipedia.org/wiki/Systematic_desensitization

The goal of systematic desensitization is to overcome avoidance by gradually exposing patients to the phobic stimulus, until that stimulus can be tolerated.

Sounds familiar? Systematic desensitization also known as Graduated Exposure Therapy in psychology.

Graded exercise therapy (GET) is a structured exercise programme that aims to gradually increase how long you can carry out a physical activity

Interestingly:

The number of clinicians using systematic desensitization has also declined since 1980. Those clinicians that continue to regularly use systematic desensitization were trained before 1986

Coincidence?

To me this suggests that GET is nothing more than graded exposure therapy for phobias. (Exercise phobias in that case)

...break down the worry you have about undertaking activity....

http://bit.do/Tq3V

...start doing a little and gradually build up..

.

http://bit.do/Tq3B

Now imagine you were a therapist trained in the seventies/early eighties and you had a strange case of someone who suffers from irrational fear of exercise. How would you treat that person?
With Graduated Exposure Therapy! I don't know if it is a coincidence that both GETs have the same acronyms. Aside from that the basic concept is very similar and based on ideas of conditioning.

They seem to believe that during a viral infection we got conditioned to have adverse effects to activity and the conditioning is still there long after the infection is gone.

Now the unethical part: How is GET promoted? Are they honest about the treatment? Do they reveal what research it is based on? Is it ever ethical to lie to patients even when well intentioned Is it acceptable? GET is called an exercise program not a psychotherapy? Why do they need to lie about the origin of the treatment?. Patient's that undergo systematic desensitization don't need to be lied for the therapy to work.

it's best to avoid the term psychological altogether..

http://bit.do/Tq2B

BTW nice to hear that we are just delusional pigeons that need to be lied to in order to get re-programmed.

http://ptjournal.apta.org/content/72/4/279.short

The Effect of Graded Activity on Patients with Subacute Low Back Pain: A Randomized Prospective Clinical Study with an Operant-Conditioning Behavioral Approach

F0rdyce3~ pointed out that pain itself
is not a disease; it is a symptom. Pain
behavior should be understood to be
a social communication, the meaning
of which remains to be discovered in
the individual ~ase.~9.30.37 It should be
recognized that we often use the lan-
guage of pain to communicate suffer-
ing. Pain behavior can automatically
come under the control of lear-11ing.3~
Learning is characterized by a change
of behavior and will occur if condi-
tions are favorable. One of the most
effective ways to change behavior is to
change the consequences that imme-
diately follow the behavior.

Scam. Pain behaviour is a social communication and can be unlearned?
Fatigue behaviour is a social communication and can be unlearned?

 

[Cheshire]

There's a major flaw in this "exercice phobia" theory which is why don't people bedbound after an operation or an accident develop CFS. Or are just people who got an accident less neurotic than people getting virus???

 

[Valentijn]

They seem to believe that during a viral infection we got conditioned to have adverse effects to activity and the conditioning is still there long after the infection is gone.

One question I've always had: if we're supposedly prone to having a hysterical reaction to illness, why did we all manage to recover from viruses in a psychologically normal manner for the decades prior to getting ME/CFS?

 

[chipmunk1]

There's a major flaw in this "exercice phobia" theory which is why don't people bedbound after an operation or an accident don’t develop CFS. Or are there just less neurotics in people who got an accident???

[satire]i think each accident type has it's own somatisation disorder. Viruses tend to cause fatigue. Car accidents cause other psychosomatic symptoms.

TThe increased prevalence of somatic symptoms beyond symptoms expected according to the organic injury model for chronic whiplash, challenges the standard injury model for whiplash, and is indicative evidence of chronic whiplash being a functional somatic syndrome.

http://www.ncbi.nlm.nih.gov/pubmed/22935146

Seriously, the theory is extremely flawed as you have pointed out. Who would believe that?

One question I've always had: if we're supposedly prone to having a hysterical reaction to illness, why did we all manage to recover from viruses in a psychologically normal manner for the decades prior to getting ME/CFS?

I have no idea. In psychobabble speak: The development is probably catalysed by a secondary illness gain working in synergy with pervasive avoidance behavior and fear of abandonment.

Translation: We were even more weak minded and insecure than usual and wanted attention.

 

[Sidereal]

One question I've always had: if we're supposedly prone to having a hysterical reaction to illness, why did we all manage to recover from viruses in a psychologically normal manner for the decades prior to getting ME/CFS?

Because the mind is all-powerful and works in mysterious ways.

 

[Valentijn]

Because the mind is all-powerful and works in mysterious ways.

Oh. And here I was hoping it was something simple like demonic possession

 

[Snow Leopard]

[satire]i think each accident type has it's own somatisation disorder. Viruses tend to cause fatigue. Car accidents cause other psychosomatic symptoms..

I think it is mostly a load of nonsense. "Somatisation" as measued is often just people ticking different boxes on a questionnaire. The actual reasons can vary greatly. Having some sort of health condition or injury may make someone more likely to tick different boxes. Therefore the ticking of boxes doesn't necessarily suggest anything about pathology.

If the psychiatrists focus entirely on the ticking of boxes as a measure of illness and treatment then it becomes an accounting exercise. This is a big mistake in my opinion. The focus of such psychotherapies therapies needs to be on functioning and in terms of measuring efficacy, objectively measuring that functioning. Are the people being treated actually overcoming their limitations or not. When psychotherapies are tested in terms of this, they are often found to be ineffective.

 

[chipmunk1]

When psychotherapies are tested in terms of this, they are often found to be ineffective

It depends on how you define effectiveness:

The psychs often think there is no problem whatsoever people just think they have a problem.

If you can make them believe there is no problem the problem has been solved.

If chronic fatigue is just activity anxiety/phobia and you can lower the reported phobic thinking patterns the phobia has been successfully treated and the treatment was a success.

if it was defined to be a phobia it doesn't matter if you can work or how your quality of life is because the problem has been solved by treating the phobia.

Also generally psych therapies are often not expected to fully cure someone. Residual symptoms are usually the fault of the patient because they hadn't learned something yet and if they learn to manage their condition better they will eventually get rid of all their symptoms. In many cases a 100% cure can not be expected anyway due deeply rooted character flaws etc.

That's psych logic. All based on the idea that your mind is not your friend and you need a certified nutjob to fight it off.