An exploration of victim blaming in ‘medically unexplained symptoms’: Neoliberalism and the need to justify the self, group and the system 2023, Hunt

available in english,german,italian, spanish and greek.

ABSTRACT
Narratives within mainstream psy disciplines around ‘medically unexplained symptoms’ (MUS), as constructed through (bio)psychosocial theorising, have been charged with promoting victim blaming. Psychosocial discourse and practice within this field are also critiqued on grounds of inadequate empirical support and associated with patient harms, yet (bio)psychosocial hegemony persists.

Understanding what drives current practice and attendant victim blaming in the field of MUS is therefore important in challenging dominant discourse and changing psychotherapy practice, thus precluding patient harm. In this article, practitioner psychology is explored through a critical lens, locating this within a context of organisational and biopolitical influences which likely reinforce mainstream theory and practice.

It is argued that victim blaming tendencies within dominant discourse around MUS may serve relational, existential and epistemic needs for practitioners and social actors more broadly, alongside fulfilling a need to assert moral value in the face of social injustices that threaten the neoliberal ‘just world’ view. In other words, (bio)psychosocial constructions of MUS satisfy society’s need to create and ascribe to a shared reality, dominated by a belief in a just, meaningful and relatively predictable world that justifies the status quo. Critical reflexivity is emphasised as a starting point for transforming practice.

https://www.tandfonline.com/doi/abs/10.1080/13642537.2023.2240809?src=&journalCode=rejp20

 

If Hunt’s arguments about the psychopathology of clinicians have any validity, they should apply to absolutely every professional in every context as well, making them reductive enough to be meaningless.

 

Isn't the point that when people who need help don't fit into the box marked 'How to help', some professionals will blame the people who need help, rather than blaming the box? By understanding that phenomenon better, professionals can be on guard against that tendency in themselves and others.

It would surely be helpful if 'victim-blaming by professionals' became a widely understood phenomenon among the counsellors and psychologists at whom this journal is aimed.

It would also be good if that audience had some awareness of victim-blaming when they are assessing the evidence for the supposedly widespread phenomena of 'false illness beliefs' and 'secondary gains'.

 

That may be true. What purpose does a supposed aetiology of victim-blaming tendencies serve, though, if awareness of victim-blaming is all that is needed?

 

Greek

 

Interesting ideas.

One should ask the question why so many people very strongly want unexplained symptoms in others to have a psychological origin. By definition they are unexplained, which would normally mean that we don't know the cause.

The impression is that this satisfies some kind of need. It seems possible this has something to do with the cultural values of our time, but I'm not sure that these are only neoliberal values.

An effective response to ME/CFS would require things that aren't well aligned with neoliberal views, like public health measures to minimize exposure to viruses that trigger ME/CFS, a social safety net for those that never had the chance to work, and public investment in research to find treatments.

CBT and exercise therapy seem very aligned with the individualist and self-improvement culture of today. The illness is depicted as a problem for the individual to solve, and the hardship of rehabilitation becomes a test of strength of character and motivation to get better. Wanting a pharmaceutical treatment is seen as personal failure.

Somehow CFS also became a symbol for various moral failings of society. Patients are accused of medicalizing their personal difficulties, and of being lazy and unwilling to exercise (exercise is a virtue).

But patients can't overcome the illness on their own (this reality is erased), are dependent on others (which is a sin in today's culture), and other people suffer as well (this aspect is mostly ignored because it doesn't fit the idea of the illness being an individual problem).

Psychologization of other people's illness also seems to satisfy the emotional need to avoid feeling the despair that results from witnessing a devastating untreatable illness, because the psychologization always depicts the illness as something that can be relatively easily solved just by thinking differently or overcoming some personal flaw. It also allows the person to take on the role of moral authority that gets to lecture the inferior patient about good behavior. I would argue that this emotional reward of not having to deel despair and feeling superior to others is one of the most important reasons illnesses are psychologized.

 

To persuade psychologists and counsellors who find that kind of reasoning persuasive, including many psychologists giving CBT in the Talking Therapies / Improving Access to Psychological Therapies programmes, the ones performing assessments for insurers, etc. etc.

I don't want to argue for or against another discipline's methodologies, but it seems to me that if psychologists are debating the relative influence of epistemic need fulfillment and of practitioner team building (p. 15) in the aetiology of victim-blaming, it may be possible for the rest of us to get back to talking about the causes of, and treatments for, this debilitating disease.

 

It’s a nice idea, but if the best hope is to distract psychologists, and the only way to do so is by insulting them, I’d prefer another patient group to get the blame!

 

Has anyone been able to read the full paper? I’d like to but can’t at that link and it’s not up on SciHub yet as far as I can tell.

 

I think the tendency for physicians to blame patients, especially if their illness is poorly unexplained, is much older than the neoliberal era, which people usually equate with the economic policies of Tatcher and Reagan in the 1980s.

 

I was able to read this paper thanks to a generous s4me user. I don’t want to fall afoul of any forum rules, so I’ll just say I’d be happy to pay their kindness forward and my PM inbox is open .

I think many of the arguments in this paper will be familiar to members of this forum and are along the lines of things we often talk about:

I don’t understand the paper to be arguing for neoliberalist ideology as the sole cause of patient blaming but as one factor which lends discriminatory human impulses ethical cover in many contemporary societies:

The author forwards arguments about the psychology of patient blaming. I’m not convinced of the truth of their position by what’s offered but the idea that the dehumanization of disabled people comes from a place of mortal fear feels plausible to me: