That sounds appealing, but I'm not sure it really works. It is plausible that someone who is a bit stupid and hysterical has convinced themselves that the minor aches and pains that everyone feels is a sign of major illness, and that they should rest in bed. And then when someone opens the curtains, their eyes hurt, and when they stand up after all day in bed, they feel a bit dizzy and their muscles are stiff. And they interpret those feelings as signs they should lie down again. Thinking like that might even make sense if they feel anxious at work, overwhelmed by the world or enjoy being taken care of.
It's so plausible that that idea is what many people start with, when faced with someone with severe ME/CFS,. That is, the idea that the illness is caused by faulty behaviours caused by false illness beliefs, and that those beliefs can be removed with concerted reasoning. Under that model, the false illness beliefs are irrational, yes, but can either be removed or replaced by some other less harmful beliefs including 'yes, you are sick, but recovery is possible if you do what your therapist says'.
So, CBT could be expected to work in psychosomatic illness. There's just the problem that it doesn't.
The key thing with eg me/cfs is that I guess people are assuming we are deluded in thinking that we will get worse if we try and increase what we do (or list many other things like the idea of exposure therapy for light sensitivity) and of course the more severe we are the more ridiculous what we have to say sounds. I cringe at having to say two weeks to recover from an appointment but that’s not the half of it re: how often I should be lining then up back to back with each other.
the issue is that no one will ever believe us even I imagine if someone was locked in a ward for six months with their exertion controlled then observed for the six months afterwards. And get worse
and we all know in outpatient clinics who only see people without PEM who are polite and nod and leave
but there must be some level of delusion going on from the medic side in the instances where they’ve seen these iller people. You watch it ratchet up as they make fii accusations or ban them from family members or assume maybe they are doing something else first.
once someone has any kind of psychiatric label - both (function back door) of which are as powerful a weapon as each other (only one of which is regulated , sort of or supposed to be) then it says the patient ‘lacks insight’ - and PS this is interpreted (quite honestly) as ‘they are liars’ , which is the behaviourism attitude anyway as they don’t like to treat people as humans who might question as ‘valid’.
By this exact ‘move’ of putting a question mark over that person - regulated of correct it not you invalidate them vs the perhaps deluded medics who believe in the easy options. Question resolved on ‘who is wrong’ and then they go no further to question why someone isn’t improving with sleep hygiene or exercise or anything else other than to say ‘this psychosomatic is extreme’. I actually think they think people can psychosomatic themselves to death and that’s how pwme die. Nothing they can do ‘medicalising’ they belief would make it worse.
which is a major issue for a condition where the added dusabiiity is the medics lacking insight or ability to see what’s in front of them fir what it is.
to allow this free pass. It bars people from ever accessing medical care for anything, being heard or being free if they do get ill.
it’s all very well doing these rhetorical debates about these terms but they are no joke and as harmful a thing you can do to a person it presents a deep removal of themselves and takes their safety and identity and peace when they are as ill as we are and you realise if you did die it would be written off and you wouldn’t even have the dignity of your own story.
But then to this is my other point which is that I imagine there was some learning to do, just as we all have with our illness and trying boundaries vs the typical diagnostic tools and time spans . And surely if something is new then you only know if it’s acute when time elapses. Although ironically I don’t know would they back then have been more used to illnesses without good treatments where they might have calmed down from an acute stage but still remained (and might have further acute stages or deterioration etc )
I also agree with the comments about provocation regarding ‘perceived mood’ if someone is realising these notes and attitudes are going on around them it wasn’t ’at nothing’ in that situation. Plus I suspect it was no better than now regarding the terminology allowed to be used being rude and tactless or certain terms tgat perhaps meant little were derogatory versions like did medics just use hysteria for any upset woman back then?
the thing is that the slowest subject to move on of any even outside medicine inckuded seems to be that psychosomatic end of psychiatry - so they would see what they recognised in the notes wouldn’t they. And if they’d been the only doctors there would they have just assumed it was mass hysteria as a starting point at the time?
