Problems arising for pwME from additional diagnoses of MCAS, hEDS and POTS. Advocacy discussion.

I think it is being argued that there might now be a small way forward even just getting a few serious clinicans involved on the basis of things like DecodeME, but that for that to happen the other mist has to clear.
Sure, but I can't imagine a physician being interested in doing something meaningful deciding against it on this basis, or even being influenced. It's just noise, every disease has weird ideas being floated around, sometimes insistently by patients, and none of this usually happens. It's a normal part of the job and it doesn't matter.

If a physician can ignore the whole psychosomatic model, and they have to in order to do real work, then they can handle this far easier bump in the road. It really needs to be pointed that in order for a physician or researcher to do real research on ME/CFS, they have to ignore the current dominant psychological model. This is already a lot to ask, far more than the biobabble that no one in the profession takes seriously and is ultimately of no consequence precisely because it's not taken seriously.
 
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I am confused by your reaction, @rvallee. Can you help me to understand?

You seem to be saying this thread is about blaming the victim, ie patients. That's far from what I'm talking about.

I agree we have, in ME/CFS, a disputed diagnosis that a lot of physicians don't believe has any biological basis. But at least in the UK it is officially recognised by the NHS and has a NICE guideline that's probably better than nothing, though I am increasingly doubtful about that.
I'm not saying this discussion is victim blaming, I'm saying it accepts the idea that this is why we are mistreated and discriminated against, which is simply false. If none of those labels had ever been discussed, nothing would be different. I just can't see it having happened differently, and of course that's just my opinion.

There is no winning against a rigged system, there is especially no point trying to cajole it into not being rigged, we can only point out that it is rigged, that the justifications given for this systemic negligence are false and nonsensical. It's one of those situations where we can do everything right and still lose. We can be right and still lose. We can be polite and deferential and do all the things that the physicians who claim that they aren't helping us because of those things, and in my opinion it wouldn't change a damn thing. It was already pretty obvious to me, but LC made this all perfectly clear. None of this has anything to do with us, at all.

The vast majority of us never say or do any of those things. We don't bring weird labels and certainty of opinion like what is claimed. In fact most of us hide those diagnoses, knowing they will be used to discriminate against us. It's just not happening at a scale that makes it a legitimate cause, and there are decades where it didn't happen that serve as evidence.

Psychosomatic ideology goes far beyond us, it has nothing to do with us, and a lot of people with acceptable diagnoses are mistreated just the same as us. It was also going to happen this way even if such an illness as ME/CFS had never existed, and it will continue to harm people even when ME/CFS is a diagnosable and treatable illness.
 
That's not the fault of the pwME and nobody here is saying it is. Nobody is blaming patients or saying they should stop saying they have these extra diagnoses.

The aim of this discussion, as I see it, is to work out whether there is a need for some kind of action we can participate in, to

help us to understand more about these diagnoses, so we can understand better if a doctor wants to diagnose us with one of them,

and to see if we can contribute in any way to better understanding of the evidence for and against the diagnostic categories so clinicians and patients organisations provide more accurate information to others.

Is there anything wrong with these aims?
I do read this in the original post, and I know it only repeats justifications said in private and is not meant as a blame by professor Edwards, that if patient just stopped saying those things then we would have had help. I just completely disagree with it. It might be that many physicians are saying it, they might even believe it, I just think it's completely false.

I think we are already doing everything we possibly can about it, and so have tens of thousands over decades. There is uncertainty and ignorance and a need to know more, and this is what we keep trying to say, but I strongly disagree with the idea that ME/CFS is this special thing while the other problems are not. I have no idea what they are, or how to improve things, but the problem is not with the labels, or what patients tell physicians, it's the same problem of uncertainty and lack of evidence.

Where it overlaps with abuse and victim blaming is the idea that there is anything we can do, or convince other victims how to behave, that will fix anything. It won't. This isn't so much blaming the victims as it is about ignoring the fact that it is abuse, and it is technically forbidden, even illegal. That we can't do much about it doesn't change anything because there is no winning against a rigged system. The fault is entirely with the medical profession and it is them who will have to change because there is nothing we could ever do that could make a difference about that.

Frankly I see little difference between the worst psychosomatizers and any physician who would legitimate behave this way, refuse to act about blatant injustice just because they find us annoying. Ethically it's just as despicable, and although I am clearly irrationally angry about it, I think it's perfectly justified.
 
I am travelling again so not in a position to write much at the moment. I appreciate all the input. I think @Utsikt's post sums up the way I look at things. It is not my intention to blame patients - certainly I wouldn't dream of blaming the regular members here. My main aim is to point out the need to try and avoid making the situation worse than it already is.
 
I'm not saying this discussion is victim blaming, I'm saying it accepts the idea that this is why we are mistreated and discriminated against, which is simply false.

It is not @rvallee . I have an electronic copy of the documents that show quite specifically why clinical and laboratory work at UCL on ME/CFS was asked to be closed down. They are shocking. And I have been at a departmental meeting where the same points were made "these patients simply should not be seen at all". I may operate in a partiular environment but it is the environment I have to try and change and nobody else much in UK medicine seems to want to change anything.

I personally don't see any way forward for me as an advocate unless some of this is addressed. If I talk to BPS colleagues they can simply laugh in my face, as they have done so far. It isn't the whole problem - not at all - but it is a key obstacle to my making any headway.
 
I'm truly sorry if anything I have said in this discussion has been experienced as patient blaming.
I know it's not directed at me but I do want to make it clear that both my rational and irrational anger are 100% directed at the medical professionals who are failing us, as well as the dysfunctional systems that fail to enforce their own rules and regulations in ways that explicitly destroy millions of lives.

Their state of wrong is a completely different kind, not the "something is wrong on the Internet kind" but the "professionals systems are clearly in violation of their duties, responsibilities and even the laws that govern them and it has so far been as ruinous as a damn world war" level of wrong.

I just don't see anything productive out of following this framing, mainly because it is false. We are already doing everything right, and obviously no one can influence millions of people to change their behavior anyway.

I do agree that those are the cards we have been played, but that doesn't mean we have to pretend that the rigged system isn't mostly rigged, and not just against us. I frankly don't see a realistic way of solving ME/CFS that doesn't end up with the whole of psychosomatic ideology being discredited. It's a cultural force more than anything, it's irrational, and that's why reason doesn't change a damn thing no matter how hard we push for it.
 
It is not @rvallee . I have an electronic copy of the documents that show quite specifically why clinical and laboratory work at UCL on ME/CFS was asked to be closed down. They are shocking. And I have been at a departmental meeting where the same points were made "these patients simply should not be seen at all". I may operate in a partiular environment but it is the environment I have to try and change and nobody else much in UK medicine seems to want to change anything.
I don't doubt those things are being said and written down, and possibly even that they actually think they are legitimate reasons, but those justifications are not valid and would be happening regardless of anything. In fact they did happen, decades ago, and we are still living with those consequences. There will always be a reason, and it extends far wider than us.

People are weird. Super damn weird. Even smart professionals. Especially about things such as pretty much throwing millions of people in the trash in a profession that explicitly forbids it by its entire regulatory framework. I just can't take those reasons seriously, even if they are written down and voiced with a serious professional face. They are cope, and in most cases technically illegal.

Most of us know how hard the health care profession is, how so many professionals deal with actual physical abuse. They still treat those people. Every physician will treat the wounds of a terrorist, of murderers and even human traffickers. And yet they recoil at us? Please. This is not legitimate. It's just the weirdness of human nature mixed with the growing pains of a profession that is capable of miraculous outcomes despite knowing so very little about the whole of it.
 
Doctors have said doctors have neglected patients because of what patients said. And they’ve written that down.

Why do the doctors get the benefit of the doubt here? Could they be, even if inadvertently, misguiding themselves and others?

Once again, I agree we should combat the woo. I agree with the actions. But I absolutely reject the framing. It seems convenient for those who want to avoid responsibility and unhelpful in convincing other patients and advocates who are suffering here to let go of the woo.

If we stop the woo there will still be doctors refusing patients care. They will just have one less excuse to hide behind.

“If you don’t make him angry he won’t hit you” never works in the long run.
 
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It is not @rvallee . I have an electronic copy of the documents that show quite specifically why clinical and laboratory work at UCL on ME/CFS was asked to be closed down. They are shocking. And I have been at a departmental meeting where the same points were made "these patients simply should not be seen at all". I may operate in a partiular environment but it is the environment I have to try and change and nobody else much in UK medicine seems to want to change anything.

I personally don't see any way forward for me as an advocate unless some of this is addressed. If I talk to BPS colleagues they can simply laugh in my face, as they have done so far. It isn't the whole problem - not at all - but it is a key obstacle to my making any headway.
To me, it sounds like the way forward should be to press criminal charges or, at the very least, to revoke licenses and terminate positions.
These people clearly hate us and either do not care if we suffer and die or believe we actively deserve it.
 
So @Jonathan Edwards Doctors have said doctors have neglected patients because of what patients said. And they’ve written that down.

No, sorry, doctors have said, and written down, that they think their department should have nothing to do with a group of patients because of the way those patients behave.

But I absolutely reject the framing.

I am not sure what you mean by the framing. Nobody is defending these physicians.


I am not sure that I am saying anything very neww or controversial. The BPS approach is based on the idea of patients having false beliefs about illness. If I say to them that this is wrong, they do not have false beliefs and should be taken seriously, they can say "are you serious, they all think they have this and this and the other ...". Maybe it cannot be changed but when an advocacy group like MERUK sends out an article on 'MCAS' that is totally misleading I think we do have a problem that could be addressed.
 
To me, it sounds like the way forward should be to press criminal charges or, at the very least, to revoke licenses and terminate positions.

I entirely agree that this is criminal negligence but do you seriously think that hiring a lawyer to press charges would be good tactics? It would be like vegetarians bringing a case of mass murder against a licensed abbattoir surely? We live in a real world and I am trying my best to find a way forward.
 
I’ve been trying to sort out of the order of events here. The way I see it, there are four forms of medical neglect and abuse going on, and none of them are the fault of the patients.

First:
The BPS and rehab proponents are actively harming the patients and trying to stop progress in more fruitful areas of research. They are directly responsible for unfathomable amounts of suffering and deaths.

Second:
The woo practitioners (hEDS, MCAS, etc.) are giving out highly questionable diagnoses, gaslighting the patients about pathology that we have no evidence of being involved, and promoting and prescribing expensive, unproven and potentially harmful treatments. Little is gained from these diagnoses, because they don’t lead to better access to benefits or other healthcare. Some might come to accept or even appreciate this kind of healthcare because they perceive it as better than some alternatives, and I perceive this as an understandable and frankly expectable result of the continued abused and neglect that people face.

Third:
Through some kind of twisted logic, some practitioners that do not adhere to the woo or the BPS don’t like to deal with the woo so they refuse to see pwME/CFS altogether.

Fourth:
Most of the rest of the healthcare system is standing by watching and not doing anything to fix the ongoing problems or just provide appropriate care.

———

We have already discussed the harm done by associations and advocates that promote or otherwise don’t work against the BPS and rehab abuse.

What we are discussing here, is the harm that is done by associations and advocates that promote the woo. They are allowing the woo to happen more than it otherwise would, and indirectly, the extent of the denial of care due to the woo increases.

We all agree that denying care due to the woo can’t be blamed on the patients. But I think we can also acknowledge that limiting the woo would be beneficial for everyone - and the patients and advocates have influence here which they should use responsibly.

All of this is independent of another argument for limiting the woo: it’s not good science or medicine. So regardless of if you agree with my line of reasoning above, the conclusion is the same: anyone involved in ME/CFS should distance themselves from the woo.

To make it abundantly clear: if anyone personally want to say or think that you have hEDS, MCAS or any other diagnosis or pathology, you are free to do so. You should not face any negative consequences for it.

At the same time, people that take it upon themselves to advocate on the behalf of others on the topic of medical issues have an ethical duty to take extra measures to ensure the information they spread is medically and scientifically sound. Please use caution and be responsible.
 
No, sorry, doctors have said, and written down, that they think their department should have nothing to do with a group of patients because of the way those patients behave.
I still struggle to get over the ultra-weirdness and total lack of basic humanity of throwing thousands of patients in the bin because some of them spout woo. Spouting woo should not be a reason for being shut out of treatment, but surely these doctors don't think that all patients spout woo? Even if they don't care about the ones who do, do they really think there aren't any who don't?

Tons of people with cancer surely spout woo all the time because the media is full of woo but we don't see oncologists shutting up shop and refusing to see anyone with cancer.

I just don't understand how we've ended up in this special hell.
 
@Jonathan Edwards
How can we make it worse if we've been shut out from medical care?
Collectively by doctors.
In the Netherlands I'm seen, pays bills doesn't it, but specialists only see ME, not me and no testing if they can prevent it.

Please publish, name and shame as much as you can. You can't make it worse, they did.

It can't get any worse than being shut out from care, in my case 34 years, others even longer.
Collectively doctors have to come of their high horses and study ME/CFS., see the very severe patients with their own eyes.
Only then are they alllowed to have an opinion.
 
It's not just about woo-spouting or the lack of woo-spouting. The real truth is that it's about who is & is not perceived as a genuine patient, and it's about us being lumped together with the patients Jonathan elliptically describes as a "different lot of people... with an entirely different sort of problem" and the strong aversive reactions that physicians have to this. Therein lies the kernel of the "special sort of hell". It's why the murderer, the thief, the terrorist will get proper medical treatment and we get all manner of unpleasantness.

In fact, in some ways, psychosomatics could be conceptualised as a defence mechanism for the medical profession.

What is most urgently needed is for charities, prominent advocates & advocacy organisations to be sensible. Don't associate with fringe practitioners; don't join "overlapping illness" alliances; don't promote tenuous links to disputed conditions; avoid taking on as advocates people who likely have conditions other than ME/CFS; don't hype trivial or non-credible research; advocate for supportive medical care, not BPSery or unproven drug therapies. In short, present as sane, sober, and sensible interlocutors.

Current advocacy efforts are simply not working. No progress is being made in the areas where we most desperately need change. In the UK, at least, a wholly different approach is required.
 
What is most urgently needed is for charities, prominent advocates & advocacy organisations to be sensible. Don't associate with fringe practitioners; don't join "overlapping illness" alliances; don't promote tenuous links to disputed conditions; avoid taking on as advocates people who likely have conditions other than ME/CFS; don't hype trivial or non-credible research; advocate for supportive medical care, not BPSery or unproven drug therapies. In short, present as sane, sober, and sensible interlocutors.

Current advocacy efforts are simply not working. No progress is being made in the areas where we most desperately need change. In the UK, at least, a wholly different approach is required.
I agree 100% with this. But how do we get our UK advocacy groups to see it?
 
In fact, in some ways, psychosomatics could be conceptualised as a defence mechanism for the medical profession.
That's extremely well put.
What is most urgently needed is for charities, prominent advocates & advocacy organisations to be sensible. Don't associate with fringe practitioners; don't join "overlapping illness" alliances; don't promote tenuous links to disputed conditions; avoid taking on as advocates people who likely have conditions other than ME/CFS; don't hype trivial or non-credible research; advocate for supportive medical care, not BPSery or unproven drug therapies. In short, present as sane, sober, and sensible interlocutors.
So is that. It's a really thorough list of all the damaging strategies.
 
I find this thread interesting from the point of view of that historical group of people with very real health problems who grouped themselves (in some cases) or were grouped by some Drs under a label which was disbelieved & stigmatised, and still is. I.e. Me/cfs. And now we're talking about an overlapping group of people with very real health problems & judging the labels that they use to try to describe their v. real experiences in order to organise and help themselves.
The difference though is that the label ME/CFS makes no claims about cause or treatment, whereas other labels such as MCAS do. It's a bit like if we decided that we actually had a disease: 'Microclots Everywhere'. There is a possibility (increasingly remote) that microclots are the cause of our problems, but the claim is not sufficiently well evidenced to be labelling patients with it, or to be prescribing blood thinners for everyone.

I don't think there is widespread negative judgement about people who say that microclots (or collagen problems or haywire mast cells) are the cause of their symptoms. Very few of us have not thought that some idea or other probably was the cause of our symptoms at some point in our illness, only to realise later that it probably wasn't. It's the setting in stone of an etiology in the form of a disease label that is the problem.

Judging a causal hypothesis and finding it wanting should not be the same as judging a person. But, a label like MCAS makes those two things uncomfortably similar.

Having a holding label of ME/CFS that makes no clams of etiology makes it much easier for me move from being keen about one idea about a cause to another. It makes it easier for clinicians to too, and researchers and advocacy groups, to not get stuck in a silo, to not have blinkers on about what the biology is and what treatments work. I liked @StellariaGraminea's idea about holding labels lightly, but, I think labels that claim unwarranted certainty about a cause are unhelpful in many ways and are very difficult to hold lightly.

I think there are things we, as people with ME/CFS, can do that would make things better for people with ME/CFS. I don't think it is patient-blaming or victim-blaming to say that. It's reasonable to call for our advocates and advocacy organisations to be better. Saying that is not the same as saying that it is our fault that things are so bad, in just the same way that past calls for civil rights groups to work more effectively were not saying that racism is ok.

Nightsong expressed things extremely well in the post above that included this manifesto for change in our advocacy groups:

What is most urgently needed is for charities, prominent advocates & advocacy organisations to be sensible. Don't associate with fringe practitioners; don't join "overlapping illness" alliances; don't promote tenuous links to disputed conditions; avoid taking on as advocates people who likely have conditions other than ME/CFS; don't hype trivial or non-credible research; advocate for supportive medical care, not BPSery or unproven drug therapies. In short, present as sane, sober, and sensible interlocutors.

There are things we as people with ME/CFS can do ourselves too. We can get involved in our charities if we have the capacity, we can elect sensible trustees. We can call out charities that don't present themselves as professional credible organisations. We can reward good organisations with our donations.
 
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