Blaming the victim, all over again: Waddell and Aylward’s biopsychosocial (BPS) model of disability, 2016, Shakespeare et al

Blaming the victim, all over again: Waddell and Aylward’s biopsychosocial (BPS) model of disability, 2016, Shakespeare et al

https://journals.sagepub.com/doi/full/10.1177/0261018316649120

 

I think I may've seen this before but it is worth re-reading.

It made me think a bit about what PACE tells us about CBT and GET.

The implication of the Mansell-Aylward BPS model, which may or may not be admitted to be the BPS model of the PACE authors but seems close enough, is that disability is perpetuated by attitude or lack of 'personal effort' as Lord Freud called it.

OK so the obvious way to deal with that is to tell people to buck their ideas up and change attitude, put in a bit more personal effort and go back to work. In other words get the message that they aren't really that sick and can get on with life.

But, it seems that Chalder and co will say, it is not so simple as that. The attitudes are locked deep in the psyche and need 'cognitive strategies' to be winkled out. And White and co will say that the attitude will not change unless gradually increasing exercise has been undertaken to overcome the symptoms of deconditioning that perpetuate the attitude.

So, assuming we ignore all the problems of expectation bias that actually explain all the results, does PACE show that 'cognitive strategies are necessary to unlock the hidden attitudes? And does PACE show that graded increase in exercise is needed to overcome the inhibitory symptoms.

It looks as if we have to consider two scenarios. One is that in PACE CBT and GET arms actually got the same thing, with physios using cognitive strategies and psychotherapists making sure there was a graded increase in exercise. In which case we cannot know whether or not either element was needed.

The other is what the PACE authors intended - that CBT and GET are different, one including expert cognitive strategies and the other expert exercise teaching. (Without this expertise presumably patients could get all the necessary information from a book.)

But in this scenario PACE seems to prove that cognitive strategies are not necessary, because GET is just as good. Moreover, skilled teaching from physios is not necessary because CBT is just as good. Neither is necessary in order to change attitudes (at least as reported by questionnaire) it seems. It is not really credible that one skill somehow does the job of the other. What seems much more plausible is that special skills are irrelevant to persuading people to change attitude.

 

I thought Kennedy's response to this was a bit unhelpful, and unlikely to encourage the authors to look into PACE/CFS issues: https://journals.sagepub.com/doi/10...cid=int.sj-related-articles.citing-articles.8

 

pdf of full paper
https://ueaeprints.uea.ac.uk/58235/1/1351_Shakespeare.pdf

was telling a young man I know with RA (who was quoting Nietzsche at me yesterday) about the bps model (or the version being used by DWP etc) ........he had never heard of it but has been on the receiving end of the consequences of its implemetation.

 

Moved post.

Quote from a poster on Facebook who linked the article below.
'If true and he doesn't turn round and do a Prof Garner on us, this is big news. I'll post more on the relevance of this later but Prof Mansel Aylward is one of the main promoter of the biopsychosocial model of illness. Key in playing down longterm illnesses like ME and discouraging doctors not to investigate the causes of back pain.''


bbc.com
Covid: 'This virus was completely underestimated'
One of Wales' most senior doctors - who nearly died with Covid-19 - says the UK was unpre

https://www.disabilitynewsservice.com/former-dwp-medical-boss-makes-wca-pledge-to-protesters/
S'ir Mansel said he sympathised with the protesters, and himself now found the BPS model “unsatisfactory” and believed it “no longer addresses the real needs of disabled people and the exclusion of disabled people from society”.

'He said the “social” element of the BPS model had been “neglected” and that he had a personal “distaste” for the medical model, which focuses on people’s impairments as the cause of their disability......'

This post has been copied and subsequent discussion moved to
Mansel Aylward on BPS, ME/CFS and Long Covid

 

The BBC article is from today and has some interesting quotes.

Whereas this

is from 2012.

 

Another "expert" who has got on in life by squashing helpless people. He helped mould the DWP into the threat to sick people that it is today and disseminated BPS thinking to politicians. Ideology over knowledge and compassion but now it has happened to him it is a different story. All the symptoms that were just us being needy and looking for the gains of the sick role are to be taken seriously because he has them.

 

Not sure why Aylward saying things like this would be seen as big news. Sounds entirely in-keeping.

His 2012 comments always just seemed like an evasive attempt to placate protesters.

 

Are we going to see all the BPSer's going down with Long Covid and then miraculousy recovering?

 

Sadly one thing these people have in common is an inability to learn from experience, even their own. And a clear pattern of projection, they all seem like heavy catastrophizers and clearly project their own inability to deal with illness onto others. Gerada is the same, these people would not be able to cope with ME or something that disabling.

I wonder how he would have enjoyed the experience of a GP telling him it's all normal because he's old and blah blah blah.

 

Statistically, about 90% would recover so yeah absolutely they would put it all to their mental fortitude and never look back at those who didn't have it in them.

Maybe higher, actually, since they are all financially comfortable with strong personal and professional support. They are in the lowest risk population, being able to rest as much as they need with no repercussions. Which, of course, they do without hesitation. The opposite of their own advice, probably because the "symptoms are real", unlike for us.

 

So would insisting on a level playing field be appropriate?

ETA - apparently not.