BMJ - Not "all in the mind", 2024, Richards

This opinion piece by associate editor Tessa Richards is from three days ago. She writes about a MUS-event that recently took place in London, so thought it might be of interest to some:

Quote:

Patients with persistent, severe, but medically unexplained physical symptoms baffle and frustrate doctors. Without a diagnosis they can’t be put on established disease pathways and it’s hard to know how best to manage them. Patients struggle with “unvalidated” illness and seek views from many different practitioners. Recently, a multidisciplinary group of clinicians and patients with an interest in “medically unexplained symptoms” (MUS) got together in London to shed light on a problem which deserves more attention than it gets.


https://www.bmj.com/content/385/bmj.q1210

 

Wow. Nice to see a few of these obvious issues flagged and outing that MUS has been used to lump and dump. And probably to just quietly remove care for certain patients (if it’s not a red flag and we guess it’s chronic no healthcare) but also that this has then been used to change what departments are available and do (I suspect by tail wags dog on diagnosis by where you can send them meaning the numbers get put under ‘mental health’ that should have gone to wherever if they are investigated would have been needed as a dept to then send them

what I’m intrigued by is the author - am I reading correctly that this is sn associate editor of BMJ ?

is that a good sign if so?

 

And taking the funding that follows them from having been siloed into said psychosomatic kingdoms (via CCG and gp guidelines and priming I suspect ) to put it hopefully closer to where it always should have been

yes some of these might have rare diseases or ones not discovered until recently- which is evidence of the harm the label has established to create for these people. I bet 1in 17 is a drop in the ocean given the incitement of ‘radioactive’ type stuff in notes and with labels.

but how many it was just bypassing them from accessing quite basic investigations for diagnoses where there was treatment and depts who could have treated them , who now perhaps don’t have the funding because it followed that sleight of hand on the patients to where they got dumped ?

 

Seems a bit of a rag-bag of 'noble thoughts' to me, mixed with a good dose of the usual guff about multidisciplinary teams. The heart is in roughly the right place but I prefer my scepticism in the form of straight 'grappa' rather than aperol spritz.

 

Heeeh... not true. Not entirely. It's only true because psychosomatic medicine is not formally a specialty of its own, but for decades the entire concept has been dominated by the ideology and this is why no progress has been made. I don't like this "no one is responsible for this" take, it's very wrong. There are people responsible for this, and they're not dancing alone. It takes people to make the invalid claims and it takes a majority who either endorse it, or never object to it. It's a partnership, and while the ideologues who make the stuff up about psychosomatic models have a lot of blame, so does the profession as a whole for embracing it and enabling their reign of error.

This was not handed down from the heavens on stone tablets or the product of natural of random chance, such as evidence that was overwhelmingly strong but turned out to have been incorrect because of genuine ignorance. It was all made-up based on long-ingrained myths and beliefs, founded far more in bigotry than in anything having to do with science.

It's been happening for the exact same reasons why there is such a thing as gay conversion therapy, the principles and beliefs underneath are the exact same, and so are the outcomes.

And there's this:

True, but in our case those organisations have been vilified and fully discriminated against, and continue to. They have almost zero professional recognition, in fact it's standard practice to advise against ever talking with other patients, a choice some people made based on delusional beliefs and logical fallacies. Long Covid is following exactly the same standard patterns.

Then you need to end the reign of psychosomatic medicine, because it's built entirely out of abusing those limits to make baseless assertions. There is no future in which the millions of people suffering from illnesses discriminated by medicine on the basis of psychosomatic models receive competent professional care and psychosomatic ideology remains in its current state, of fully dominating the space consisting of things medicine doesn't fully understand.

And really the "fully understand" is critical now, as psychosomatic ideology keeps expanding despite having never delivered anything, and that has included this absurd idea that it's possible to have a disease, but the symptoms, the illness, are "better explained" by the old mythical conversion disorder, reflecting distress from knowing about, or even just believing in, having a disease. This was always complete horseshit and it can't be avoided to say it, acknowledge it and act on it.

It's great that this is being talked about in honest terms, but it's a struggle similar to slavery: there is no future in which those enslaved are freed where slaveowners continue to exist or even thrive. Those are mutually exclusive futures, they have zero overlap with one another. Psychosomatic ideology has been a literal plague on humanity, a capstone on medical science, and it has to be said plainly. Evil is banal, it's bureaucratic, often mediocre, indifference to others.

This is what psychosomatic medicine does and will always do as long as it exists in any form. Putting a cute bow on it won't even come close to making up for it, in fact fake compassion, with intent to build trust on false pretenses and manipulate the patients, is a cornerstone of current psychosomatic models.