Diane O'Leary, philosopher, media articles and interviews

[Art Vandelay]

Podcast: "Doctors and dualism" - Diane O'Leary, 2022

A podcast from ABC Australia featuring Diane O'Leary. Apparently ME/CFS is a prominent feature of the discussion:

https://www.abc.net.au/radionational/programs/philosopherszone/doctors-and-dualism/14004928

So you’re feeling sick, and you go to the doctor. The doctor examines you and sends you off for a range of diagnostic tests, which come back inconclusive. What happens next? In many cases, you’ll be referred to a practitioner in the field of psychosomatic medicine – a branch of psychiatry – where the assumption will be that whatever might be wrong with you, you don’t have a physical disease. This is a common sequence of events, particularly as clinicians see an increasing number of patients reporting long COVID symptoms for which there’s no apparent physical cause. Our guest this week argues that this can be very dangerous for patients, and that at the root lies a series of philosophical misunderstandings about mind/body and subjective/objective evidence.

(I haven't the cognitive function to listen to it yet.)

Edit: discussion specifically relating to ME and Long Covid starts at around the 14 minute mark.

 

[alex3619]

I haven't the cognitive function to listen to it yet.

We have been discussing this stuff on forums for decades, you probably know much of it already. I might try to listen later.

 

[Sly Saint]

Diane O'Leary

she is a member here
@Diane O'Leary

 

[Trish]

I have just listened. It's one philosopher interviewing another, Diane O'Leary, on her ideas about philosophy of mind and dualism, and how that applies to medicine's approach to medically unexplained symptoms.

It was OK, though I think adding a layer of philosophical jargon to the question of why it's wrong for doctors to assume anything they can't explain must be psychosomatic just over complicates the problem.

I think her point is that doctors are being trained to look for objective evidence of illness, and if they don't find any, to shove the problem off to the psychiatrists with their therapies in psychosomatic medicine, and to stop investigating. And that this is an error caused by misunderstanding of dualism. Or something. I got a bit lost.

She says this was the problem with ME/CFS, but in the USA, and more recently in England, the psychosomatic approach has been rejected, and it's now recognised as a physical disease, but that the same mistakes are now being made with Long Covid.

O'Leary has a book coming out soon with a title including 'gaslighting'.

 

[Hutan]

4.50 "It turns out diagnostic uncertainty is extremely common in medicine. In fact by many standards, half of symptoms are diagnostically uncertain, medically unexplained."

17.00 Interviewer "So what about Long Covid then, are we seeing the same story play out all over again?"
"Yes, and it's very very sad to see. For me it's quite astonishing because I have been working in this area for 8 years or so, I've had a lot to do with chronic fatigue, it's now called ME/CFS, and, you know, a lot to do with the UK decision to shift over from a psychological to a biological perception of that disease. And now, here we are, and suddenly there are literally millions of people around the world who have something very much like ME/CFS, ah, chronic fatigue, and here we have the whole medical system around the world going "whoa, I don't know, mind-body, I don't know, probably you need psych care".

I think it was probably a helpful interview, in terms of getting the message out that psychological treatments don't fix ME/CFS or Long Covid.

It was OK, though I think adding a layer of philosophical jargon to the question of why it's wrong for doctors to assume anything they can't explain must be psychosomatic just over complicates the problem.

I thought the same.

This was good, talking about sorting out what is psychosomatic and what is biological:
"If we can't sort it out, we need protocols that tell us how to manage the uncertainty in a way that is safe".

 

[Andy]

I've had a lot to do with chronic fatigue, it's now called ME/CFS

Errr, no, not quite.

a lot to do with the UK decision to shift over from a psychological to a biological perception of that disease

well, I guess self-belief is a virtue but I personally think it's taken an effort of more than 8 years by many many people to get us to the point where NICE properly analysed the evidence for behavioural therapies and discovered for themselves how poor it was.

 

[BrightCandle]

Errr, no, not quite.


well, I guess self-belief is a virtue but I personally think it's taken an effort of more than 8 years by many many people to get us to the point where NICE properly analysed the evidence for behavioural therapies and discovered for themselves how poor it was.

Indeed it took a lot of patient protesting to undo the damage that the PACE study did and expose its flaws, to get people such as yourself on a committee and then all that work to publish updated guidance. There is a lot more to do to, the bulk of hospitals are still using GET/CBT by the looks of all the letters Charles Shephard is sending out, some are in open revolt and its going to require something stronger than a letter to change their ways. Charles Shephard's influence is largely nepotism based due to Sajid Javid's personal relationships, its not patient lobbying or the guidance that got that working group there. Your average GP still doesn't have a clue but the fight right now is to get the specialists to accept the evidence, that is insane when you think about it! This fight has only just begun, it will probably take a generational change in the medical staff to solve it unless someone finds a good biomarker and a treatment that works, that will accelerate acceptance a lot faster, without it this is a long uphill battle for acknowledgement.

 

[Arnie Pye]

She says this was the problem with ME/CFS, but in the USA, and more recently in England, the psychosomatic approach has been rejected, and it's now recognised as a physical disease, but that the same mistakes are now being made with Long Covid.

From reading S4ME I would question the idea that English medicine and English doctors have rejected the psychosomatic approach. I thought it was still increasing dramatically, despite the NICE Guidelines rejecting CBT and GET.

 

[Trish]

There is a lot more to do to, the bulk of hospitals are still using GET/CBT by the looks of all the letters Charles Shephard is sending out, some are in open revolt and its going to require something stronger than a letter to change their ways. Charles Shephard's influence is largely nepotism based due to Sajid Javid's personal relationships, its not patient lobbying or the guidance that got that working group there.

I think in attempting to condense the long story of what got us to the stage of the NICE guideline, Charles Shepherd's letters to clinics, and the government's latest move with the working groups, this message comes across rather confusingly.

I disagree with this statement:
'Charles Shephard's influence is largely nepotism based due to Sajid Javid's personal relationships, its not patient lobbying or the guidance that got that working group there'.
The 'nepotism' referred to here is presumably based on Sajid Javid's interest when he was Health Secretary being at least in part based on his family member's experience. But it was the launch of the APPG report that was the reason given for the working groups being set up, and that was based on pwME contacting their MP's to support the APPG over a period of years, and Carol Monaghan's efforts leading that group. I think Charles Shepherd's letters to clinics are an ME Association project based on the NICE guidelines, not anything directly to do with Sajid Javid's actions.

 

[alktipping]

i have always thought that the mind body approach was just an excuse used by medical practitioners to put the onus on patients rather than doing the hard work necessary to get answers to patient problems . political an insurance motivation to reduce cost has just made the whole fiasco a thousand times worse .

 

[Adrian]

The 'nepotism' referred to here is presumably based on Sajid Javid's interest when he was Health Secretary being at least in part based on his family member's experience.

There is a point which I think is significant its not about nepotism but rather that people with personal experience of ME are often shocked by what is happening. If Javid hadn't encountered how ME patients were treated personally he would probably not have believed how bad things are and been told (and believed) that it is just patients complaining,

 

[chrisb]

I was just musing on the idea that mind-body duality is probably a cultural issue, having been introduced into Christian theology by the neo-Platonist, Plotinus. That made me refer to Russell's History of Western Philosophy. He makes the interesting observation:

Both Aristotle and the Platonic Socrates complain that Anaxagoras, after introducing mind, makes very little use of it. Aristotle points out that he on;y introduces mind as a cause when he knows no other.

Plus ca change... He was born in about 500 BC.

This is not a problem of modern origin.

 

[JemPD]

more recently in England, the psychosomatic approach has been rejected, and it's now recognised as a physical disease,

if only!

That just makes me laugh. If anyone can show me where anything has actually changed in terms of treatment of patients, rather than lip service language change, i'll be thrilled to hear it, but the notion that everything has changed is laughable iyam

 

[bobbler]

4.50 "It turns out diagnostic uncertainty is extremely common in medicine. In fact by many standards, half of symptoms are diagnostically uncertain, medically unexplained."

17.00 Interviewer "So what about Long Covid then, are we seeing the same story play out all over again?"
"Yes, and it's very very sad to see. For me it's quite astonishing because I have been working in this area for 8 years or so, I've had a lot to do with chronic fatigue, it's now called ME/CFS, and, you know, a lot to do with the UK decision to shift over from a psychological to a biological perception of that disease. And now, here we are, and suddenly there are literally millions of people around the world who have something very much like ME/CFS, ah, chronic fatigue, and here we have the whole medical system around the world going "whoa, I don't know, mind-body, I don't know, probably you need psych care".

I think it was probably a helpful interview, in terms of getting the message out that psychological treatments don't fix ME/CFS or Long Covid.

I thought the same.

This was good, talking about sorting out what is psychosomatic and what is biological:
"If we can't sort it out, we need protocols that tell us how to manage the uncertainty in a way that is safe".

There have been a lot of newspaper articles talking about dualism over the last few years - often from columnists who didn't do philosophy as their educational background getting inspired by BPS-related people mentioning dualism.

I'm no philosophy expert, but through my career had to look at it enough that I know what they spout is nonsense and I'd be mightily peeved if my area was being bas****ised naughtily - and then redone by people infected by hubris (they are unaware of) and enthusiasm amateur part-time philosophers have - and then becoming more discussed than the real stuff. It's shocking really like the meme dodgy version of the social media account of the famous person not just getting more famous but being more believed as 'the word of' that subject area.

Having been brain-wise and experience-wise not suitably positioned to retort the pseudophil, but knowing enough to know that is what it is and that a real philosopher could use their special techniques to cut through fallacy, I'm pleased at least one of them is doing this. They did it to Engel's model, then CBT didn't fight back..

 

[alex3619]

If we can't sort it out, we need protocols that tell us how to manage the uncertainty in a way that is safe

There you go, the book I was once going to write summed up in a sentence. "Embracing Uncertainty" was a very deliberate title for me.

 

[Amw66]

Moved posts

Diane O'Leary has an article on medical gaslighting.
.

 

[Arnie Pye]

There might be a better place for this post. I don't think we have a general thread on gaslighting.

From this article :

Title : Opinion: Here’s why #MedicalGaslighting has taken social media by storm
Link : https://edition.cnn.com/2023/09/06/opinions/medical-gaslighting-social-media-women-health-oleary

My bolding in the quote...

Neither the American Medical Association nor the National Institutes of Health has a program to address, or even understand the nature of the problem, and neither do leading medical centers such as Johns Hopkins or the Mayo Clinic. And though gender equity is a common theme now in medical and governmental health organizations, it centers on women’s obstacles getting to the doctor, not the obstacles we face once we’re there.

What’s the problem here? Why has this intense public dissatisfaction with medicine failed to generate action?

The trouble is, first, the buzzword. Strictly speaking, gaslighting is a psychological issue — the emotional harm that occurs when a credible voice is discredited to the point of self-doubt. In an article in the Journal of General Internal Medicine, for example, two doctors respond to the recent social media storm by dismissing medical gaslighting as a mere “perception,” one that will disappear if physicians present their decision to ignore symptoms with an optimal tone of voice. This response is not surprising.

As long as we define medical gaslighting in purely psychological terms, it will be reasonable for medicine to respond with psychological remedies. In reality, though, psychological harms are the least of our worries. It’s damn unpleasant to be manipulated by your doctor in this uniquely demeaning way, but that’s nothing compared with the harm that comes from untreated disease.

The bit I've bolded makes me wonder why it is that doctors appear to learn to communicate in a different language to their patients. How can the authors believe what they've written? They think all they need to do is learn how to dismiss their patients better and they'll be happy?

I've often thought that the doctors I've met in appointments don't understand or recognise "desperation". Since I've been labelled as a drug-seeker for 50 years every contact between me and the medical profession becomes just a way for the doctor to practice how to get me out of their office as quickly as possible. And then they don't bother recording the appointment or they lie about what was said.

Edit : Another paragraph worth quoting :

When it comes to the most common form of psychosomatic diagnosis, “somatic symptom disorders,” Medscape and American Family Physician tell doctors to expect that they’ll see 10 females with the disorder for every one male. The fact is that doctors attribute predominantly women’s symptoms to their psyches because they’re explicitly trained to do so and do so often.

 

[Arnie Pye]

In the final quote from the previous post (#17) the references from Medscape and American Family Physician are :

Medscape : https://emedicine.medscape.com/article/294908-overview

which says the following in the Epidemiology section :

Sex
Females tend to present with somatic symptom disorder more frequently than males, with an estimated F:M ratio of 10:1. [6] This may be due to a greater willingness to report somatic symptoms in the female population.

Reference 6 for this paragraph is :

Kurlansik SL, Maffei MS. Somatic Symptom Disorder. Am Fam Physician. 2016 Jan 1. 93 (1):49-54. [QxMD MEDLINE Link].

and the Link in blue in reference 6 takes you to the abstract only :

https://read.qxmd.com/read/26760840/somatic-symptom-disorder

From that link the full reference can be found here :

*** https://www.aafp.org/pubs/afp/issues/2016/0101/p49.html

Under the heading "Epidemiology" that link says :

Epidemiology

The prevalence of somatic symptom disorder in the general population is an estimated 5% to 7%,3 making this one of the most common categories of patient concerns in the primary care setting.7 An estimated 20% to 25% of patients who present with acute somatic symptoms go on to develop a chronic somatic illness.8 These disorders can begin in childhood, adolescence, or adulthood.4,9 Females tend to present with somatic symptom disorder more often than males, with an estimated female-to-male ratio of 10:1.9

Yates WR, Dunayevich E. Somatic symptom disorders. http://emedicine.medscape.com/article/294908-overview. Accessed August 5, 2014.

And that link takes us back to the Medscape link that I first quoted. So its circular, and who originally came up with the 10:1 female:male ratio for Somatic Symptom Disorder is unknown.

Following up the American Family Physician reference from that last quote in post #17 takes us to the link above with three stars next to it. So it is circular too.

I expect doctors everywhere think that 10 times as many females have SSD as males. And since SSD is essentially a hysteria diagnosis it means that ten times as many women are being labelled as hysterical and untreated as men. (Even though in modern times the hysteria word is allegedly never or rarely used.)

 

[rvallee]

The epidemiology is especially awful. It can begin in childhood, adolescence, or adulthood. Which is basically all there is. When you have to include nonsensical facts like this just to pad up a weak claim, you obviously got nothing.

But if you can get away with circular references, then you can get away with anything. What an embarrassment this all is, and it can't stop precisely because it's to embarrassing to stop. This stuff has as much basis as whatever nobles in old aristocracies used to justify their superiority over the rest of the population. And they all believed it, because they didn't know any better.

 

[Ravn]

interview with Diane O'Leary on The Dissenter vodcast by Ricardo Lopes, episode #863 (haven't listened yet)

In this episode, we talk about topics in the philosophy of medicine. We talk about the relationship between philosophy and medicine. We discuss the issues with how medicine deals with mind-body dualism, and property dualism. We talk about objectivity and subjectivity in medicine. We discuss how psychosomatic symptoms are dealt with, and the specific case of the history of chronic fatigue syndrome. We talk about how medically unexplained symptoms are dealt with institutionally and in research, and the importance of taking patients’ claims seriously. We talk about limitations of the biopsychosocial model. We discuss gender bias in healthcare and psychiatry, the legacy of the diagnosis of hysteria, and why women go to the doctor more often. Finally, we discuss why philosophy is still relevant.