Big news from Sweden: Fatigue diagnosis to be disappeared

To understand the policy changes and their implications - absolutely. And I appreciate your effort to educate myself and others.

To understand the research and studies - much less so. If a study is inadequate, it’s inadequate regardless of the topic or the societal context of the topic. I don’t need the context to see the red flags.

Understanding the researcher’s agenda might make it easier to ignore their propaganda, but I’m a firm believer in the principle that any argument’s validity is dependent on the argument itself and not the person making the argument.

So understanding why they did a study is useful to understand the societal context, but not really for judging the merits of the findings.

I’m not saying that you agree or disagree with any of this. I’m just trying to say that my approach to combating e.g. a study is to go after the study itself and not the reason for the study. Therefore, I focus on the study and not the context surrounding it.

Apologies for taking it that way.

 

Trying to see this from high up, it seems that the idea is mainly about dropping rest as a therapeutic option, because it doesn't work for everyone, and instead going on a widespread implementation of active rehabilitation, which works for even fewer people, and will make lots worse. But it's likely assumed to be cheaper, as long as no one actually counts, because it can be done for cheap over a few weeks, or whatever.

I very much doubt that the 'ED' treatments are any effective, rather it's the flexible adaptation and rest that likely help most. Because rest is good for well-being and health, in good dosage. And this being a grab bag of various things without known causes, that's rather expected, but it will still help some. This is why vacations and week-ends exist, after all. If work was actually good for health, people who work the most and hardest would be the healthiest and live longer. And of course that's not the case at all, but that's inconvenient so entirely looked over.

But it's pretty much guaranteed that active rehabilitation and removing time off will fare worse overall, making the argument that rest doesn't work for everyone hypocritical and nonsensical, the numbers-to-treat and outcomes are atrocious, so this is likely why they pretend that there is no evidence at all, so they can do it all over again. The idea suffers from similar flaws as rest, but with additional problems tacked on. And of course it changes the 'therapy' from a passive thing, which is , to an active thing, which is . It feels like doing something. Even if that thing is mostly harmful. Which I guess is to them.

This is an idea that can't fail, it can only be failed. What absurd nonsense. However silly things are in the US right now, health care has always been just as much of a mess about problems they don't know how to deal with. They both pretty much look the same to me, same as what the UK is doing.

 

Another opinion piece in one of Sweden's largest newspaper, framing ED as a cultural illness potentially caused by toxic positivity.

Varför är alla moderna människor så sjukt trötta?
https://www.dn.se/kultur/sandra-stiskalo-varfor-ar-alla-moderna-manniskor-sa-sjukt-trotta/

 

I think this review is quite interesting and gives a flavour of how the ED diagnosis has been used. They searched for research on ED and found about 50-60 useful articles, many of which were from about half a dozen Swedish groups. The equivalent figure for ME/CFS would presumably run into a thousand or more.

They say that ED is defined as work-related 'burnout'. The symptoms are then described as what is seen in burnout. They point out that ICD-10 recognises burnout as a social phenomenon but not as a medical condition. I suspect that in countries other than Sweden that line has been taken and burnout is distinguished from what is seen as a medical problem that might have been triggered by work - which broadly speaking would seem to cover reactive depressive illness, but also very likely cases of ME/CFS that have been wrongly attributed to overwork per se (clearly overwork could precipitate ME/CFS or turn a mild state into a worse one).

The symptom pattern described for ED is interesting because it seems to be a mix of reactive depressive features such as depersonalisation and sleep disorder of the insomnia rather than early morning waking (biologic depression) type. They also mention emotional lability and irritability, which are a bit difficult to know where to fit in.

As far as I can see this is considered a psychological diagnosis - pretty similar to the 'chronic fatigue' of White and Sharpe's Oxford criteria maybe. But it also appears that the name may have been taken to imply, at least for patients, a 'physical' problem of 'exhaustion', perhaps a bit like the way 'functional' is taken to mean something physical by patients.

That seems to bring us back to the debate we had about whether 'functional' is ever a useful term for patients and whether it should be revealed as the double-speak term it is. I guess that all this has played out in a slightly unusual (or best-end of spectrum maybe) state-run health service in Sweden - one that in the past has tended to be viewed very highly as compassionate and efficient.

I can see that this may well be a symptom of a political shift in Sweden, which like that in the UK, does not feel to be going in the right direction. How much changing a dubious name will contribute to that I wouldn't know but I suspect other forces will be more important.

All this will become irrelevant to people with ME/CFS if we can get some scientific answers. I am optimistic that we will but I realise that I don't have anything specific to back that up with just yet.

 

Yes, a psychiatric diagnosis (that includes physical symptoms).

I've never gotten the impression that they have tried to frame ED as a "functional" disorder. ED used to be called "utmattningsdepression" (literally "exhaustion depression") until 2003.

Thank you so much @Jonathan Edwards, for taking the time to share your thoughts on this, it is appreciated.

 

I wonder what the BPS brigade would say about that take!

 

Another opinion piece in a very large newspaper.

”Avskaffad diagnos röjer ett haveri”
https://www.svd.se/a/kwzzPk/haveriu...yndrom-nu-avskaffas-skriver-isac-riddarsparre

 

I have tried to articulate what I see happening on a broader scale right now in Sweden. I'm not sure if it comes across in the translation, as much depends on the language and the words that are used. Implications. But maybe?

”It feels like we have suddenly found ourselves in the middle of some kind of normalization process around the concept of cultural illness.”

Autotranslated blog:
https://mitteremitage-wordpress-com..._sl=sv&_x_tr_tl=en&_x_tr_hl=sv&_x_tr_pto=wapp

 

Irony was already dead. They just dug its grave and treated it like a dead horse.

No matter how much you know how everyone is winging it, and people holding difficult jobs are all out of their depth, it never fully captures just how thoroughly out of their depth a lot of people are, while totally convinced they have such superior knowledge they can fully dispense with having to put in any more effort than lazily winging it.

The cringe level here is so high that I am going to become the Joker.

I guess that's one person who has never gone on the Internet, or ever left the room they were born in.

 

Thanks - can I assume what is fatigue syndrome in this translation is exhaustion disorder?