The concept of ‘illness without disease’ impedes understanding of chronic fatigue syndrome: a response to Sharpe and Greco, 2020, Lubet & Tuller

cassava7

Senior Member (Voting Rights)
Mod note: The reply by Lubet and Tuller was in response to an article by Sharpe and Greco, discussed here:
Michael Sharpe: Mind, Medicine and Morals: A Tale of Two Illnesses (2019) BMJ blog - and published responses


By Steven Lubet & David Tuller.

Abstract:
In a recent article in Medical Humanities, Sharpe and Greco characterise myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) as an ‘illness without disease’, citing the absence of identified diagnostic markers. They attribute patients’ rejection of psychological and behavioural interventions, such as cognitive–behavioural therapy (CBT) and graded exercise therapy (GET), to a ‘paradox’ resulting from a supposed failure to acknowledge that ‘there is no good objective evidence of bodily disease’. In response, we explain that understandings about the causes of and treatments for medical complaints have shifted across centuries, and that conditions once thought to be ‘psychosomatic’ have later been determined to have physiological causes. We also note that Sharpe and Greco do not disclose that leading scientists and physicians believe that ME/CFS is a biomedical disease, and that numerous experts, not just patients, have rejected the research underlying the CBT/GET treatment approach. In conclusion, we remind investigators that medical classifications are always subject to revision based on subsequent research, and we therefore call for more humility before declaring categorically that patients are experiencing ‘illness without disease’.

Link: https://dx.doi.org/10.1136/medhum-2019-011807
Sci-Hub: https://sci-hub.tw/https://dx.doi.org/10.1136/medhum-2019-011807
 
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Excellent brief article by Lubet & Tuller :-)

I love this line "Given psychiatry’s long history of mistaken theories of disease causation, there is an almost wondrous grandiosity to Sharpe and Greco’s proposed solution to the supposed ‘paradox’ that troubles them."

Wondrous grandiosity - fabulous :-)

Bw
Joan
Counselling
Psychologist
 
Sharpe needs a history lesson if he thinks that not being able to explain illness is unusual.

There have been many claims of psychogenic illness that all ended when the biological mechanisms of some at the time unexplainable illness became sufficiently explained. Then proponents of the idea of psychogenic illness moved on to some other illness that was poorly understood. This ideology is an explanation in search of a problem.
 
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That was a great response. Clear and, unlike the original piece, coherent. Also unlike the original piece: actual facts. Bold move.

My mind more or less exploded when I found out that Greco has an MA in Critical Theory. Seriously. I just can't wrap my head around being this bad at my chosen profession, it's simply unimaginable to never have a moment of self-awareness for this long to seriously produce actual god of the gaps arguments. I have second hand cringe from it.

Though the idea that tens of millions of lives can be written off based on cheap incoherent and inconsistent philosophy is a crime of gargantuan proportion that I also cannot wrap my head around. It's not the suggestion that is insane but that it is considered credible to the point of putting it into practice through near (as we can tell) universal approval and support despite documented evidence that it is disastrous on a level comparable to detonating nuclear bombs in large cities simply to observe the effects. It's no less immoral than deciding on prison sentences based on a random Facebook quiz, a Bingo draw or a skull measurement.

A philosophical question does deserve to be asked: if we continue to this day with barbaric practices, does that not make us barbarians still? I would argue barbarians are defined by committing barbarian acts and this is a clear act of savage barbarism, to erase millions by discriminating against specific health problems, to even categorically reject the idea that we can solve this particular problem. Not much different from abandoning (though this was by necessity) a member of the tribe if they can't follow because of a broken leg.

If we are judged by how we treat the most vulnerable among us, even medicine frankly fails this critical test because of this moral blind spot. We can and have to do so much better than this.
 
Slowly or (hopefully) more quickly understanding of our illness and others will move on without Sharpe et al. But when a better grasp of the physiological underpinnings of this illness and appropriate treatment happen IMO this will not change anything for BPS true believers.

I think they will continue to suggest that 'it is complex' in their sense meaning that personality, mental disturbances etc contribute in a way that makes their treatment still valid (at least CBT and perhaps a GET that will have morphed into pacing).

There is no undermining this theory. We know so little about how the mind / brain functions. They can continue to flaunt vague ill defined concepts using the language of science to convince the general public that they know far more then they do.

Ultimately, society needs to develop antibodies against propaganda.
 
Really excellent article Steven and David.

To my mind there is genuine and much more pressing paradox:
  • Medical scientists, by definition, are always aware there is still much yet to discover; what purpose would they have if there wasn't?
  • Researchers implying that physiological medical knowledge is fully understood for some illnesses, claim to be scientists.
Just as for Sharpe and Greco, this seeming paradox is not really paradoxical at all of course. I don't think it needs any great wisdom to spot why. But it does of course need just a touch of that essential quality for any real scientist - humility.
 
This seems relevant to the topic and rather smart:

Improving Diagnostic Accuracy: Medical Mimicry, Part 2

https://pro.psychcentral.com/new-th...g-diagnostic-accuracy-medical-mimicry-part-2/

In part 1 of Medical Mimicry, readers were reminded about how psychiatric symptoms can be brought on by general medical conditions, requiring physician intervention. Now, in Part 2, let’s turn our attention to the evaluation process.

Many people are referred to psychotherapy by their primary care physician (PCP) because they have a clean bill of physical health and their anxiety, mood, sleep problems, etc. are deemed psychological. Barring this “pre-evaluation,” while we are not physicians, it is not difficult to ascertain if current psychological symptoms may be influenced by a medical complication and need referral for medical assessment.
Other medical conditions commonly masquerading as depression are hypothyroidism (slow thyroid), chronic fatigue syndrome, low iron, and sleep apnea. Psych Central harbors numerous helpful articles and posts on the sleep apnea:mental health connection such as Dr. Rick Nauert’s 2018 post. People with sleep apnea may think they’ve slept all night, but the sleep is restless given the tossing and turning as they choke themselves awake. Consequently, they feel tired, can’t concentrate, are unmotivated and irritable, just like depression can present. This is also a good reminder of why we should try to get family member input. Most spouses/partners are happy to complain about their nocturnally-loud other half!


Another article from the same author, again pretty smart on the topic:

Improving Diagnostic Accuracy: One Symptom Isn’t Enough, Part 2

https://pro.psychcentral.com/new-th...-diagnostic-accuracy-one-symptom-isnt-enough/
As you can see from the previous post, it is dangerous business to highlight one symptom as reason for a diagnosis. It unfortunately is easy for otherwise well-meaning clinicians to latch onto a diagnostic buzz word and quickly transition to whatever diagnosis they are familiar with that harbors it as a key feature. With that mindset, hallucinations mean Schizophrenia, social awkwardness means Autism Spectrum, obsession means OCD, and the list goes on. This isn’t entirely their fault- supervision deficits and the fact that there is little preparatory training in diagnosis other than a survey of the DSM in most programs, are set-ups for such diagnostic habits. The good news is, despite these hurdles, I’ve found most new clinicians are interested in honing diagnostic skills because it indeed leads to better treatment outcomes and boosts confidence.
 
Definitely relevant to the confluence of MUS/FND, ME, COVID-19 and medical gaslighting as a standard operating procedure created by the concept of conversion disorder. This is particularly relevant as it highlights the reality of creating trauma, through medical gaslighting, even as the BPS brigades are pushing in many places to put COVID-19 post-viral illness under PTSD: literally creating the problem they present as the cause.

It also basically presents all the features of the ME debate unfolding over the last few decades, the exact same objection to being gaslighted, simply because it's wrong and thus a pointless waste of effort, and how it only amplifies the problem. The same language and frustrations. The same consequences, too.


Dismissed, unsupported and misdiagnosed: Interview with a COVID-19 ‘long-hauler’

https://www.pslhub.org/learn/coronavirus-covid19/patient-recovery/resources-for-patients/dismissed-unsupported-and-misdiagnosed-interview-with-a-covid-19-‘long-hauler’-r2461/
A significant number of people, who may or may not have been acutely unwell with COVID-19, are experiencing a prolonged and debilitating recovery at home. Symptoms and experiences of care seem to vary greatly among this group, sometimes known as the COVID-19 ‘long-haulers’. Many are finding comfort and reassurance through online communities, set up by and designed for patients who are struggling to get back on their feet.
We need to be part of the narrative. We need to be monitored, treated and researched. We need to drop the word ‘mild’. We can’t keep slipping down the cracks.

And the gaslighting labels needs to stop. Labelling someone as ‘anxious’, without thoroughly exploring clinical symptoms, is as dangerous as it is abusive. Symptoms like kidney pain, low blood oxygen, black fingers… these symptoms do not, and never will, sit under the umbrella of anxiety – and yet this is what people in the support groups are being told.

This is a new, complex and multi-system disease. Long-term sufferers are now coming forward with stories of heart and lung damage, including some acutely serious conditions not detected with ECGs, chest X-rays or bloods. Bottom line – if basic tests are clear and the person is still suffering with severe symptoms – you don’t slam the door. You open it more.

Some people will have post-viral fatigue (PVF) and so it’s great to raise awareness about this condition. But I worry about such labels being used as a catch-all. Like with anxiety, PVF should only be diagnosed where the symptoms match and where all physical explanations have been exhausted through thorough investigations. And then, once a diagnosis is made, the patient needs support, not silence.

While the individual GPs do need to take responsibility for their unconscious biases, it is also on the government to ensure NHS staff are properly supported – that includes ensuring GPs have good guidelines, extensive support for their wellbeing and training in the bias surrounding chronic illness. That is how you protect the NHS.
Do you feel your wellbeing and mental health has been impacted by your experience?

The uncertainty is difficult and I’ve felt down at times but this has made me more resilient than I ever thought I could be. I have my meltdowns, but I do believe I’ll get better, especially now I have a cardiologist.

The worst part is the medical gaslighting. It is traumatising to be dismissed with dreadful catch-all diagnoses that do not explain my symptoms.

On the plus side, I’ve really learned to listen to my body, and to soothe myself. I have a great support network too, so while I might have some post-traumatic stress ahead of me, I’m confident I’ll get through it, somehow
The "mental health" focus of ME has been nothing but disastrous for the mental health of those it locked in the chokehold of the conversion disorder ideology. Like firefighters burning down the whole city and celebrating how good of a job they are doing since there's nothing left to burn and thus no more fire. No more buildings, or life, either.
 
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