Brian Hughes - If you spend 20 years gaslighting your patients, perhaps you should think twice before accusing *them* of trolling *you*

I think it's more the common language of pseudoscience than it is the language of psychiatry. There are many schools of thought and disciplines within psychiatry, even when it comes to the clinical psychology of illness.

The logic behind the psychosocial model of ME is about the same as with astrology: stars and planets exist, therefore surely they influence us. Replace "stars and planets" with "the brain" and you have roughly the same belief system. The entire mechanism is hidden in the mystery step 2, where something happens that can't be shown or confirmed but this step is glossed over by creating a magic leap between steps 1 and 3.

Good psychiatrists do not rely on a magical step 2. That would be most of them. It takes mediocre minds to build anything out of such a model, whether they are licensed physicians or sell rhino horn boner pills.

 

Any looseness with language, simplification or inaccuracy will give people like Wessely an easy out. It's a difficult situation when it seems so many people are uninterested in reading a detailed analysis of the problems with their work but simple summaries are almost impossible to produce fairly, but that's the way it is.

 

It looks as though SW is again trying to pretend that his undated letter to Aylward which was received on 6 OCT 1993 never existed. Its contents are misdescribed by Cosmicella but then its existence has been misdescribed by SW.

 

The obvious tweet back to that is....

Why just CFS? Do you think psychological and social factors "affect" all illnesses? And why has the PACE trial failed to provide any evidence that your treatments aimed at those factors have any efficacy in CFS?

 

Yes, liaison psychiatrists do.

If you skim several issues of the Journal of Psychosomatic Research:

https://www.sciencedirect.com/journal/journal-of-psychosomatic-research

or other journals of psychosomatic research, you'll find papers on factors affecting coronary patients, patients with COPD, diabetes, stroke, cancer, cystic fibrosis etc.

 

I feel like I've seen enough Wessely responses to those questions that I can reply for him:

Do you think psychological and social factors "affect" all illnesses? Yes. And why has the PACE trial failed to provide any evidence that your treatments aimed at those factors have any efficacy in CFS? PACE was a good trial that provided evidence CBT and GET were useful for some patients. They weren't a panacea and they don't help everyone, but they do help some people. No trial is perfect, but I'm afraid that the controversy around PACE is a very sad reflection of the way many people still stigmatise interventions that they see as tainted by an association with psychiatry.

 

Yes. In a way that disempowers his statement that, "psychological and social factors affect the outcome of CFS" doesn't it?

Especially when the PACE trial failed to prove any efficacy from his treatments using his hypothesis outlined in his statement.

I also wonder if he thinks its ok to change the recovery criteria halfway through a trial only when studying CFS.

 

Just as long as the trial is elegant.

 

I suspect it will be inevitably be true that psychological and social factors do indeed influence outcomes of just about any illnesses - the question is in what way and to what degree? I imagine recovery from all sorts of conditions will be impaired if you live in abject poverty compared to reasonable comfort. And if you are deeply down on life then you may not be motivated to look after yourself so well anyway, which could also affect outcomes. So it's a safe statement for SW to make, so long as he does not have to pin it down a bit more.

 

Thank you for saying that Jonathan. As a mental health sufferer you summed up my thoughts on this better than I ever could.

 

https://twitter.com/user/status/1109174140773302272

 

Therapeutic nihilism? Like, "First, do no harm"?

 

Nevermind the psychological vs whatever. The model is behavioral, implying something directly under someone's control. This is not a characteristic of mental illness, over which thoughts and beliefs play little role. It's not really about psychological either, it's about behavior, about conscious choices we make and can adjust.

Bit ironic that this is something people have often remarked about me, that I can change, break or form a new habit as easy as I can breath. If it was that easy I would have been the perfect candidate, a model patient.

I don't know what that implies but it's a distinction with a difference. Is it a better argument? It's certainly more accurate. What is the status of strictly behavior illness. Is that even a thing?

 

I have marked fluctuations within a timeframe as short as a few hours. Inconsistency is a nonsense criterion. In reality they do not have any rule that can be used to distingush feigned from real illness.

 

I'm too tired for a cogent response, my brain is a furnace of pain.

Anyone want to add something about how what he describes as having happened 30 years ago is THE SAME DAMN PACE MODEL THAT HAPPENED 10 YEARS AGO AND IS STILL PUBLISHED! Almost verbatim!

And his detail about mood is just nonsense, it was never proposed that it could play anything so "showing" something arbitrary is entirely wasted. And 30 years the best he can come up with how much his model improved is "we showed something that no one suggested could play a role".

 

His nonsense about there being no treatment is he thinks it should be better addressed by making up a fake treatment rather than recognizing this simple fact and funding research so we could actually have a treatment. The idea that "there is no cure" is part of the illness, that it perpetuates the delusion of believing we are sick.

There is no treatment for ALS and many other diseases. That has never been used as justification to deny funding or make up fictitious treatments. It's a completely fake argument that is misdirection as you don't need a medical treatment for a behavioral problem, which is how he still sees it or pretends to, because admitting his mistake would destroy his career.

 

Economy. Savings. Not necessarily to distinguish, but to characterize.