Wessely: Cancer patients do not lobby for psychologists because they believe that psychological factors are why they developed cancer in the first place (which is certainly progress given that in previous times there have been scientists who have made those erroneous claims). They do so because they feel that it is safe and permissible 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 in safety, but not before.
Compare and contrast this with the well known reluctance of sufferers from chronic fatigue syndrome (CFS) to do the same.
Here is a group who are not demanding better access to psychotherapy.
Instead, the principal focus of some activists is the reverse—to reduce and even eliminate all traces of the psychological from the CFS clinic, and even the planet itself if some ultras had their way.
The difference between these CFS sufferers and those with cancer is the former are not confident that the somatic basis of their problems has been established beyond doubt, even if they are convinced that it will in time.
Worse, they suspect, and with good reason, that their doctors are not confident either, and if pushed might well endorse a psychosomatic contribution to ill health.
In these circumstances it would be foolhardy to lobby for better psychiatry, since that would only increase their sense of stigma and rejection.
[...]
Wessely: That was a powerful and uncomfortable paper. We should remember a couple of things, though. You presented a strong argument against hubris and accepting fashionable trends, merely because they are fashionable.
There will undoubtedly be many people, including, for example, those who one might call 'CFS activists', who would have loved every word you were saying.
There is a popular and seductive Whiggish view of medical history in which we move implicitly from unknown diseases which are thought to be psychiatric and as we become brighter, better scientists they are finally accepted in the pantheon of real diseases.
You should remember that there is an opposite trend as well, which you didn't mention. You ignored the history of visceral proptosis, floating kidney, autointoxication, or focal sepsis, for example. There are also lots of other things that are seen as very clearly organic and which switch the other way.
Chalder: I find it refreshing to talk about physiological and behavioural aspects of development in individuals, given that I work in cognitive behavioural psychotherapy, where the emphasis today seems to be more on cognition.
I was brought up more in the behaviour/physiological paradigm. What is your perspective on how one should intervene and what would be the most powerful intervention?
Chalder: I could see the link instantly.
If you think about how easily conditioned we are as babies, this will influence our physiology and behaviour for the rest of our lives.
Rather than starting with middle-class businessmen, we should be starting with babies and children and following them up in order to understand more clearly the link between physiology and behaviour.
Cognition comes much later in one's development. Given that cognition develops so much later, how should we then intervene most powerfully?
White: I want to make a link between rats and humans
Marien: It seems to me that a lot of this boils down to a sort of dualism. We haven't really talked about Descartes.
Aylward: Yesterday we discussed some important issues, but today we have hit on what I think are the crucial issues.
These aspects of the biopsychosocial (BPS) model have had the greatest impact in developing social and welfare policy in the UK.
These techniques are simply described and one can communicate them to our colleagues, and even our politicians, who sometimes find it difficult to grasp these issues.
This sort of work will strongly influence how social policy and rehabilitation will develop over the next year or so.
