The Psychosomatic Approach to Primary Chronic Rheumatoid Arthritis. (1965) Ehrlich

J

JohnTheJack

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A book review from 1965.
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/572067

Abstract
One of the first patients referred to me was a woman whose rheumatoid arthritis had already produced many established deformities, but whose disease still smoldered. Many hours of application of what I had been taught and some of what I had not resulted in remission of the inflammation.

I then called in a very competent surgeon whose skill corrected unstable knees and useless hands. Many hours of physical and occupational therapy later, the patient was still a hopeless invalid.

There was no longer an organic basis for her disability; she doted on ill health, and enjoyed tyrannizing her husband, who had become her virtual slave. I had, of course, neglected to acquaint myself with the psychic needs the disease was serving.

Since then, many patients who have rheumatoid arthritis have been referred to me for consultation. The attending physicians often begged me to take over the total treatment; they pleaded.
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Male doctor about woman patient.
We tried all possible remedies.
There is no ongoing pathology.
Referred to me by other specialists.
Other doctors see them as 'problem patients'.
Mustn't be dualist.
May not be aetiological but perpetuated by emotional.
Personalities same as those with other psychosomatic illnesses.
Multiple disturbances.
Many used to be very active.
Use psychotherapy.

Rheumatoid arthritis or ME?
 
I then called in a very competent surgeon whose skill corrected unstable knees and useless hands.

I remember looking after patients who had seen surgeons like that. Knees were 'corrected' in those days, before replacement, with arthrodesis - fixed straight. Hands were converted from quite useful claws to completely useless ping-pong bats with fingers nicely straight but incapable of lifting a fork. As a result husbands were 'tyrannised' by having to feed their wives and take them to the toilet.
 
Ehrlich said:
Since then, many patients who have rheumatoid arthritis have been referred to me for consultation. The attending physicians often begged me to take over the total treatment; they pleaded.
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The above reminded me of the following bit of the interview with SW on The Life Scientific:
Simon Wessely: And as I got a bit older I had a stroke of luck that I went to Queens Square, The National Hospital for Neurology and that was in this fantastic hospital, surrounded by neurologists, so there were only three psychiatrists, and that’s when I really started to get interested in research, and that’s where I got interested in “chronic fatigue syndrome”.

And because these patients were being seen there. I have to be honest, and say nobody really liked them.

Jim Al-Khalili: Tell me about some of these patients, that you saw at Queens Square.

Simon Wessely: Well, there were people being referred (Queens Square is the home of neurology), and, at that time, it was felt that this might be a mysterious muscle disease, there was a headline in one newspaper and of course Queens Square is the best place on earth to deal with mysterious muscle diseases. They rapidly concluded it wasn’t a muscle disease and then didn’t really want to have anything to do with the patients to be honest with you. So they started – this happens a lot when people don’t know what to do – they do ask psychiatrists to get involved. So I started getting involved, and I was the only one, and I just got more and more fascinated.
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Source: https://www.meassociation.org.uk/20...life-scientific-bbc-radio-4-13-february-2017/

As I’ve written before, it’s almost as if the only thing we learn from the history of medicine is that we don’t learn from the history of medicine.
 
I have to be honest, and say nobody really liked them.
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And now they hate us even more because Wessely's massive ego can't handle failure. Great job. Not many people actually manage to regress an entire field of medicine. Actually, make that two with GWI. The guy is almost impressively bad at his job.

Robert 1973 said:
As I’ve written before, it’s almost as if the only thing we learn from the history of medicine is that we don’t learn from the history of medicine.
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Same with peptic ulcers
Same with Crohn's disease
Same with Lupus
Same with so many others and plenty more still left

Always the same language. The same illogic. The same assumptions. The same explanations. Some texts you could put side-by-side and struggle to tell apart despite being separated by a century.

That's actually one of the most fascinating tidbit in this, many actual historians of medicine are psychosocial fluffers. The very people who are supposed to learn about the history of medicine are themselves happily and enthusiastically encouraging the same mistakes with zero awareness that they are doing just that. They don't see the parallels despite the language, diagrams, methods and assumptions being identical. It's almost impressive.

Henrik Vogt may be one of the most fascinating specimens. The guy is actively promoting pseudoscience that probably even makes many homeopaths cringe and he has or is working on a PhD in history of medicine. People like that are like parodies of cluelessness but they are actually real and have real impact on the world.
 
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Jonathan Edwards said:
Yes, well they would have done - anything to palm off a patient with an incurable illness you had no idea what to do for.
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I like that there's the bit about the patients being strongly disliked and not making the connection that it's not at all about whatever this guy thinks he's skillfully doing, rather they're offloading what they think is garbage waste of their time.

Somehow makes me think of Flowers for Algernon. The cluelessness, but somehow mixed with some of the later smarts, still the cluelessness definitely outweighs. If only they had even half of his morality and good nature.
 
Jonathan Edwards said:
I then called in a very competent surgeon whose skill corrected unstable knees and useless hands.

I remember looking after patients who had seen surgeons like that. Knees were 'corrected' in those days, before replacement, with arthrodesis - fixed straight. Hands were converted from quite useful claws to completely useless ping-pong bats with fingers nicely straight but incapable of lifting a fork. As a result husbands were 'tyrannised' by having to feed their wives and take them to the toilet.
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Are there any studies or just articles describing these surgeries? How inadequate they were?
 
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