Letter to BMJ: "Medical gaslighting: to say that invoking psychological symptoms is equivalent to dismissal is reductionist", Michael Sharpe

Andy

Andy

Senior Member (Voting rights)
"The news article on medical gaslighting raises the important point that doctors should always accept patient concerns about symptoms and never dismiss them as imaginary.1 But …"

Paywalled, https://www.bmj.com/content/378/bmj.o2236


This seems to be a published rapid response to a BMJ News item from August

"Sixty seconds on . . . medical gaslighting

Is this something to do with the Ingrid Bergman movie?
That would be the 1944 film Gaslight, which tells the story of a man who manipulates his wife to such an extent that she doubts her own sanity. Since then, the term gaslighting has been widely used to describe any form of emotional abuse that makes someone question their own grasp of reality.

Is Medical Gaslighting the sequel?
No, it’s a term usually used to describe when a medical professional wrongly blames a patient’s …"

which is paywalled here, https://www.bmj.com/content/378/bmj.o1974


However the rapid responses aren't paywalled, which allows us to see this one from Michael Sharpe,

"Dear Editor,

This short piece on 'medical gaslighting' raises the important point that doctors should always accept patient concerns about symptoms and never dismiss them as imaginary. But it also risks making the serious error of conflating considering a role for psycholgical factors in the aetiology of symptoms, with dismissing them, and the ordering of biomedical investigation as a key indicator of acceptance. The consequences of this line of argument are potential iatrogenic harms from denying patients a full understanding of their illness and the potential benefit of psychological treatments as well as increasing the risk of adverse consequences of unnecessary biomedical investigation. To say that invoking psychological factors is equivalent to dismissal is to retreat into a narrow biomedical reductionism that many of us hoped we had escaped long ago.

Competing interests: No competing interests"

Open access, https://www.bmj.com/content/378/bmj.o1974/rr
 
Isn't it strange how the people who reduce every problem to "wrong thoughts and behaviour" also mention "biomedical reductionism" a lot?

Also, it's not a competition to produce the most complex or holistic hypothesis, but one to prove a hypothesis correct and find a working treatment.
 
I wouldn't mind if I got a psychological diagnosis if the treatment actually worked, but it doesn't. Its a useless diagnosis to provide especially having done no testing whatsoever and it means whatever is really wrong is not being addressed. If at some point they could actually show some effectiveness of the treatments that wasn't completely fabricated with a high quality study then it wouldn't be a bad diagnosis, because it would mean you would get better. But so far several decades of bad studies later and the bulk of patients are worse than they were before it doesn't work and continuing to shout it at us is medical gaslighting.
 
BrightCandle said:
I wouldn't mind if I got a psychological diagnosis if the treatment actually worked, but it doesn't. Its a useless diagnosis to provide especially having done no testing whatsoever and it means whatever is really wrong is not being addressed. If at some point they could actually show some effectiveness of the treatments that wasn't completely fabricated with a high quality study then it wouldn't be a bad diagnosis, because it would mean you would get better. But so far several decades of bad studies later and the bulk of patients are worse than they were before it doesn't work and continuing to shout it at us is medical gaslighting.
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100% That's his approach. He likes to make out that we only reject his model of ME because it's psychological when he must know full well that we reject it BECAUSE IT DOESN'T WORK! It's a way to make it appear that we're the problem, not his research. It's ridiculous and so incredibly disrespectful. As if we'd all be turning down perfectly good treatment options just because we want to have a physical illness not a psychological one! We wouldn't care what the treatments were if they worked!! I mean most of us have tried these treatments early on in our illness so the argument that we just reject them out of hand based on our own ignorant prejudice doesn't make any sense. This article is just more gaslighting, ironically.
 
Does Sharpe ever wonder why nobody is consulting him regarding Long Covid? If he’s the paragon of knowledge for post viral illness, surely governments would be clamoring for his expertise. Instead, he’s feverishly penning these juvenile opinion pieces. A descent to irrelevancy
 
strategist said:
Isn't it strange how the people who reduce every problem to "wrong thoughts and behaviour" also mention "biomedical reductionism" a lot?

Also, it's not a competition to produce the most complex or holistic hypothesis, but one to prove a hypothesis correct and find a working treatment.
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Yeah one issue with all of this is that they are aiming for a theory of everything, even though they don't have a single intermediary theory. It has to be a totalitarian explanation, it explains everything, or bust. Simply can't leave room for any serious effort that will simply cancel all of this as effectively as how all psychological treatment for peptic ulcers has ceased years ago.

Very similar to religious fanatics espousing freedom of religion. They mean freedom of their religion, at the exclusion of all others. Ideologues are the same, whatever the belief system they're selling.
 
Charles B. said:
Does Sharpe ever wonder why nobody is consulting him regarding Long Covid? If he’s the paragon of knowledge for post viral illness, surely governments would be clamoring for his expertise. Instead, he’s feverishly penning these juvenile opinion pieces. A descent to irrelevancy
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I think he's leading or involved in a Long Covid clinic at Oxford.

But despite his status as "leading expert" on the topic, according to himself, he's just one of many, no one thinks of him as an expert on this. Same with Chalder and Crawley, they are involved in several projects but they aren't leading anything because their expertise is still seen as mostly a sham.
 
Andy said:
potential iatrogenic harms from denying patients a full understanding of their illness
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Well, since nobody has an understanding of the illness, and least of all psychologists who have no idea how to evaluate evidence (and apparently no idea of human nature)...

Sharpe has a talent for letting the cat out of the bag. He makes the dumbness of the BPS approach totally transparent.
 
I decided to look back and what I can find is that he "helped set up" the clinic at Oxford, someone else is heading it (seems to be a respiratory consultant, or at least was at the time the articles were published).

This interview shows frankly an absurdly low level of knowledge for someone who is supposed to be a leading expert on this topic, during the biggest outbreak of its kind. Easily tens of thousands of patients understand this better than he does, probably in the hundreds of thousands. https://www.swissre.com/institute/c...-impacts/Summary---Expert-forum-COVID-21.html

And not much different from Wessely, when asked about the big findings of his extensive work on ME, and the best he could come up with was something like "we thought it was depression, and it doesn't seem so", even though one of his main argument has always been how they can't tell the difference and he is likely aware that the vast majority of physicians think ME is depression, so even his big findings are a complete dud.
 
But it also risks making the serious error of conflating...
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Not that MS would ever conflate anything to his advantage of course :rolleyes:.
... potential iatrogenic harms from denying patients a full understanding of their illness and the potential benefit of psychological treatments
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Neatly conflating with the BPS' approach of potential iatrogenic harms to patients from medics professing to understand their illness, convincing them to undertake harmful treatments, and convincing them any harms, or lack of improvement, must be due to the patient's non-adherence to the prescribed treatments. A recipe for patients to doubt their sanity. Gaslighting.
 
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