Michael Sharpe: Mind, Medicine and Morals: A Tale of Two Illnesses (2019) BMJ blog - and published responses

Sad man meme - this explains more: https://knowyourmeme.com/memes/pablo-escobar-waiting

 

Thanks for that. I've never seen that meme before, never heard of Pablo Escobar, nor have I heard of or watched Narcos, so I had no chance of getting that.

 

Me neither, but I thought he looked a bit sad, so I googled it! [well, actually, I Tin-Eyed the pic and then googled it]

 

I'm such a Luddite I had never heard of Tin-Eye before either! I did remember to google that though.

 

Sharpe has tweeted the link again!
One response at the moment.
https://twitter.com/user/status/1149993537615912960

 

What a small, sad man. He wants approval from his peers to continue hurting millions and justify his malicious incompetence.

 

Baffled by the photo posted with the tweet. Can someone enlighten me as to how it relates?

 

It's showing the cover of the current issue. The content management system controls it and it's just not set up to pull something specific for each article.

Common mistake and it's pretty sad that a publishing company would make it but whatever.

 

Q. Are MS et al not taking advantage of an opportunity occasioned for them by the history of the English language to create categories on the basis of simplistic, language-conditioned dichotomies? What is Krankheit, what is sjukdom, what is bolezn'? They all are translated as sickness, illness and disease. And are not intelligent speakers of other languages, while appreciating the utility of distinguishing for some purposes symptomatic experience from organic pathology, likely to balk at illness vs disease as a linguistically conditioned false dichotomy?

"This is illness and this is disease" or to paraphrase "Das sind die Symptome der Krankheit und das ist die Patologie der Krankheit" rendered back into English as "those are the symptoms of the illness/disease, and this is the pathology of the disease/illness"

I think the above shows that even if illness and disease can be distinguished with nuance, such distinction is by no means the one made by Sharpe. He's still in assertion mode.

 

Poor Michael. Almost (but not quite) tempted to give him a pity like to make him feel a bit better.

 

Hope it was tuneful!

 

Does he not realise anyway that taking a word which has routinely been used as an overarching term to include pathologies and symptoms and newly identifying it with symptoms only, is likely to cause confusion among the general populace? Or is he waiting to tell us all how naive we are and how we misunderstand everything he et al say, due to the malign influence of "activists"?

Just to show we do at least try to understand him et al:

"illness refers to a person’s subjective experience of symptoms; disease refers to objective bodily pathology.
Chronic disabling fatigue is a common symptom of many illnesses"

So "Chronic disabling fatigue is a common symptom of many persons' subjective experience of symptoms"

Is that right?

Hope I'm not repeating anyone else's posts. Pimentel pioneered use of low dose antibiotics (neomycin) for IBS and fibromyalgia on basis of hydrogen breath tests and gram negative bacteria cell walls (LPS stimulating immune system. Worked for some. Sub groups.....

PS neomycin can make you deaf so careful now.

 

A similar quote of his here, in 2007;

On the soma side of the street

"Cancer patients do not lobby for psychologists because they believe that psychological factors are the cause of their cancer. They feel it is safe to engage with psychological therapies precisely because their doctors do not hold with psychosomatic theories of cancer. Once the physical basis of disease is established, then one can explore the psychological, but not before."

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)60092-0/fulltext

Generally speaking, there does seem to be a lot of research interest in CBT for FCR - Fear of Cancer Recurrence. I really hope it isn't anything like the CBT targeted at ME/CFS patients.

I can't help but wonder if that focus is motivated by the desire to cut costs - don't waste money scanning the "cancer-free" patients to see if their cancer has come back, just tell them through an app that they now belong to the "worried well" demographic.

https://clinicaltrials.gov/ct2/show/NCT03763825#moreinfo

( M.Sharpe listed in references for this trial.)

 

hmm
https://twitter.com/user/status/1148100902986948608

The Cancer Personality scandal
http://blogs.discovermagazine.com/neuroskeptic/2019/02/25/cancer-personality-1/#.XS7mRrjk_CM

 

A response from Carolyn Wilshire and Tony Ward

Medical Humanities - Conceptualising illness and disease: reflections on Sharpe and Greco

Conclusion
The term “illness without disease”, in the sense that Sharpe and Greco use it, is problematic. Its implication, that we must create a distinction between medically confirmed disease on the one hand and feelings/beliefs/attitudes on the other, is founded on the very type of dualistic thinking that Sharpe and Greco so strongly reject. In this paper, we have presented a new framework for conceptualising the relationship between explanatory disease models and the illness experience. This framework helps us to understand why some models are better than others at predicting illness phenomena. Crucially, it treats all types of causal claims in the same manner, whether they are phrased at a psychological or a biological level of description, and demands the same high standards of supporting evidence for both. We have argued here that, in medicine, it is not appropriate to make claims about causation on the basis of non-specific observations, in which direction of causation has not been clearly established, or simply because there is a lack of anything better.17 Causal claims that are phrased at a psychological level of description need to be subjected to the same tests as any other causal claim. Treatments founded on unsubstantiated claims—even psychological ones—can do harm, no matter how well intentioned they are. Even if patients are not directly harmed by the treatment, they may bear other costs. For example, they may feel personally responsible if they fail to recover. Also, any concerns they do raise may be dismissed, or even caricatured. Sharpe and Greco’s own characterisation of the concerns of patients with MECFS provides a powerful illustration of this latter consequence.


Moderator note:
This post has been copied to a new thread on the Wilshire paper. The discussion that followed has also been moved here:
https://www.s4me.info/threads/conceptualising-illness-and-disease-reflections-on-sharpe-and-greco-2019-wilshire-and-ward.12809/

 

for reference:

Psychosomatics
The Journal of Consultation-Liaison Psychiatry
Published by Elsevier

Assistant Editors
Per Fink, MD, PhD, DrMedSC, FACLP, Aarhus, Denmark
Michael Sharpe, MD, FACLP, Oxford, United Kingdom

President-Elect
Michael C. Sharpe, MD, FACLP, Headington, Oxford, UK

https://www.elsevier.com/journals/psychosomatics/0033-3182?generatepdf=true

Dec 2019

eta:

 

How "Liaison psychiatry" proved it was necessary

1996
Developments in liaison psychiatry

https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01783313/full

 

https://en.wikipedia.org/wiki/Liaison_psychiatry

@dave30th

 

The most prominent proponent of the psychosomatic view on ME/CFS in Belgium Boudewijn van Houdenhove wrote about the state of liaison psychiatry in the 1990s. He basically argued that patients suffering from unexplained chronic symptoms such as pain and fatigue offered an opportunity to emancipate themselves from their purely advisory role to form their own biopsychosocial therapeutic policy (Unfortunately the article is only available in Dutch: http://www.tijdschriftvoorpsychiatrie.nl/assets/articles/articles_649pdf.pdf)

Sharpe wrote about the same topic. In the early 1990s he said that "... the need for British liaison psychiatrists to justify their existence is just as acute. Thus on both sides of the Altantic clinicians are looking for research findings to support their case." [...] As well as those with mood disorders, general hospital patients with unexplained, disproportionate or functional somatic symptoms are of increasing interest to liaison psychiatrists. [...] Their identification and appropriate treatment may be one area where cost-effective interventions could be made." At one point he argues that the future of liaison psychiatry, will determine the survival of psychiatry as a medical discipline. Sharpe's promotor Richard Mayou played an important role in the liaison psychiatry and the direction it would take. Source: https://journals.lww.com/co-psychia...ychiatry_and_psychological_sequelae_of.5.aspx

So I think the origin of the psychosomatic view on ME/CFS and the fear-avoidance model, goes back to liaison psychiatrists who had to justify their existence and wanted to emancipate themselves from an advisory role at the end of the 1980s and early 1990s.