Chronicity rhetoric in health and welfare systems inhibits patient recovery: a qualitative, ethnographic study of fibromyalgia care, 2025, Cupit

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Dolphin

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Social Science & Medicine​

Available online 10 June 2025, 118313



Chronicity rhetoric in health and welfare systems inhibits patient recovery: a qualitative, ethnographic study of fibromyalgia care​


Caroline Cupit 1, Teresa Finlay 1, Catherine Pope 1
For the PACFiND Team2
Rosemary Hollick 2, Gareth T. Jones 2, Louise Locock 2, Gary J. Macfarlane 2, Paul McNamee 2, Kathryn R. Martin 2, Peter Murchie 2, Ernest Choy 3, Sue Ziebland 4, Karen Walker-Bone 5, Chris Eccleston 6, David A. Williams 7, Neil Basu 8

2University of Aberdeen
3University of Cardiff
4University of Oxford
5University of Monash
6University of Bath
7University of Michigan
8University of Glasgow

1University of Oxford
Received 22 January 2025, Revised 8 April 2025, Accepted 6 June 2025, Available online 10 June 2025.

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Handling Editor: Medical Sociology Office
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Highlights​

  • •
    Biopsychosocial services offer valuable and holistic care
  • •
    Experiential evidence indicates that improvement/recovery is possible
  • •
    Chronicity rhetoric arises from Biomedical Research and Welfare Benefits systems
  • •
    Chronicity rhetoric inhibits biopsychosocial healing work
  • •
    Systems-level intervention is needed to roll out effective biopsychosocial services

Abstract​

Fibromyalgia is a leading cause of disability in the UK and worldwide, but is difficult to diagnose and treat due to unclear pathogenesis and diverse and fluctuating symptoms.

Although various treatment modalities are recommended, no treatments have been proven to effect sustainable improvement or recovery, and patients are typically dissatisfied with their care.

Increasingly, biopsychosocial services are being developed, that aim to take a multifaceted, holistic approach.

In this paper, we draw on a qualitative, ethnographic study of biopsychosocial services in the UK (including 59 interviews, 200 hours observation, document review, and stakeholder workshops), that are providing new and promising forms of support. Drawing on Smith’s Sociology for People as our analytic framework, we explore the work that is undertaken in these services.

We discover chronicity rhetoric that interrupts practitioners’ and patients’ efforts to promote healing and recovery.

We show that chronicity rhetoric is produced and reinforced through Biomedical Research and Welfare Benefits systems.

Our findings are likely to have wider applicability to services for other difficult-to-treat conditions that are having increasingly problematic impacts on health, wellbeing and economic productivity worldwide (e.g., chronic pain, Chronic Fatigue Syndrome (CFS), Myalgic Encephalomyelitis (ME)).
 
My understanding of FM is that it is a lifelong chronic condition. Not reversible.

Recovery as a concept for FM patients is giving false hope or actually lying.

From the American Pain Society (per the medicine-net website):

"Fibromyalgia is the second most common rheumatic disorder behind osteoarthritis and, though still widely misunderstood, is now considered to be a lifelong central nervous system disorder, which is responsible for amplified pain that shoots through the body in those who suffer from it. Daniel Clauw, M.D., professor of anesthesiology..."

Daniel Clauw, MD is a noted FM researcher associated with the University of Michigan.

edited
 
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Four of the authors are also authors of this study, which found CBT had no effect on whether people developed chronic pain, but the authors claimed efficacy and success anyway.

Hutan

Post in thread 'Maintaining musculoskeletal health using a behavioural therapy approach: a population-based rct, (the MAmMOTH Study), 2021, Macfarlane et al'

Argh. Mammoth Study - doesn't that sound offensive?

Short story: So they did the study, at that ridiculously great (mammoth) expense, found it didn't work, but of course claimed success anyway. When will the madness stop?

We don't seem to have a thread on it yet:

Maintaining musculoskeletal health using a behavioural therapy approach: a population-based randomised controlled trial (the MAmMOTH Study)
https://ard.bmj.com/content/80/7/903
  1. http://orcid.org/0000-0003-2322-3314Gary J Macfarlane1,
  2. Marcus Beasley1,
  3. Neil Scott2,
  4. Huey...
Click to expand...
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Enshittification in action. What is there even to say about drivel like this? It's like doing a simple search and replace to swap "chronic" for "temporary" and asserting that it'll do the trick. And it all pretends like this is some new idea, rather than the set of junk beliefs that have blocked all progress.

The parallels to politics, where the victims of violence are vilified for resisting violence, by those enabling it, are just too much. It has complete disregard, almost contempt, for reality, what is happening, what has been done, and the outcomes it has created.
 
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