I have sent this letter via email today co-signed by a colleague:
4th June 2020
FAO Editor Alexandra Beverfjord
Dagbladet,
Box 1184,
City Centre,
0107
Oslo
Norway
Dear Alexandra,
We write in response to your debate article “ME-sick Constant spread of fear” published in Dagbladet.
“ME-organisasjoner internasjonalt og i Norge er ensidig negative til forskning på alt som forbindes med noe «psykologisk».”
Translation: “ME organizations internationally and in Norway are unilaterally negative to research on everything associated with something "psychological."”
This statement from Recovery Norway is wholly untrue and misrepresents the feelings and wishes of patients with the neurological disorder ME. In our experience as psychologists, working for more than a decade with hundreds of patients with ME, is that they wish to be well and symptom free. To be able to live their lives unhindered by debility and pain.
People with ME’s symptom burden and debility are intense and overwhelming making day to day functioning and everyday tasks almost impossible. They are some of the most debilitated and disabled patients any doctor will meet in clinical practice. It is our experience that patients are open to working on their emotional difficulties when this is in the context of understanding their condition from a biological, psychological (including neuropsychological) and social perspective. When the biological effects are minimised or ignored it is understandable that they become disenfranchised and upset. Patients’ distress is often due to and compounded by other people’s disbelief and the distress of being psychologised and rejected by medical colleagues. The later have little to offer this patient group beyond simple, symptom management. Many of which are poorly tolerated by people with ME. Together the physical and social difficulties patients face can lead to intensely distressing social and physical withdrawal and stigma. Patients are often physically isolated due to high levels of debility causing intense social strain due to lack of human comfort and support. They can experience distress if others around them believe that they are exaggerating their symptoms or that they could overcome their condition if only they would try harder.
The general intolerance across society of chronicity, ambiguity, and an inability to tolerate witnessing ongoing suffering is felt keenly by patients. When this is compounded by people in high status such as medical professionals: the uncertainty and ambiguity can lead to a tendency for the victim, in this case the person with ME, to be blamed for their predicament. Therefore, patients can feel intense pressure from those around them and from within themselves to engage in psychosocial treatments that have low/no face validity. The ethics of this need examining openly – is it acceptable that such a ‘treatment’ as the Lightening Process (LP) can meet even the minimum ethical requirements?
The difficult medical and social process these patients experience detracts from the failure of the medical and research communities to study this complex condition. The last three decades have seen many small and larger scale psychosocially focused studies proposing to ‘cure’ patients with ME using psychosocial / behavioural means: Cognitive Behavioural Therapy - CBT (to encourage increased activity) and Graded Exercise Therapy - GET (to increase physical stamina and activity by overcoming deconditioning). This tranche of work has failed to demonstrate that the underlying hypothesis (deconditioning and fear avoidance) can be overcome. No objectively measured cures are to be found. The failure to demonstrate objective evidence of recovery and the over reliance on subjective outcome measures in non-blinded trials renders the small benefits, if any are found, of these trials to be meaningless.
What psychosocially focused researchers seemingly fail to grasp is that patients with ME have spent years, sometimes decades, persisting through their pain, debility, flu-like malaise and disability and enduring on in the hope that they would come out the other side of it well and fit. If the fear avoidance/deconditioning theory were true – patients would have been well years ago! This does not happen. The more patients engage in physical and mental tasks, the sicker they become. This is the hallmark of their condition. There is objective evidence of exercise intolerance; neuropsychological difficulties (unrelated to low mood), immune dysfunction; that symptoms often, but not always, follow an infectious disease. Patients experience a wide range of debilitating symptoms including post exertional malaise (PEM) which is not noted or part of other medical or psychiatric conditions.
Regarding specifically the Lightning Process (LP): this poorly defined and vague intervention is not without risks. Joan has worked with patients who have been hospitalised with internal bleeding after being encouraged by LP practitioners to continue to ignore symptoms and increase activity. There are numerous reports and evidence of harms from increasing activity in people with ME. There is little or no explanation as to why the opaque LP intervention might work; an absence of testable theory ensuring that this can be shown to be false by observation or physical experiment. Instead the LP researchers are focused on verification – a failure to understand the scientific process. The LP lacks scientific credibility; is untestable; fails to define clear boundaries and limitations (it is effective apparently for all patients with ME although there is recognition that subgroups of patients exist). The LP is in line with speculation and conjecture. For example, the LP relies heavily on anecdotal evidence and personal experience and fails to incorporate the biological changes found in patients. LP supporters reverse the burden of proof to the critic/patient. Science places the burden of proof on those making a claim, not on the critic. The personalisation and questioning of the motives, character, morality, or competence of anyone who questions the LP are telling.
Patients with ME overwhelming want medical professionals to understand their disease and to help them to cope until effective, disease modifying, and curative treatments are available. In the meantime, patients who are highly distressed should be able to access appropriate psychological support that understands their condition, limitations, and difficulties. At best this can help patients to cope, reduce distress and to live well despite their ongoing high burden of symptoms.
Yours sincerely,
Joan Crawford
Chartered Counselling Psychologist
Co-signed by
Dr Dionne Joseph
Chartered Clinical Psychologist
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I will ask other psychologist colleagues to co-sign when they are free from clinics today.
If other ME organisations / individuals write too that'll be helpful
Warm regards
Joan
Counselling Psychologist