Chapter on Chronic Fatigue, Sharpe, in Science and Practice of Cognitive Behaviour Therapy

[Esther12]

When my stomach is stronger I must try to reread the chapter by Salkovskis and Bass on Hypochondriasis in the Science and Practice of Cognitive Behaviour Therapy. It looks to cover the same ground. You'll remember the book. It's the one in which Sharpe said he knew of patients who have recovered after a single telephone conversation that enabled them to reconceptualise their illness, reduce their fear of symptoms, and overcome their avoidance. And this was CFS he was talking about. Page 400 if you don't believe me.

I don't know if I've read that before.

I found some of it available on Amazon, so copied over the images I could get there. Sometimes different people can access different pages [edit - sorry for going OT with this, the chapter was longer than I expected].




I couldn't access p 384.









P390 missing

 

[Esther12]

p396 missing.



p400 and 401 missing because it's always the ones you most want! [edit: p400 is now at the bottom of my final post]



p403 missing.

 

[Esther12]

p408 missing.









Got 400 by searching for telephone:

Gelder has a lot to answer for.

I didn't realise Gelder was an important figure for Sharpe. Chalder's talked about how vital I Marks was for developing her understanding and approach to science. Gelder and Marks (along with Bancroft and O'Neil) worked together to treat 'sexual deviants' ("24 patients with transvestism, fetishism, and sado-masochism") with electric aversion therapy.

https://www.cambridge.org/core/jour...ric-aversion/53004861A7C5F722892C9904312B8269

That book on CBT includes a chapter from Bancroft on 'sexual problems': https://www.oxfordclinicalpsych.com...2627254.001.0001/med-9780192627254-chapter-10

I wish sci-hub worked for them, and the hypocondria one - https://www.oxfordclinicalpsych.com...2627254.001.0001/med-9780192627254-chapter-13

I'm feeling bored of going through Amazon's preview system.

 

[chrisb]

I didn't realise Geldor was an important figure for Sharpe

Oh yes. Sharpe and Hawton were part of the Gelder gang. The above book including the Sharpe chapter and the Salkovskis chapter has a foreward by Aaron t Beck. It starts

This Festschrift is a fitting tribute to the enormous contribution that Michael Gelder has made to psychiatric research and training.

 

[chrisb]

My curiosity about Gelder was aroused, in innocent, ignorant days, seemingly long gone, when I wondered what could possibly have motivated someone with no obvious interest in ME to have provided financial support for the conference establishing the Oxford criteria. The picture has become clearer.

 

[Hoopoe]

They present psychotherapy as having a long tradition of treating ME/CFS, then blame psychoanalysis for putting patients off.

In their narrative, the justification for CBT is that ME/CFS is the same as neurasthenia.

 

[Peter T]

In this chapter CFS is misdescribed as just the symptom of idiopathic chronic fatigue and any associated psychological issues. Anyone answering this discussion, by most contemporary diagnostic criteria, does not have CFS, CFS/ME, ME/CFS or ME.

To state the obvious, Sharpe deliberately or otherwise has chosen ignore all the other symptoms of ME/CFS. Either he needs to confirm he is not talking about what is generally understood to be CFS, CFS/ME, ME/CFS or ME or to also explain all the other symptoms, which for many are significantly more disabling than any fatigue. It is rather like trying to address brain tumours by just treating any headache and further inferring that anyone with a headache alone must have a brain tumour. Alternatively it is analogous to trying to treat schizophrenia by talking about anxiety, whilst ignoring any sensory overload, hallucinations or delusions.

One wonders how someone supposedly interacting with this patient group can present a description so alien to the patient experience. Also one wonders how Sharpe would deal with those few patients who are so successful at managing their activity levels that they rarely or never experience fatigue?

 

[Invisible Woman]

Looking at the references throughout I think this is a marvellous example of GIGO. The opinions of his mentors are largely unverifiable in a field that, even today, doesn't come close to conforming to standard best practice in other fields of medicine.


From the first paragraph quoted by @Esther12 in the first post-

"..his consistent encouragement and incisive criticism have been important in enabling me to turn clinical curiosity into answerable research questions"

(Bolding mine)

This was achieved by formulating the answer that suited and then designing your research to give you the desired answer.

While this might be admirable if one is a spin doctor, it is not really appropriate for a doctor in the field of medicine or medical research.

 

[Trish]

In this chapter CFS is misdescribed as just the symptom of idiopathic chronic fatigue and any associated psychological issues. Anyone answering this discussion, by most contemporary diagnostic criteria, does not have CFS, CFS/ME, ME/CFS or ME.

It makes me wonder whether Sharpe had ever met an ME patient when he wrote the chapter. The fact that it was psychiatrists making these assumptions about CFS I think is significant. They are much more likely to be sent depressed patients who present to their GP with the sort of lethargy and exhaustion that can be part of depression.

They have heard the name 'Chronic Fatigue Syndrome' and decide that this is what their depressed patients who present complaining of fatigue have, without realising they are seeing a different patient cohort from those seen by infectious disease doctors seeing patients who don't recover from infections and end up with ME.

 

[Peter T]

"..his consistent encouragement and incisive criticism have been important in enabling me to turn clinical curiosity into answerable research questions"

I would love to know what Sharpe thinks his answerable research questions are? His subsequent research has consistently failed to address any theoretical understanding of ME/CFS, but rather seems designed to confirm his belief that exercise and CBT are wonderful.

He has even constantly failed to answer the question can behavioural interventions have any measurable impact on the symptoms, other than on the patients‘ filling in of questionnaires and that impact usually disappears in a matter of months.

 

[Invisible Woman]

They have heard the name 'Chronic Fatigue Syndrome' and decide that this is what their depressed patients who present complaining of fatigue have, without realising they are seeing a different patient cohort from those seen by infectious disease doctors seeing patients who don't recover from infections and end up with ME.

There is some truth here. Years ago my ME consultant, who had contact with Wessely, actually said to me that when he heard Wessely speak about his ME patients they sounded very different to the ME patients he sees.

Of course part of that difference may well be down to the rubbish questionnaires so beloved of the psych fraternity with their ambiguous questions that are readily misinterpreted.

 

[Trish]

There is some truth here. Years ago my ME consultant, who had contact with Wessely, actually said to me that when he heard Wessely speak about his ME patients they sounded very different to the ME patients he sees.

Of course part of that difference may well be down to the rubbish questionnaires so beloved of the psych fraternity with their ambiguous questions that are readily misinterpreted.

Compounded by the fact that the Chalder Fatigue Questionnaire doesn't distinguish between someone with depression fatigue and ME fatigue.

 

[Peter T]

There is some truth here. Years ago my ME consultant, who had contact with Wessely, actually said to me that when he heard Wessely speak about his ME patients they sounded very different to the ME patients he sees.

Of course part of that difference may well be down to the rubbish questionnaires so beloved of the psych fraternity with their ambiguous questions that are readily misinterpreted.

I have heard it said that either Wessely or Sharpe did at one time say they were not talking about ME but about CFS, but I can’t remember which of them, and there seems a lot of confusion, with nothing unambiguous in writing.

 

[chrisb]

I think the picture is clearing. The Sokes et al paper described itself as dealing with "Effort Syndrome". Once the Oxford Criteria had been written to describe "effort syndrome" as CFS they felt secure in including that research as CFS research.

In probably his last word on the subject in the Winter 1989 MEA Newsletter Melvin Ramsay saw what was coming.

The second component of my case is the clinical picture of ME. The onset of the disease may take various forms involving the respiratory or gastrointestinal tracts. More rarely but very dramatically it may commence with an acute attack of vertigo accompanied by rapid heart action. The onset of the disease may be sudden or gradual. This is of no importance since the end product is the same. Muscle pain and tenderness are practically always present and after even a minor degree of physical effort there is delay of 3,4 or 5 days or longer in the restoration of muscle power. But the crucial differentiation between ME and other forms of post viral fatigue syndrome lies in the striking variability of the symptoms not only in the course of a day but often within an hour. This variability of the intensity of symptoms is not found in post viral fatigue states. I had extensive experience of PVFS during my many years as a Consultant in infectious diseased at the Royal Free Hospital. We saw and admitted all cases of acute infectious disease amongst the students. It was a frequent occurrence to find students who had influenza or glandular fever still unwell even 8 months later, complaining of muscle fatigue and tenderness coupled with inability to understand a passage in a text-book. In this condition there was no variability in the intensity of the fatigue which remained constant. The most severe of these post viral fatigue states recovered completely within 2 to 2 1/2 years and did not recur. Within the term "chronic fatigue syndrome" all these cases are lumped together and no differentiation of true ME is made.

Did the psychiatrists lack the skill or the will to differentiate?

MR was clearly an acute observer. And a great man.

 

[Tia]

It makes me wonder whether Sharpe had ever met an ME patient when he wrote the chapter. The fact that it was psychiatrists making these assumptions about CFS I think is significant. They are much more likely to be sent depressed patients who present to their GP with the sort of lethargy and exhaustion that can be part of depression.

They have heard the name 'Chronic Fatigue Syndrome' and decide that this is what their depressed patients who present complaining of fatigue have, without realising they are seeing a different patient cohort from those seen by infectious disease doctors seeing patients who don't recover from infections and end up with ME.

Yes!! It has always seemed to me that they have based everything they've done on people with depression based fatigue rather than ME/CFS. What's astounding is that they have lacked the humility or curiosity to consider that this might be the case.

 

[Invisible Woman]

I have heard it said that either Wessely or Sharpe did at one time say they were not talking about ME but about CFS, but I can’t remember which of them, and there seems a lot of confusion, with nothing unambiguous in writing.

I suspect this was deliberate. Anything they've said in the subject has always been to either deflect hard questions & criticism or simply to muddy the waters.

Wessely, Sharpe, Chalder the whole cabal have been in the game long enough and have had the platform to clarify what exactly they are referring to and clear up at least some of the many misunderstandings. That they have chosen not to do so tells us a lot.

 

[Invisible Woman]

Yes!! It has always seemed to me that they have based everything they've done on people with depression based fatigue rather than ME/CFS. What's astounding is that they have lacked the humility or curiosity to consider that this might be the case.

They certainly lack humility and may well lack curiosity but I don't for one second believe these guys are stupid.

In the early days, sure, they would be more likely to see a certain type of patient. Since then they have flatly refused to.listen to other doctors with different patient groups and the patient population. Worse still, they have gaslighted patients.

I'm put in mind of Wessely's elephant analogy of CFS - if you're all blindfolded in a room and there's an elephant in it one of you will feel a tail, one a foot and so on and will describe these as disparate bits. At the back of it all is the one beast - the elephant.

The snag is Wessely's analogy assumes that the bit he got his mitts on is more representative of the whole than anyone else's bit. That's not necessarily the case. Especially if he chooses to wear oven mitts while examining it.

 

[rvallee]

Those inner dialogues and "core beliefs" are so laughably wrong it's cringeworthy, in most cases they are the exact opposite of how humans behave in general but especially ME patients. Not only did they build a strawman, it's completely flat, has no dimension to it, cardboard personality. It reads like a terrible novelist trying to describe normal human behavior and accidentally writing what basically amounts to parody.

It's as if this group "learned" about human behavior from old television shows, the super theatrical kind with wildly amplified emotions and affect because it still retained those same ideas from theatrics. There's an entire genre laughing at men badly writing about women, describing caricatural behavior and inner dialogue, and this is actually worse because it's treated seriously.

Basically this is to ME what Reefer madness is to cannabis: completely made-up with intent.

 

[rvallee]

In this chapter CFS is misdescribed as just the symptom of idiopathic chronic fatigue and any associated psychological issues. Anyone answering this discussion, by most contemporary diagnostic criteria, does not have CFS, CFS/ME, ME/CFS or ME.

To state the obvious, Sharpe deliberately or otherwise has chosen ignore all the other symptoms of ME/CFS. Either he needs to confirm he is not talking about what is generally understood to be CFS, CFS/ME, ME/CFS or ME or to also explain all the other symptoms, which for many are significantly more disabling than any fatigue. It is rather like trying to address brain tumours by just treating any headache and further inferring that anyone with a headache alone must have a brain tumour. Alternatively it is analogous to trying to treat schizophrenia by talking about anxiety, whilst ignoring any sensory overload, hallucinations or delusions.

One wonders how someone supposedly interacting with this patient group can present a description so alien to the patient experience. Also one wonders how Sharpe would deal with those few patients who are so successful at managing their activity levels that they rarely or never experience fatigue?

He "clarified" his position once, even though it contradicts many of his own papers and obviously PACE. Basically they take all positions so they can use it as cover when convenient. Nothing they say actually matters, they gleefully contradict themselves without afterthought since it makes no difference, nobody pays attention to the substance of their claims, people are simply content with believing in the same conclusions giving them free license to dehumanize us as mere "complaints".



Obviously it's a total lie here, the PACE papers literally state CFS aka ME. These people have become pathological liars because their lies have been accepted, normalized, for so long it's become natural and nobody but us cares about their total lack of self-consistency and integrity.

 

[rvallee]

Might as well put this here since it's the same nonsense anyway:



I haven't bothered watching it, not worth the time. But Chalder has opinions on "fatigue" and COVID.