“Lumping” and “splitting” medically unexplained symptoms: is there a role for a transdiagnostic approach? - Chalder/Willis (2017)

Trudie Chalder & Claire Willis (2017) “Lumping” and “splitting” medically unexplained symptoms: is there a role for a transdiagnostic approach?, Journal of Mental Health, 26:3, 187-191, DOI: 10.1080/09638237.2017.1322187
https://www.tandfonline.com/doi/full/10.1080/09638237.2017.1322187

(Open access)

Haven't read it, just saw it includes a "Proposed matrix: illustrated with fatigue as a transdiagnostic symptom" [for "IBS, CFS, Fibromylagia etc."]

(Table 2 in the text)

 

Claire Willis works at the Chronic Fatigue Research and Treatment Unit, London, UK
I gave up after reading about the "good evidence base" for CBT especially in CFS (ref PACE).

 

I gave up when I saw they were studying ruminants.

 

Isn't this an issue they should have given consideration to decades ago in their research careers?

 

Just had a random thought. Does anyone know if the BPS cabal treat post-polio symptoms as MUS?

 

There is an extraordinarily frank figure in this paper, it really does reveal exactly what these people believe. Which is refreshing. They usually do such a nice dance around how we "don't really know" and that their proposed treatments take a "pragmatic" approach. But this figure tells it like it is.

 

People with untreated and significant illness are going to engage in "physical attributions", they're going to have beliefs on what helps and what harms which can be entirely correct ("fear avoidance beliefs"). They're going to have disturbed sleep (which can be interpreted as behaviour and labelled a poor sleep routine). They're going to try and get diagnosed and treated, and if the illness is a serious problems they won't easily give up. They're going to have symptoms that are too intense to just ignore, but that could get them labelled as focusing too much on symptoms (" "symptom focus"). They're of course going to worry as any responsible person would. And so on.

All these BPS proponents are doing is putting their own misantropic spin on the lives of people struggling with chronic illness. I sometimes think that we need a new term for this because it's the chronic illness equivalent of racism.

 

I noticed that diagram and thought how impressive were the developments over the years - in the art-work. It says so much. And leaves so much un-said.

 

Wessely and White had a gentlemanly "debate" on this in 2004.
https://www.researchgate.net/publication/8424117_There_is_only_one_functional_somatic_syndrome

It's their sacred cow, sorry, mandala.

 

I had not yet heard of "rogue representations"

https://www.tandfonline.com/doi/full/10.1080/23311908.2015.1033876

Brown 2004: https://pubmed.ncbi.nlm.nih.gov/15367081/

 

This is a very accurate and succinct statement of their position. Exactly.

It's a good explanatory statement for anyone embedded in the psychological position (who are outside the actual cabal of researchers) and who seem incapable of imagining that there may be legitimate reasons for why we reject their BPS views.

I hope the sentiment of the statement gets taken up and sees a wider viewership.

And I don't think the chronic illness equivalent of racism or mysogyny or aporaphobia (hatred of the poor) is in any way exaggerated. It is that. They may not consciously be promoting it but that doesn't change what it is.

 

This is just a bunch of random concepts with arrows thrown in without sense or reason. It reads exactly like those conspiracy webs that link cow manure and aliens, or whatever. You can link bin Laden to climate change with this approach, it's just someone putting their imagination to paper.

It's really absurd that this stuff, which should be a career-ender, is taken seriously.

 

It seems to be another way of saying patients imagine a problem where there is none.

 

Thanks for the laugh ---

 

I can tell you how this goes when the patient is setting in the chair. I've been there.

 

You probably laugh through horror films too!

 

Yea fair point - I was thinking of adding --- if it were not serious (which it is)!