Michael Sharpe skewered by @JohntheJack on Twitter

Wow! So, in the meantime, Prof Sharpe, you could stop doing your level best to stifle biomed research and encouraging the view that treatments, specifically modified for ME patients and usually used as a bolt on therapy in addition to drugs for other illnesses, can magically improve the lot of ME patients.

 

In the meantime carry on pacing and stop lying about the efficacy of GET and CBT, release all the data and get ready for NICE to change the guidelines.

 

Its a widely acknowledged framework, but not accepted. Its taught, then ignored. Its heard, then ignored. Its mainly useful for simple overgeneralised answers that can persuade those who don't know better. Its also so vague and pliable that we might as well ignore it.

 

New drugs can take 20 years once a mechanism is understood. Repurposed drugs can be used immediately, though formal approval for specific uses can take a few years.

I question that a treatment that is badly received, does not achieve the primary needed outcomes, and makes patients sicker, is better than nothing. I would rather have nothing and some honesty.

 

Ah I see, so you and your mates are using the bastardised version then?

 

"The BPS persepctive is not an ideology..."

(goes on to explain it in a manner that's almost a textbook definition of an ideology)

 

"Understanding all illnesses".

(I can't even invoke the proper language for this hubris)

 

Yes, I understand they are telling a nice story about illness. It belongs right alongside other books of mythology.

Telling stories is the modus operandi. They make up a story. They create some facts from some cohort that may or may not properly represent the disease in question. Then they throw the facts at you.

Oh, and they put a lot of effort into getting a statistically significant result. Which only tells you some odds the result is due to chance. Its not due to chance. Its due to biased methodology far too often.

 

Pace is a fraud designed to confirm an irrational theory.
Psychiatry is about using chemicals to alter emotions and "improve" emotional well being
Psychology is about human behavioral traits, personality types such as Myers-Briggs constructs, and logical fallacies and so forth.

Psychiatry is about the belief that negative emotions are caused by brain defects and can only be fixed by drugs. Its a conclusion looking very hard for a cause to justify it. And the amount of money and propaganda spent on this is enormous.
Its much easier to claim there is defects in much of the population then to admit reality sucks.

There is plenty of research that uncovers the painful part of our psyche, and how to deal with emotions we don't like. But its not mainstream and its got little money behind it unlike the biochemical theories that are always 5-10 years away for over half a century now. They will eventually be now because some day we will understand enough of the brain to say this is what combination is sadness, but that misses the point, its not a defect, its an emotion and emotions have roots even if we would do almost anything to avoid seeing them. Houses of cards can be very resilient when we don't want the truth.

Alzheimers is a physical condition that causes irreversible brain damage, schizophrenia has been chased forever and was considered biochemical or demons for untold centuries, depression and anxiety are emotions. That said sometimes people do have legitimate medical conditions that affect emotions, from prions to thyroid to hormonal to tumours... But these are real conditions not i feel hopeless so there must be something biochemically wrong and we won't rest until we invent theory after theory to explain it an they all keep failing but we will never stop believing.

Interestingly the current class of antidepressants can't be treating the "real" problem because we are not investigating their target as "the cause" anymore because we found nothing yet they "work" and are indispensable. Also if they are still somehow hitting the real cause then its an amazing cause, because a dozens of classes of drugs work on it.

If you don't want to know then you will never see.
There is plenty of evidence that PTSD is caused by real life events, there is plenty of evidence that abuse leads to long term emotional problems, there is plenty of evidence that insecure attachment patterns often leads to long term negative effects, there is plenty of evidence that attempting to force societal norms onto people causes long term harm (conversion therapy for example is now considered unethical yet is still being pushed in many quarters)...

Behavioural problems are an outcome not a cause, emotions are a reaction to things, hence A leads to B leads to C. The problem is you can't always trace a straight path from A to B then to C hence its easy to ignore the path dependence involved or explain it away.

Someone once said bad manners are a fault of the parent and not the child. A bit punitive but the point is maladaption is not the result of faulty human evolution but of what preceded the problem. Again if one has a physical issue as mentioned above (tumour, thyroid etc) that should be treated but if people are unable to function then we don't need to wait for scientific "discovery" and treat it with uppers.

I am reminded of this article i recently read which has nothing to do with biochemical imbalances, neuroinflammation, genetic defects, tumours, schizophrenia or any such biochemical cause.
https://www.npr.org/sections/goatsa...32/the-conflicting-educations-of-sam-schimmel

Tribal behaviour, hate, discrimination, violence, doublethink are likely evolutionary leftovers, ones we can use as an excuse to hate thy neighbour or challenges we can overcome if we choose to. Unfortunately these base emotions are great for politicians who want to drag back social progress.

The "media" is as human as the rest of us as it is composed of humans. While there are many ways i would improve it its biggest flaw currently is its insistence on bothsiderism and false equivalence. The theory of being "objective" is incompatible with the actual truth that bothsiderism in many cases does not exist or the unwillingness to acknowledge that the media being manipulated is easily done.

Its an echo chamber of its users, and more so with algorithms that will elevate alternative facts. And powerful people with money enhance this as a form of manipulation for their own gains.

This is true, money talks, it is used to convince people to vote against their own interests. In a democratic country its voters who choose their leaders but they are persuaded by big money and appeals to hate to vote against their own interests over and over again. The solution to this is to either attack the source or for voters to use their brains. Obviously brainpower is not winning.

Social issues are not mental issues. Trickle down economics is a fraud but scapegoats are used to keep people from recognizing reality and holding the perpetrators responsible.

I disagree completely. The current CBT paradigm is an evolution of Freud who made an interesting observation but his theories about why and how to fix it were complete crap. CBT for depression is much like the ME/CFS version where you pretend the problem doesn't exist so it will disappear. The difference being that we have a physical condition so when we do what our bodies tell us not to we get worse. In depression its an emotional condition so when you ignore your emotions it gives you some relief. You can also bury your emotional pain with pills which works better then ignoring it. Symptom control.

I know i am stepping on some feet here and will likely be asked to edit this post or it will get deleted. My intention is not to piss people off, but to explain that which is uncomfortable to hear which i apologize for doing.

 

+1

 

Isn't this just a straightforward equivocation?

It seems to me that 'original' biopsychosocial is a truism that simply encourages people to take into account that more than just the outright biology impacts the clinical course of an illness.

For instance, if somebody has a heart attack, whether or not they 'tough it out' through chest pain affects the outcome. Or whether doctors take their chest pain seriously and treat promptly. Or if somebody can't afford necessary medication for an illness. And so on. Not a scientific theory, more just a reminder to think about the big picture I would say.

Biopsychosocial as applied by PACE is a causal assertion that thoughts/cognitions directly produce the illness - in effect, constitute the illness. It's a euphemism for psychogenic/somatoform/psychosomatic which are euphemisms for conversion disorder which is a euphemism for hysteria (in my estimation).

 

The original paper is viewed as a treatise on psychosomatic medicine, but given a new label.

 

I would argue the justification of the diagnoses is often Freudian, but I am not sure CBT itself is. However some applications of CBT look like they might be, including CBT for ME, which is based on an unproven assumption, and defended by imprecise arguments. Some of the arguments about why to use it are Freudian though. BPS itself has two layers. At one level it makes sense but tells you almost nothing. The other level is a justification for psychosomatic medicine, which is definitely heavily influenced by Freud. This is mainly discredited mythology, yet it persists. Its why there has been comparison of Freudian theory with cults, its more like religion than science. Yet one can also argue that most of psychiatry is deeply flawed.

They could make things more scientific, but that would probably mean the publication rate would drop by maybe over 90%. The more I look at this the less scientific it all seems. PACE uses bogus statistical analysis, and its deliberate, but misuse of statistics, and misunderstanding of statistical outcomes, is rife in much of psychiatry. Its pretty common elsewhere as well, but psychiatry seems to be particularly vulnerable to this.

Psychiatric research is hard. Its about observable atypical behaviour. It requires an understanding of how the brain works. We do not even yet have the tools to really figure out the brain. We might not for some decades. So its mostly unproven hypotheses and claims. They could have seen this as a need for strict, rigorous science. Instead its been used as an excuse for lax use of science, and low standards. This needs to reverse.

 

In the sense that negative thoughts are labelled "unhelpful", yes, this is probably true, but the ME/CFS version is much more insiduous.

Depression is physical. It might only be (mostly) confined to brain and endocrine system, but it's still physical. I do think the distinction between physical and mental is unhelpful sometimes, but I wouldn't go as far as the BPSers, because categorising can have its uses.

Oh, if only that were true! The confusion is that depression can be a symptom of other things (just as fatigue can be). Depression as a disorder is not just about emotions. And it is probably not just one disorder.

 

CBT for depression says your thought patterns cause your depression so ignore them and think happy thoughts and your depression will go away.
CBT for ME says your not ill you just think you are so start doing what you say you can't and your 'disease' will go away

Freud said to solve problems tell them to someone who acts like a blank slate, who never replies and never shows emotion. Unsurprisingly this failed. CBT is an evolution that still ignores our humanity but says thinking about your problems causes them so stop doing it.

It is deeply flawed, it says your problems are biochemical so take uppers. The reason for this biochemcial imbalance will keep changing till we find one that sticks but its a belief.

The publication rate is not about how scientific something is though.
PACE is a fraud, they redesigned the study to make their numbers work.
I'll bet money they believed their garbage theory but the numbers that came back failed to "prove" their lies so they so they doctored them and published it because they could not admit their data refuted their beliefs.

Its not hard at all, but you have to know what your doing (or at least be willign to learn) instead of using preconceived notions that are wrong. Someone once said half of what you learn in medical school will later be proven wrong.

It does not, Over a century of research, has proven this, some good, some bad, some way out there.
I would be happy to post some references but suggesting treatments breaks forum guidelines.

This is correct, we do not have complete knowledge of how the brain or body works but this is irrelevant

Our entire modern understanding of science from medicine to physics to philosophy is culled from reverse engineering the universe. We are only a millennia into it, and only a century or so with real technology.

Most of science is based on incomplete knowledge, in fact we don't even know the long term effects of most of the drugs in use today, as short term trials are all thats needed for approval.

 

If you ignore your problems they don't unfortunately go away. I wish they did. Just like ignoring the symptoms of ME/CFS won't make them go away. I also wish they would (desperately)

How can it be proven physical when there is no proven mechanism?
There is a theory which keeps changing, just a few years ago it was a biochemical imbalance, also unproven. If we had had this discussion then Depression would be physical because its a biochemcial imbalance.The conclusion is predetermined, we just keep looking for a theory that can stick

If you ignore something it looms slightly less. However CBT for depression has a dismal cure rate because ignoring something does not make it go away even if it hurts slightly less.

 

As I said, depression is not one disorder. I'm pretty sure I have a mood disorder that is neuroendocrine in nature. But just because we haven't found a mechanism, doesn't mean it doesn't exist. That's the same mistake that the psychogenic proponents make. Everything has a physical mechanism at some level. Even circumstantial depression caused by mental stress has a physical mechanism - even easier to see there, because once you remove the stressor, the depression lifts. But not for me.

But we're going off topic.

The biopsychosocial model was never intended as a framework for explaining anything. It was supposed to be a better method of treatment - to treat patients as whole people, and to treat their condition in the context of their social and psychological environment. That takes skill and understanding.

 

I'm sorry to hear about your disorder

Indeed we are
I'm happy to drop this and get back to dealing with the PACErs
I'm sure today being a new day means more MS tweets

BTW are his tweets happening on the clock (being paid by taxpayers)?

 

Would someone please ask Wessely for the proof that employment as opposed to income is good for health? Also why does he leave out that the research shows that the jobs have to be 'good' jobs, not just any old ones.

I know that the BPS school think it is, but their evidence only showed that income is good for health. It is quite a banal point, as obviously the more able you are to adequately clothe, feed and provide shelter for yourself in a capitalist society, the more income you need.

It's important if part of your government strategy is to deny income (social security) to sick people in order to force them to work.