Blaming the victim, all over again: Waddell and Aylward’s biopsychosocial (BPS) model of disability, 2016, Shakespeare et al

Andy

Andy

Retired committee member
Blaming the victim, all over again: Waddell and Aylward’s biopsychosocial (BPS) model of disability, 2016, Shakespeare et al

Abstract
The biopsychosocial model (BPS) of mental distress, originally conceived by American psychiatrist George Engel in the 1970s and commonly used in psychiatry and psychology, has been adapted by Gordon Waddell and Mansel Aylward to form the theoretical basis for current UK government thinking on disability. Most importantly, the Waddell and Aylward version of the BPS has played a key role as the government has sought to reform spending on out-of-work disability benefits.

This article critiques Waddell and Aylward’s model, examining its origins, its claims and the evidence it employs. We argue that its potential for genuine interdisciplinary cooperation and the holistic and humanistic benefits for disabled people as envisaged by Engel are not now, if they ever have been, fully realised. Any potential benefit it may have offered has been eclipsed by its role in Coalition/Conservative government social welfare policies that have blamed the victim and justified restriction of entitlements.
Click to expand...
https://journals.sagepub.com/doi/full/10.1177/0261018316649120
 
Last edited by a moderator:
I think I may've seen this before but it is worth re-reading.

It made me think a bit about what PACE tells us about CBT and GET.

The implication of the Mansell-Aylward BPS model, which may or may not be admitted to be the BPS model of the PACE authors but seems close enough, is that disability is perpetuated by attitude or lack of 'personal effort' as Lord Freud called it.

OK so the obvious way to deal with that is to tell people to buck their ideas up and change attitude, put in a bit more personal effort and go back to work. In other words get the message that they aren't really that sick and can get on with life.

But, it seems that Chalder and co will say, it is not so simple as that. The attitudes are locked deep in the psyche and need 'cognitive strategies' to be winkled out. And White and co will say that the attitude will not change unless gradually increasing exercise has been undertaken to overcome the symptoms of deconditioning that perpetuate the attitude.

So, assuming we ignore all the problems of expectation bias that actually explain all the results, does PACE show that 'cognitive strategies are necessary to unlock the hidden attitudes? And does PACE show that graded increase in exercise is needed to overcome the inhibitory symptoms.

It looks as if we have to consider two scenarios. One is that in PACE CBT and GET arms actually got the same thing, with physios using cognitive strategies and psychotherapists making sure there was a graded increase in exercise. In which case we cannot know whether or not either element was needed.

The other is what the PACE authors intended - that CBT and GET are different, one including expert cognitive strategies and the other expert exercise teaching. (Without this expertise presumably patients could get all the necessary information from a book.)

But in this scenario PACE seems to prove that cognitive strategies are not necessary, because GET is just as good. Moreover, skilled teaching from physios is not necessary because CBT is just as good. Neither is necessary in order to change attitudes (at least as reported by questionnaire) it seems. It is not really credible that one skill somehow does the job of the other. What seems much more plausible is that special skills are irrelevant to persuading people to change attitude.
 
Adrian said:
Its worth reminding people that Aylward was the one getting funding for PACE from the DWP and I think was involved in the trial stering group.
Click to expand...

Yes, he was an observer for the DWP. He then left the DWP and was asked to stay on (as an observer, I think) in a personal capacity. He did not declare his many conflicts of interest even when he was there in a personal capacity.

I seem to recall seeing that while a DWP representative attended one meeting after he left, they then pretty much lost interest in the trial and the illness. It was always his own little project and obsession.
 
Moved post.

Quote from a poster on Facebook who linked the article below.
'If true and he doesn't turn round and do a Prof Garner on us, this is big news. I'll post more on the relevance of this later but Prof Mansel Aylward is one of the main promoter of the biopsychosocial model of illness. Key in playing down longterm illnesses like ME and discouraging doctors not to investigate the causes of back pain.''


bbc.com
Covid: 'This virus was completely underestimated'
One of Wales' most senior doctors - who nearly died with Covid-19 - says the UK was unpre

https://www.disabilitynewsservice.com/former-dwp-medical-boss-makes-wca-pledge-to-protesters/
S'ir Mansel said he sympathised with the protesters, and himself now found the BPS model “unsatisfactory” and believed it “no longer addresses the real needs of disabled people and the exclusion of disabled people from society”.

'He said the “social” element of the BPS model had been “neglected” and that he had a personal “distaste” for the medical model, which focuses on people’s impairments as the cause of their disability......'

This post has been copied and subsequent discussion moved to
Mansel Aylward on BPS, ME/CFS and Long Covid
 
The BBC article is from today and has some interesting quotes.
It would take Sir Mansel - also chairman of the Bevan Commission health think-tank as well as the Life Sciences Hub Wales - nine months to recover from the virus.

"The long-Covid as it's known, started two or three weeks after my acute attack and that disabled me even more," he said.

"I couldn't sleep, I couldn't even get out of a chair, I had to be helped, I had difficulties getting in and out of bed.

"I felt dreadful, I had days when I had depression. I wasn't thinking properly - that's a thing my family noticed. I found difficulty finding a word, I forgot things quickly. I said some silly things and did some silly things."
Click to expand...

The under-estimation of the virus meant people "understandably said, including my colleagues, it's only a mild cold, sniffles, mild influenza. That was wrong and we should have been on to that much more quickly".

He added: "I'm to blame as much as anybody else. I was chair of Public Health Wales for eight years. And each year we had a couple of days where we planned for a pandemic.

"So yes, I think we were prepared 'theoretically' about what we should be doing, But we weren't prepared in the way of doing something concrete at the beginning, well-planned, well-written out.

"We could have done more much more quickly, but when the NHS got around to it, once we got moving we did go 'above and beyond' and that's the silver lining, the way people worked together, communities understood and listened and there was much closer working between health and social care."

He said the challenges facing the health service would last for many years and the pandemic had proved there was a clear need to "spend more money on the NHS".
Click to expand...

Whereas this
Suffolkres said:
https://www.disabilitynewsservice.com/former-dwp-medical-boss-makes-wca-pledge-to-protesters/
S'ir Mansel said he sympathised with the protesters, and himself now found the BPS model “unsatisfactory” and believed it “no longer addresses the real needs of disabled people and the exclusion of disabled people from society”.

'He said the “social” element of the BPS model had been “neglected” and that he had a personal “distaste” for the medical model, which focuses on people’s impairments as the cause of their disability......'
Click to expand...
is from 2012.
 
Another "expert" who has got on in life by squashing helpless people. He helped mould the DWP into the threat to sick people that it is today and disseminated BPS thinking to politicians. Ideology over knowledge and compassion but now it has happened to him it is a different story. All the symptoms that were just us being needy and looking for the gains of the sick role are to be taken seriously because he has them.
 
Not sure why Aylward saying things like this would be seen as big news. Sounds entirely in-keeping.

He said he "needed confidence" he would not remain like that for the rest of his life.

"[But] that support came from my family in particular, from physicians, endocrinologists, psychiatrists, GPs - they all needed to be there as Covid is a multi-faceted disease," he said.
Click to expand...

His 2012 comments always just seemed like an evasive attempt to placate protesters.
 
Last edited:
Sadly one thing these people have in common is an inability to learn from experience, even their own. And a clear pattern of projection, they all seem like heavy catastrophizers and clearly project their own inability to deal with illness onto others. Gerada is the same, these people would not be able to cope with ME or something that disabling.

I wonder how he would have enjoyed the experience of a GP telling him it's all normal because he's old and blah blah blah.
 
John Mac said:
Are we going to see all the BPSer's going down with Long Covid and then miraculousy recovering?
Click to expand...
Statistically, about 90% would recover so yeah absolutely they would put it all to their mental fortitude and never look back at those who didn't have it in them.

Maybe higher, actually, since they are all financially comfortable with strong personal and professional support. They are in the lowest risk population, being able to rest as much as they need with no repercussions. Which, of course, they do without hesitation. The opposite of their own advice, probably because the "symptoms are real", unlike for us.
 
You must log in or register to reply here.
Back
Top Bottom