Psychocorporal approach to functional somatic disorders 2024 Kachaner, Lemogne and Ranque

Abstract

Functional somatic disorders (FSD) are common conditions that result in a significant deterioration of the quality of life. Their origin is multifactorial and poorly understood, and their management is often inadequately defined. Medications typically show limited effectiveness, while mind–body approaches play a central role, guided by three key principles: establishing an empathetic, respectful, and sincere doctor–patient relationship; promoting regular and gradual physical activity; and implementing cognitive behavioral therapy (CBT).

Special attention must be devoted to establishing a trustworthy relationship between the physician and the patient. Recognizing the reality and severity of symptoms and providing a positive diagnosis as well as an explanatory model to account for them rationally are fundamental aspects of patient management. Cognitive and behavioral maintenance factors should be investigated and constitute therapeutic targets. Cognitive factors include focused attention on body functioning and catastrophizing. Patients frequently display avoidance behaviors, particularly in relation to physical exertion, and it is crucial to motivate them to reintroduce gradual physical activity customized to their abilities.

This approach has demonstrated efficacy in improving fatigue, pain, and the physical and mental quality of life for patients with FSD. Among psychotherapeutic approaches, the benefit of CBT is well-established. The combination of gradual physical activity and CBT appears to be complementary. Other mind-body approaches such as mindfulness meditation might help although their level of evidence is weaker. Given the prevalence of FSD in the general population, it seems necessary for all physicians to be trained in managing this condition.

Open access in French, https://www.sciencedirect.com/science/article/pii/S0248866324006325

 

Looks like a highly problematic article, suggesting the opposite of what actually should be done to help patients.

It refers to the Cochrane review (Larun et al.) to argue that GET is beneficial and to the PACE trial to argue that pacing is not (they suggest the term should be abandoned).

They constantly repeat that patients with functional disorders are highly perfectionistic, that they catastrophize etc. They formulate the old CBT paradigm with the same confidence of Wessely and Sharpe in the early 1990s. Here's for example a translation of one section in the article:

"Among the factors that maintain symptoms, the most frequent avoidance behaviour is the avoidance of physical activity. Fearing that symptoms will occur or worsen after exertion, the patient reduces physical effort to a minimum. The resulting sedentary lifestyle leads to muscular and cardiorespiratory and cardiorespiratory conditioning, depressive cognition and social exclusion [24]. Physical inactivity also increases catastrophic thoughts about symptoms, which encourages anxious hypervigilance anxious hypervigilance with exacerbated attention to the the slightest bodily sensation.Muscular and cardiorespiratory deconditioning and cardiorespiratory deconditioning itself aggravates fatigue and certain symptoms, including pain and digestive problems, creating a veritable vicious circle."​

 

It's easy to lose track of how legitimate insane this is. By insane I mean this is properly in the same category of "I will raise an army of war guinea pigs and conquer the world because they can build and ride tanks and also my cat can build nuclear bombs".

What does it say that they recognize the importance of trust (I'll just ignore the absurdity of there being a "relationship" between physician and patient, the whole concept is silly and almost never exists) only to then advise to essentially abuse and destroy that trust. Immediately followed by the idea of recognizing the reality of symptoms, which they literally don't, in fact they show how they understand absolutely nothing of illness, but then finish off with the foolish notion that their decades-long attempts at providing an explanation based on bullshit models is a legitimate way of doing things. Literally decades of that, and it's still some novel idea that they just haven't perfected yet. Insane.

They all know that most patients reject this strongly. They seem to hold on to the minority who are willing to go with a magical method, or those for whom it doesn't make any difference since time was the only relevant factor in the outcome, and how they can convince the majority to their cause. But still they talk about trust, which they fully intend to abuse, because they deny and reject the lived experience of the patients.

Genuinely 1984 "war is peace, ignorance is strength" levels of disinformation. And it's literally always the same. It never changes, it's all just self-important people parroting the same bigotry as if having the same opinion many times over adds to its validity. They simply use slightly different labels but it's all 99% the same, just a weird Rube Goldberg bootstrapped model, pulling itself into shape in an impossible way.

You can tune to any Youtube or podcast from someone who rants and hates on the poor, on immigrants, on any group of people suffering at the bottom of society, and it's just as hateful and ignorant in its content. Here the style has a layer of academic language expressing fake sympathy supported by lies, but the intent and outcome are the same, it's the medical equivalent of destroying homeless camps and stealing all their possessions. So disgusting.

 

I'd be an idiot if I didn't "employ avoidance behaviors."

Problem-solving, something our brains evolved to do. (Adaptation to new environments, learning to survive. My body has become a new environment.)

So lazy and facile to project blame onto the patient rather than ask oneself to deeply imagine the truth of what patients are telling you. Such a lack of curiosity, of intellect. They won't be so smug when the biological mechanisms are elicited. They will be seen as quacks, of persons with limited intellectual capabilities, alas.

Akin to a general sending a small squad to see if there is enemy over the hill. The squad comes back telling the general that there are thousands along a wide swath beyond the hill. Ah, but the general is in denial, for some psychological quirk of his own, and orders his army forward. Heed what they are telling you. Don't dismiss it.

 

Indeed, the (non) functional-bps folk are catastrophizing around the concept of catastrophization.

And besides, the damn word is too long and hard to spell.

 

Scale responses are not symptoms. More researchers who don't understand the danger of equating the two, failing to understand that modifying cognitions can lead to altered scale answering behaviour even if there is no change in underlying symptoms.

 

A question and a comment...

Do the authors mean a "trusting" relationship? I don't know what a "trustworthy relationship" actually is in the context.

The problem with trust, as far as I'm concerned, is that the medical profession doesn't trust me, and yet I am expected to trust them.

...

For anyone who hasn't already looked it up, psychocorporal therapy is also known as "mind-body therapy" according to the title of this paper :

https://www.sciencedirect.com/science/article/abs/pii/S1158136010001301

I notice the author of the above paper is also French (or works in France) and is described as a Psychoanalyst, Sexologist, Professor in Sexology at University Paris 13 Bobigny.

...

 

Same old, same old. Absurd.

Is there a French ME Association that might wish to becaware if this?

 

There is Millions Missing France/
Des millions d'oubliés
https://millionsmissing.fr/

 

Millions Missing France and especially ApresJ20, the largest association of long Covid patients, have had to battle against Lemogne and Ranque since 2020. They are the co-leads of the long Covid clinic CASPER (yes, like Casper the friendly ghost) at the Hôpital Hôtel-Dieu, a renowned public hospital in Paris, and they sit on the Haute Autorité de Santé’s committee for the development of long Covid guidelines (the HAS is the French equivalent of NICE).

They have a considerable influence because they have a wide reaching network — very likely all the way up to government advisors from what I’ve been told —. For instance, they were able to get the co-director of the infectious diseases department of Hôtel-Dieu, Prof Dominique Salmon, who supports a somatic pathophysiology to long Covid and sits on the medical advisory board of ApresJ20, fired because she also had a cohort of LC patients. I believe that, officially, the grounds for her dismissal were serious professional misconduct.

Ranque essentially has a free pass to publish in this Journal of Internal Medicine (which is the national French society of internal medicine’s journal) because she is an eminent internist: a couple of years ago, she had an opinion piece entitled “Long Covid: To call a spade a spade” or something similar, where she suggested that LC patients take up gardening and painting to alleviate their symptoms, published there.

(Of note, also in 2021-22, they and their long Covid clinic were ridiculed on French public television by an investigative journalist who had long Covid. She interviewed Lemogne and Ranque who suggested unevidenced therapies such as mindfulness and exercise, and generally came across as not knowledgeable of the condition.)