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

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.
 
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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?

rvallee said:
Especially given the recent Chalder paper about online CBT treatment for IBS and the media blitz pushing a psychological model not just as treatment but as the full explanation.

I don't know what status IBS has, it seems mixed, but it would be great if more professionals dealing with disputed diseases started paying attention to this nonsense. The MUS train will not stop and already lays claims to autoimmune conditions like MS and psoriasis.
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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.
 
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Michiel Tack said:
The argument by Sharpe & Greco has been used by Simon Wessely in the past. A 2011 interview with The Times reads:
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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

MEMarge said:
I do not think that even W & Co are promoting psych therapy in cancer as anything more than supportive/coming to terms with/talking things through.
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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.)
 
fossil said:
They feel it is safe to engage with psychological therapies precisely because their doctors do not hold with psychosomatic theories of cancer.
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hmm

Dr Ronald Grossarth-Maticek reported that he had discovered a cancer-prone ’emotionally repressed’ personality. Someone with this personality type was, he claimed, at very high risk of later developing cancer. A second personality type predicted ‘internal diseases’, such as stroke and hypertension. Even more remarkably, Grossarth-Maticek said, a brief course of psychotherapy was enough to virtually eliminate the excess risks.
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...at the end of the 1980s, he started a collaboration with Prof. Hans Eysenck, of the Institute of Psychiatry in London (now part of King’s College London).

Eysenck was an eminent and extremely influential psychologist in Britain, perhaps the most prominent of his era, so the papers that Eysenck and Grossarth-Maticek published together around 1990 were widely read. Eysenck had no role in the data collection of any of these studies, but his name was an endorsement of their credibility.
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It might be said that this is all ancient history now, and there is no need for an investigation after so long, but I think this is entirely the wrong attitude. If anything, the fact that these frankly bizarre results are still in the literature (and, as Pelosi points out, still being cited) 30 years later makes the scandal even worse.
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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/
 
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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:
Ethics in publishing
Please see our information pages on Ethics in publishing and
Ethical guidelines for journal publication.

Declaration of interest
All authors must disclose any financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work. Examples of potential competing interests include employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, and grants or other funding. Authors must disclose any interests in two
places: 1. A summary declaration of interest statement in the title page file (if double-blind) or the manuscript file (if single-blind). If there are no interests to declare then please state this: 'Declarations of interest: none'. This summary statement will be ultimately published if the article is accepted.
2. Detailed disclosures as part of a separate Declaration of Interest form, which forms part of the journal's official records. It is important for potential interests to be declared in both places and that the information matches.
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How "Liaison psychiatry" proved it was necessary

1996
Developments in liaison psychiatry
Abstract

Recent publications have attempted to clarify the need for liaison psychiatry. Recent randomized, controlled trials indicate the efficacy of cognitive‐behavioural therapy in chronic fatigue syndrome and other medically unexplained symptoms. Support from an appropriately experienced specialized nurse can prevent depression in mastectomy patients. Data indicate that the quality of care for outpatients can be enhanced by liaison psychiatry, The principle challenge ahead is to show the efficacy of liaison psychiatry in general medical wards. The potential to reduce both mortality and costs is clear; further research is required.
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https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01783313/full
 
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The Faculty of Liaison Psychiatry was established within the Royal College of Psychiatrists in 1997. The European Association for Consultation Liaison Psychiatry and Psychosomatics also produced a set of guidelines for training in Liaison Psychiatry.[4] The American Psychiatric Association formally recognized C-L psychiatry as a subspecialty in 2004, with its own sub-specialty board exam. The profession debated about the best term for this specialty, finally settling on "Psychosomatic Medicine".
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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.
 
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