The FHJ debate: The NHS is failing to provide services for patients with symptom-based disorders, 2025, Burton et al

[Jonathan Edwards]

 

[rvallee]

When they keep changing the name every 2-3 years they are completely stuffed. Medically unexplained symptoms, symptom based disorders, central sensitisation syndrome, FND ( I get some FND is real). Including IBS, POTS and migraine as the same disorder is silliness. A notorious physician started doing this in my part of the world and their career was finished in 3 years because patients could see through it.

It would really be a useful exercise to have someone go through this methodically, expose how transparently absurd it all is. We are long past the point at which this not only checks all the boxes of pseudoscience and fraud, and it's starting to look more like cartels and extremely corrupt businesses that have just a toe left on the legal side of things to not be explicitly criminal, but very obviously have significant dealings in organized crime.

I guess this is one of those things where we wait for AIs to be good enough for it, because it would be such a painful slog to do manually, and it would be so controversial most academics in the profession would rather swallow hot lava than come anywhere near it.

 

[Utsikt]

Speaking of not wanting to suggest the lack of the possibility of recover or the existence of a whole disorder to the patients, a term I've been enjoying from a trawl through this literature is 'evidence-based optimism'. I forget who I saw saying this, I think it was the editor of the Special Issue, Theresa Barnes at an RCP event. It was explained that the evidence creates the floor, but there is no need to be constrained by it. The space above the evidence is available. Yeah, I don't know but they seem to be using it as a technical term. Watch out for it and enjoy.

I tracked it down to this:

The report and statements make clear that action on the social determinants of health should be a core part of health professionals’ business, as it improves clinical outcomes, and saves money and time in the longer term. But, most persuasively, taking action to reduce health inequalities is a matter of social justice. The enthusiastic response from medical and health professionals to the challenges of a fairer distribution of health contributes to what I have described as my evidence-based optimism: we are making progress in a good cause. Join us.

Professor Sir Michael Marmot
Director of the UCL Institute of Health Equity

Barnes references Kinsella which references Marmot.

«Where is the evidence of something that can make us optimistic [about solving this problem]».

Sounds like a coping mechanism.

And it seems like it’s the same as any BPS term: it means what the author wants it to mean. There is no consistency here. Barnes is way off from Marmot and they are way off from the video.

 

[Holinger]

The hell are these people talking about? Their bullshit ideology is responsible for this, and they have always presented themselves as the solution, so this is nothing new but it still looks appalling. Arsonists who work for the fire department wondering what's up with all those fires they keep starting. Really?

Insane. Just total, pure insanity.

Quite a problem is Aust. regarding fires and arsonists. I think your analogy about certain BPS folks working in ‘symptom based disorders’ is pretty accurate.

 

[Sean]

I'm not aware that BPS theories have improved the health of any nation. Instead, people are starting to die younger than they used to.

That is largely true for the whole mental health field, IMO. They are as powerful and influential as ever, yet the mental health of society is not obviously better overall than it was previously, far as I can tell, and is even arguably declining.

Either they do not understand mental health adequately yet, or their therapeutic offerings are not sufficiently effective, or both.

When they keep changing the name every 2-3 years they are completely stuffed.

Yep, no amount of rebranding is going to convert a lemon into lemonade.

--------

Persisting Physical Symptoms​

Persistent physical symptoms?

 

[Hutan]

Persisting Physical Symptoms
Persistent physical symptoms?

ah yes, Persistent. I have amended my post upthread where I mentioned Persisting Physical Symptoms. I got carried away with the present particle (?), to match Endur-ing.

What's the equivalent grammatical form for Enduring Symptoms? Durable Symptoms? You can see why that particular name was out by lunch-time.

 

[Kitty]

I'd say evidence-based optimism is my mate ending up overdrawn every month because she's hopeful her budget will stretch to fit everything she spends.

Loads of evidence, but it doesn't mean she's not always skint.

 

[Trish]

and when did "symptom-based disorders" become the term? It's better than previous efforts, I guess--on its face, it doesn't automatically imply "psychosomatic"?

I think that may have been at 2 pm last Thursday, after 'Enduring Symptoms' was briefly tried and then abandoned when someone realised it sounded too permanent.

And how could we forget the MUPPETS, coined for a conference addressed by Esther Crawley, based on MUPS - medically unexpained physical symptoms.

Then there's all the variations on functional, bodily distress disorder, somatic symptom disorder, each with their fans, definitions, no doubt conferences.

It's all to pretend they don't mean hysteria or psychosomatic.

 

[bobbler]

And how could we forget the MUPPETS, coined for a conference addressed by Esther Crawley, based on MUPS - medically unexpained physical symptoms.

Then there's all the variations on functional, bodily distress disorder, somatic symptom disorder, each with their fans, definitions, no doubt conferences.

It's all to pretend they don't mean hysteria or psychosomatic.

It’s got to be us that has a problem somehow otherwise they’d have to look in the mirror and be outed. I’m not sure they even really get how their supposed hysteria actually works , I think it’s just trained-in dislike and things they can’t put their finger on because they don’t realise it’s years of tuts and ughs from misogynists who can’t stand that woman crying even after what they just did to them was appalling (and there’s the real thing with psychosomatic ideology - it’s actually about personality types who have no empathy but are hypocrites in what they are highly sensitive if a tenth of that hardship happens to them but they dole out then won’t be accountable for the consequences they caused. You know like telling someone to stop whinging about that bruise they gave them and it’s probably their fault it bruised).

They need to keep providing cover for those less wicked in the main body of staff they require to actually impose this dystopia on the ground , after they’ve changed the infrastructure to make other options impossible, and at least feel neutral about it. Because not everyone is deluded and/or mean and/or easily incited to take out their frustration at being treated badly in working conditions due to decisions of those above them on those under them by punching down as directed and demanded by those same people above them.

So it needs a nice little sanitised system and terms pretending this time it’s not locking up the seriously ill who happen to have the wrong demographic, face doesn’t fit, makes some Victorian-minded senior’s stomach turn when they see them for some unexplainable reason into weaponised mental health labels to remove their autonomy and rights to be heard if they complain or speak.

That’s why they try and bs the CBT is real not the anti-psychology versions and is ‘about stress’ … cos everyone’s stressed (they just think at least they don’t go loopy and start thinking they are ill when they have they think so much more pressure than most having to twiddle their thumbs every day thinking of how to rebrand the same work they’ve been churning out for their working lifetime)

I think it’s just about making the system increasingly impossible to navigate and get real care for anything even if someone finds a decent hcp who is brave enough to want to do medicine . By sinking £billions on an industry that harms people and gaslights and causes attrition by hoop jumping that is endless for any symptoms that are common to women or the vulnerable.

I just wish those responsible when they got ill were forced to not have any access to any alternatives and had to endure being buried in it themselves.

But they both know the trapdoor and use their power to ensure they won’t get treated the same.