Article: The alarming hijacking of the BioPsychoSocial model

JellyBabyKid

JellyBabyKid

Senior Member (Voting Rights)
I saw this article (which is mostly about antidepressants) on the Human Givens Institute and thought it worth sharing as it is written by a psychotherapist.

https://www.hgi.org.uk/news/latest-news/alarming-hijacking-biopsychosocial-model#continue?utm_source=ONTRAPORT-email-broadcast&utm_medium=ONTRAPORT-email-broadcast&utm_term=001+-+HG+News+(GDPR)&utm_content=Catch+up+on+news+this+April&utm_campaign=27042019

Apparently the BioPsychoSocial is being misused, antidepressants are being incorrectly prescribed and a diagnosis of depression used to justify the use of CBT/GET where it isn't appropriate: (I think I have understood this correctly; not at my brainiest this morning)

“Doctors very often believe that their patients’ are suffering ‘medically unexplained’ somatic/functional symptoms (filed under DSM ‘psychiatric’ disorders), ‘of unknown aetiology’ such as ‘chronic fatigue syndrome’, IBS, Fibromyalgia etc. The patients’ earlier diagnosis of ‘depression/anxiety’ is then used to validate the ‘psychosomatic’ label, therefore leading to the conclusion that CBT and graded exercise provides suitable treatment to correct their patients' fictitious illness beliefs.

“This is the bio-psycho-social model being turned on its head – with truly devastating health and life consequences"

Edit: the author is a psychotherapist not a psychologist
 
I haven't read the thing, but based on the post above;

So they are using an earlier diagnosis that they admit they got wrong, that implies a mental health/behavioural issue, to justify behavioural treatment for a mental health/behavioural issue that they admit doesn't exist?

One size fits all it seems.

Feeling a bit tired today? Go to the gym, do a few marathons, and if you think this is a bad idea you're clearly mad and need treatment, that there is no evidence for, to correct that/pay for my new roller.

Your left leg has fallen off? That was silly of you wasn't it. Clearly a mental health issue as no one sane would live life in such a way as to cause limbs to be removed.

Having a heart attack? Yes, this will happen if you worry too much, or if you chose to arrange your life poorly, poor diet, lack of exercise, or being obsessed with your health and having too healthy a diet, too much exercise.

You run marathons and consult health professionals? You limit the type and quantity of food you eat rather than not? Clearly obsessive behaviour.

Clearly a mental health issue either way. You're never going to get better while you think/behave this way, so it's pointless treating the heart attack until we sort out the way you're thinking old chap.

Clumsy with words this morning.
 
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Interesting.

The British Journal of General Practice published my recent e-letter – ‘The right stuff - or the wrong stuff?’ responding to their April edition themed around ‘medically unexplained symptoms’.
Click to expand...
(my bolding)
Does anyone know if we've seen this edition or any of the articles in it? Seems like it would be good to know what GPs are being told, especially with it being so recent. I mean i can imagine, in horror, the sort of stuff that edition might contain, but it'd be good to know how bad it is.
 
JemPD said:
Interesting.

(my bolding)
Does anyone know if we've seen this edition or any of the articles in it? Seems like it would be good to know what GPs are being told, especially with it being so recent. I mean i can imagine, in horror, the sort of stuff that edition might contain, but it'd be good to know how bad it is.
Click to expand...

Posts crossing as I have just posted the letter.

"There is a ‘medical’ explanation for many ‘unexplained’ symptoms: medicine. However, doctors are being actively trained to disbelieve patients’ experiences3 and to assume ‘unknown aetiology’ and/or ‘psychosomatic’ causes."

interesting indeed.
 
JellyBabyKid said:
(replying to Wonko) Actually the author is arguing against this and is making the point that doctors are getting it wrong. She has also written to the BJGP (British Journal of General Practice) about it:

https://bjgp.org/content/69/681/163/tab-e-letters#the-right-stuff---or-the-wrong-stuff

Edit: adding who I was replying to
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I am aware.

One article pointing out the bleeding obvious merely highlights the problem.

The problem still exists, and rapidly appears, as a matter of deliberate policy, to be getting worse.

It is planned, by those that do planning in healthcare, to get much, much worse, as it's considered cheaper in the short term to make it so.

It's not an accident, it's not the odd bad doctor, it's intentional.
 
Wonko said:
I am aware.

One article pointing out the bleeding obvious merely highlights the problem.

The problem still exists, and rapidly appears, as a matter of deliberate policy, to be getting worse.
Click to expand...

Ah. right sorry.

Yes - the author is making the point of being both ignored and patronised on the point in her letter to the BJGP. Good to know it's not just us patients noticing though??
 
I have read both articles. I think the author's point is that doctors are prescribing antidepressants too much. These are causing side effects in the form of physical symptoms which the doctor then misdiagnoses as MUS including CFS and puts them on CBT/GET.

I think this is an article about medication side effects being misdiagnosed and wrongly treated as MUS/CFS.

It's not clear whether the author thinks CBT/GET are the correct treatments for MUS/CFS if that's a correct diagnosis, or whether she thinks the BPS model is OK for MUS/CFS.
 
Thanks for posting this @JellyBabyKid

I have great trouble understanding terms like ‘Power of beliefs’, ‘true BPS model’, ‘doctors believe’. They don’t sound scientific to me. Interestingly, the author doesn’t seem to ‘believe’ in CFS, judging by the quotation marks.

The fact that many ailments are provoked by wrongly or over prescribed drugs is not confined to anti-depressants. It has happened to antibiotics, acetylsalicylic acid and opioids, just to name a few. Technology is faster than science, sales are more important than treatment, advertising is more appealing than education, taking a pill is easier than changing human habits, prescribing a pill is the ultimate reward for a long chain of economic investment in the drug development business. It’s not just about treating patients (or more usually, treating diseases).

There has been a time when doctors were considered less capable if they didn’t prescribe any medication. I suspect this was the result of a deliberate plan to sell drugs irrespectively of the patient’s needs.

Drug withdrawal symptoms are equally a widespread issue, and I suspect many doctors are unaware of the right way to stop taking drugs, not to mention that many drugs that have been largely prescribed for long term treatment are now restricted to short term treatment.

I have been prescribed Venlafaxine, Duloxetine and Pregabalin for a ‘suspected’ fibromyalgia/CFS/chronic pain syndrome. I wonder what would have happened if I had taken them. o_O
 
Trish said:
I think the author's point is that doctors are prescribing antidepressants too much. These are causing side effects in the form of physical symptoms which the doctor then misdiagnoses as MUS including CFS and puts them on CBT/GET.
Click to expand...
That in itself is a very interesting possibility. It would be absurdly and sadly ironic if some of the MUS diagnoses are indirectly caused by GPs themselves. It makes you wonder if some other MUS diagnoses might also be due to something as silly and obvious as medication side effects going unrecognised. I know medications list all the various side effects and their probabilities, but those probabilities will be skewed if instances of them go unrecognised / unreported.
 
aza said:
Thanks for posting this @JellyBabyKid

I have been prescribed Venlafaxine, Duloxetine and Pregabalin for a ‘suspected’ fibromyalgia/CFS/chronic pain syndrome. I wonder what would have happened if I had taken them. o_O
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I have been prescribed Venlafaxine and Pregabalin.

I was totally unable to tolerate the latter and while the former helped with depression the side effects and withdrawal were *awful*. I had to take stuff for vertigo when coming off it and I was on a dose so low it wasn't considered to be enough to be clinically effective. Sally Brompton's account of taking it in Shoot the Damn Dog is pretty terrifying.

Despite this my current GP doesn't seem to understand why I refuse to take antidepressants.
 
JellyBabyKid said:
I have been prescribed Venlafaxine and Pregabalin.

I was totally unable to tolerate the latter and while the former helped with depression the side effects and withdrawal were *awful*. I had to take stuff for vertigo when coming off it and I was on a dose so low it wasn't considered to be enough to be clinically effective. Sally Brompton's account of taking it in Shoot the Damn Dog is pretty terrifying.

Despite this my current GP doesn't seem to understand why I refuse to take antidepressants.
Click to expand...

I think most doctors don’t understand that many patients with chronic conditions are depressed as a consequence of chronic pain, not the other way round.

A friend had awful withdrawal symptoms and side effects from Venlafaxine and that has convinced me to never try it. I don’t need more troubles!

I can’t say I’m a positive type of person, and it’s clear that I have anxiety and intermittent depression symptoms, BUT, don’t we all have them from time to time? I find comfort in my negativity sometimes. It has prevented me from doing stupid things and trusting stupid people. No, I don’t need anti-depressants, at least not for long term treatment and I don’t like the sound of withdrawal symptoms for short term treatment. So it seems I won’t be taking them.

I’m open for LSD trials though :p
 
Decades ago I had a concerning side effect from a drug. This was dismissed as not connected to the drug, and perhaps not believed in the first place. I don't know if this particular side effect was known at the time, but a few years later I read that it was included in the list of side effects.

Other times when I've had side effects from drugs, I've been told I'm in the 1 percent group who get side effects.

I think we know drug reactions are not always reported to health authorities/health ministries/departments. I think the true measure of drug reactions might often be noticeably higher than 1 percent.
 
Re being told I was in the 1 percent group to have side effects: the health professional who told me this was probably just being dismissive and a jerk. At the time I thought this person was just being factual and sincere. I'm old and jaded now, hopefully would not believe that milarky anymore!
 
I once reported a side effect of an antihistamine was very severe headaches.

My GP informed me that she didn't know what had caused the headache but it wasn't the antihistamine.

Upon checking myself I discovered that over 20% of people reported headaches as a side effect, and of those 56% of the males reported it as beyond severe.

So my conclusion at the time was, don't bother telling my GP about side effects, just quietly accept the prescription and then carefully don't take the pills.

I did my bit, I got glared at, told off, made to feel like an idiot, for my trouble.

Sod 'em.

(I realise this isn't helpful to anyone else, but what's the point if observations are met with derision and not recorded)
 
We should always report any side effects, not only severe ones, to the official channel (Yellow Card Scheme in the UK) and to the drug manufacturer (they have proper channels for that). Doctors rarely know how drugs work (pharmacokinetics and pharmacodynamics) so it’s useless to tell them. Better tell your Pharmacist.
 
I did a similar thing with tricyclics @Wonko when amitryptiline wasn’t working and too sedating all I got offered was other tricyclics. I asked for melatonin but she wasn’t allowed allegedly to prescribe that. I took the nortryptiline prescription but that was just the same si I just stopped talking it and then about a year later I was asked if I’m not taking it and it was taken off my prescription - no discussion about what I am taking. Similar with pregabalin although I do order that occasionally so I can take it when neuropathic pain is bad enough to make me put up with the level of sedation the medication causes
 
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