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

It reminds me of a TV interview I saw with Dame Shirley Conran who developed ME.

Her doctor told her that her illness was really down to attention seeking (paraphrasing) and she pointed out her mantelpiece was full of invitations to all kinds of parties and society dos. None on which she could attend because she was too ill. She got far more attention by being well and accepting her invitations.

No satisfactory answer from her doctor. Surprise.

 

https://twitter.com/user/status/1344329727000145920


Direct link: December Issue: current controversy
Here at Medical Humanities, we have published a few pieces–mostly under the heading Current Controversy–regarding chronic fatigue syndrome. Today we present a preview of our final published piece on the subject, which appeared in June online. While the theme is now closed (we are not accepting new articles on CFS), today’s article presents the work of Diane O’Leary, a philosopher and bioethicist, whose work sits in the overlap between philosophy of mind, philosophy of medicine, and bioethics: A concerning display of medical indifference: reply to ‘Chronic fatigue syndrome and an illness-focused approach to care: controversy, morality and paradox’

 

@Kalliope

Can you tell me what the last line of O'Leary's article is, please?

I can't tell if I'm seeing the whole thing or not. The last line as far as I'm concerned is "When we find ourselves in a framework that suggests the possibility of medical need is somehow beside the point for medical providers, it is time to reconsider our conceptual foundations."

 

You're right, there was a little more at the end:

When we find ourselves in a framework that suggests the possibility of unmet medical need is unimportant, it is time to reconsider our foundations.

The rift that has developed between patients and professionals over ME/CFS has been profoundly unproductive, and similar conflicts have now developed with respect to fibromyalgia,37 irritable bowel syndrome,38 chronic Lyme disease,39 mitochondrial disorders40 and Ehlers-Danlos syndrome.41 It is not possible for patients to heal this rift. To accomplish that, professionals in psychosomatic medicine should state for the record that it is no longer safe to assume that patients with ME/CFS suffer from illness-without-disease. This minimal acknowledgement of risk among all providers would make it possible for patients and providers to peaceably collaborate in this challenging area of medicine.

 

I see that definitive statements about us are being made without the involvement of us, unless there are a large number of patients out there who have been consulted about this point of view.

 

Thank you.

 

Does O'Leary have the slightest understanding of what life as an ME patient is really like?

Not just the suffering caused by having ME itself but the additional burden of dealing with a disbelieving medical system that makes character assassinations where it should provide support, denial of benefits, being left isolated by friends and family, not to mention the stifling of interest and research by anyone other that those already aboard the BPS gravy train?

Are we expected to pretend to believe these folk didn't know the consequences of their actions for us?

I don't know which ME patients Diane O'Leary claims to speak for but I certainly don't agree with her.

 

That's a great ending. And so is the ending of Sunset Boulevard, where insane washed-up silent film star Norma Desmond (Gloria Swanson) has shot her gigolo (William Holden)--he narrates the whole story while already dead at the bottom of the pool, and now thinks she's starring in Salome rather than being arrested for murder. Ends with the great line: "Mr DeMille, I'm ready for my close-up."

https://www.bing.com/videos/search?...BFE7D64FC5AC4A723907BFE&view=detail&FORM=VIRE

 

I don't know where else to put that, it doesn't really deserve its thread. Or maybe there is a thread and I couldn't find it. But malingering is very much part of the question here, especially given how it relies on skills no human has ever possessed, is as credible as claims by anyone that they can reliably tell when someone lies.

Not sure how significant this is, people who have been pushing this are obviously very hostile about the possibility that they have been doing massive harm, so it will take a massive ground shift to end this abhorrent practice.

https://twitter.com/user/status/1355811773539090440

 

the associated paper for this blog is now coming up as a BMJ ad on Google searches.

 

Repackaged with the same fluff and nonsense. Medical science isn't even close to half-way done, what an idiotic argument to pretend otherwise.

I guess they had to balance the other article in the same magazine arguing the exact opposite, except with junk and pseudoscience.

This basically argues that medicine knows all diseases, every single one of them. Unwittingly, but it still does. What drivel.

Questioning Biomedicine’s Privileging of Disease and Measurability
https://journalofethics.ama-assn.or...privileging-disease-and-measurability/2021-07

 

I ethere anything in that that could not have been, and probably was, written in 1985. Apparently she is an aspiring medical anthropologist. No wonder she quotes Kleinman with approval.

 

I am seeing this narrative a lot just recently. Is it me or is this completely ar** over t*t.

When clinicians are unable to diagnose disease or correlate symptoms with measurable changes in biomarkers, patients experiencing such an illness are at increased risk for suspicion, misplaced questioning, or having their motives misinterpreted through damaging social and cultural narratives about gender, race, ethnicity, socioeconomic status, or disability. Adhering strictly to a biomedical model of thinking about disease and diagnosis can prevent clinicians from empathically engaging with patients and helping them navigate their illness experiences.

Surely what is being described is doctors deviating from there biomedical model and attributing symptoms to social and cultural narratives - exactly what the author seems to like.

 

Probably even before. Language aside, this could mostly have been written in 1915. The earliest texts on "functional illness" basically argue the exact same, only the citations and a few terms would be different. It's like a time machine, frankly, a field supposed to be based on science that has remained exactly as is for a full century. The thinking is just as circular and devoid of substance, nothing but speculation and bigoted assumptions.

 

I think that is exactly it. There seems to be no real direction to this article, unless you consider it an attempt to misdirect. To make biomedically-oriented doctors look like the bad guys, and for the "enlightened" ones to swivel to a BPS approach.

 

Yeah, seeing that too. Seems to be the main argument lately. This argument is founded on the assumption that the scientific effort has been sufficient to have uncovered something if there's anything to discover. Obviously not even close, and anything that faces this much opposition can be made to fail even if adequate resources were provided.

But to pin this on the failure of a "biomedical model", aka medicine, is plain weird, when the very thing that is at fault is precisely this pervasive opposition to it, insisting that there must, MUST, be something more than this impossibly complex thing we barely know half of and is the source of literally all progress in medicine.

 

Phew.

 

She seems rather hopelessly confused. Learning vague conceptual models and vaguely applying them without considering any evidence or displaying any common sense ends with this sort of thinking. It adds nothing but no doubt makes the writer feel good.

Better to get to know sick people well over a long period of time. It clears the mind of applying vague concepts thought up by well people.