Brian Hughes - If you spend 20 years gaslighting your patients, perhaps you should think twice before accusing *them* of trolling *you*

[wigglethemouse]

http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.729.2487&rep=rep1&type=pdf

Do a search for "CFS" in the above link, which appears to be a PDF of a book published in 2003. Wessely is mentioned in the list of contributors (pages 11 - 12), and so is Sharpe. So is Mansel Aylward. I'm sure there must be other (in)famous names that I'm not familiar with.

Folks please READ the above post. Please don't follow the link unless you want punishment. If you do you will see the book of the conference titled "Malingering and illness deception" (this is where Malingering comes from) which contains things like this

The meeting which formed the basis for this book would not have been possible had it not been for the enthu-siastic support of Professor Mansel Aylward and funding from the Department for Work and Pensions.

There is a need for a paradigm shift away from the implicit determinism of the biomedical model and a move towards the proposition that human beings, in most everyday situations (including many aspects of their illness) possess a sense of control and influence over their actions (as opposed to behaviour); that is, they can choose between different courses of action.

Lacking evidence of objective disease, it is perhaps surprising how over the past two decades there has been a growing acceptance of ‘medically unexplained symptoms’ (an explanatory ref-erence used mainly in psychiatry for symptoms that currently cannot be explained by disease or psychiatric disorder) and ‘subjective health complaints’ (a term used mainly within medical psychology and disability medicine—see Ursin 1997; Eriksen and Ihlebaek 2002) both of which ultimately depend on the patient’s reports and the growing belief that relevant psychosocial factors play a contributing role in their presentation

Without evidence of a definitive neurobiological or physiological malfunction, calling a set of behaviours and symptoms a syndrome and treating it as such ultimately depends on the underlying beliefs of the patient, doctor, and society at large. In many cases however, ‘diagnosis’ operates along pragmatic rather than strictly definitional lines—some doctors believe they can recognize disease even if they cannot observe or explain the pathology. For example, none of the functional somatic syndromes are independently verifiable beyond what the patient says and how he or she behaves. Clinicians use the same features which define a disease to justify its status as a disease.

Apart from the first quote the others are picked at random from the only one page I went to in the book (I wasn't brave enough to actually read or search). Makes me Sick Sick Sick. I daren't see what SW and MS wrote. It's all a load of tosh written for the benefit of DWP, paid for by the DWP, to set future policy......

 

[wigglethemouse]

Okay, here is another one lumping Fibromyalgia and Chronic Fatigue as Malingerers

A recent study of 131 practising members of the American Boardof Clinical Neuropsychology provided estimates of the prevalence of malingering and symptom exaggeration for a variety of different clinical conditions (Mittenberget al. 2002). In this study, estimates of the base rate of malingering/symptom exaggeration were calculated using over 33 000 annual cases seen by a group of clinical neuropsychologists. The reported base rates (when statistically adjusted to remove for the influence of referral source) were 29 per centfor personal injury, 30 per cent in the case of disability or workers’ compensation, 19 per cent in criminal cases, and 8 per cent in medical or psychiatric cases. The same rates broken down by diagnosis revealed 39 per cent in the case of mild head injury, 35 per cent in fibromyalgia and chronic fatigue, 31 per cent chronic pain, 15 per cent for depressive disorders, and 11 per centin the case of dissociative disorders.

Blimey that's only page 17. Nooooooooooooooooooooooooooo I can't go any further.............

 

[wigglethemouse]

Note sure what this one on P35 means.

In the unequal struggle between patient and doctor, the only weapon left for the patient was dislike and contempt, a legacy which certainly continues to the present. One might say that every psychiatrist or physician who has been insulted or harried by patients with symptoms or syndromes such as chronic back pain or chronic fatigue is reaping the legacy of the insurance doctors.

 

[wigglethemouse]

Shall I go on? All right I wonder what is next P158

It is also worth noting that the problems posed by subjectively defined illness are not limited to psychiatry. The so-called medical ‘functional somatic syndromes’, which make up a large part of medical practice, and include conditions such as chronic fatigue syndrome, irritable bowel syndrome, migraine headache, and various pain complaints (Wesselyet al.1999) are also definedonly in terms of symptoms. Indeed such patients are also likely to meet criteria for the psychiatric diagnosis of somatoform disorder (American Psychiatric Association 1994).

I had to look it up - from web MD
"Somatic symptom disorder (SSD formerly known as "somatization disorder" or "somatoform disorder") is a form of mental illness that causes one or more bodily symptoms, including pain. The symptoms may or may not be traceable to a physical cause"

 

[wigglethemouse]

Where are my nausea meds . Page 295

Thus, the development and maintenance of chronic pain and fatigue, chronic disability and, indeed, long term incapacity for work, particularly in the context of low back pain and chronic fatigue states, rests more on psychological and psychosocial influences than on the original benign and mild forms of physicalor mental impairments.

 

[Jonathan Edwards]

Has psychiatry as a field outlived it’s usefulness? Has it done more overall harm than good?

No and no. I think people forget just how much essential work is done by psychiatrists day in day out for people with terrible long term illnesses that are completely hidden from society. Some of the treatments work very well, if maybe not as well as cancer treatments.

The problem is 'liaison psychiatry' which tries to insert itself where it does not belong.

 

[Jonathan Edwards]

They've just changed the words they use because it's no longer acceptable to state publicly that we are malingering.

I think this is probably not quite right. As I said before, malingering means deliberately pretending to be ill when you do not believe you are ill. So it is completely distinct from the BPS idea of believing you are ill.

But considering the historical context it looks very much as if the BPS crew were disingenuous enough to deliberately confuse the two in the political arena. The impression is that the BPS people were wanting to build an empire out of psychotherapy. They discovered that around 2000 the Blair government (maybe Milburn) were keen tocsin up the benefits scroungers and Waddell and Aylward were getting major interest from DWP on a malingering ticket. So the BPS guys went along to the malingering conference to be buddies with that crowd, being careful not to mention that they weren't actually dealing with malingering.

 

[Trish]

The problem is 'liaison psychiatry' which tries to insert itself where it does not belong.

Also called psychosomatic medicine, I think - they have their own conferences and journals.

And for psychologists (who are not doctors) I've only recently gathered there's a whole branch with its own training courses called 'health psychology' which, as I understand it, is specifically about the psychological treatment of people with physical symptoms.

And then there's 'therapy', where you don't seem to need any medical training or even a psychology degree, and there are all sorts of varieties of therapy each with their own training and organisations.

 

[Jonathan Edwards]

And then there's 'therapy', where you don't seem to need any medical training or even a psychology degree, and there are all sorts of varieties of therapy each with their own training and organisations.

Indeed. Much of this is about an already existing deep divide within psychiatry between the Feudian psychotherapy tradition and the biomedical psychiatry tradition. Psychiatry is in a sense two completely incompatible groups of people under one roof.

 

[chrisb]

the MUS chap at Sheffield (Burton?) on the NICE group seems to believe that ME does not exist but is subsumed in a larger group of psychosomatic or somatising conditions and peoples mistaken belief they have a physical illness is made worse by doctors giving medical assessments;

That description seems to broadly fit the concept of Abnormal Illness Behaviour as described by Pilowsky in 1969 and which David, Wessely and Pelosi thought, in 1988, lay at the root of the condition.

 

[Dx Revision Watch]

From the forthcoming ICD-11:


https://icd.who.int/dev11/l-m/en#http://id.who.int/icd/entity/443670483

Parent: MB23 Symptoms or signs involving appearance or behaviour

MB23.B Feigning of symptoms

Description
Intentionally simulating, faking, or grossly exaggerating a physical or mental symptom.

Exclusions
Malingering (QC30)

-------------------------------------------------------------------

https://icd.who.int/dev11/l-m/en#http://id.who.int/icd/entity/1136473465

Parent: Reasons for contact with the health services

QC30 Malingering:

Description
Malingering is the feigning, intentional production or significant exaggeration of physical or psychological symptoms, or intentional misattribution of genuine symptoms to an unrelated event or series of events when this is specifically motivated by external incentives or rewards such as escaping duty or work; mitigating punishment; obtaining medications or drugs; or receiving unmerited recompense such as disability compensation or personal injury damages award

Exclusions (amongst others)
Bodily distress disorder (6C20)

--------------------------------------------------------------

Under Bodily distress disorder (6C20) there is a Exclusion for

Feigning of symptoms (MB23.B)

 

[chrisb]

Remember all the talk about "secondary gain". This is what they meant.

 

[Cheshire]

Remember all the talk about "secondary gain". This is what they meant.

I think many would happily use a kind of oxymoron like "uncounscious malingering". And indeed the reference to secondary gains is symptomatic of it. It's not malingering, but the patient is finding advantages in being sick, but it's not really conscious, but maybe a bit....

 

[Jonathan Edwards]

Remember all the talk about "secondary gain". This is what they meant.

I think not. Secondary gain is a term of art relating to 'subconscious motivation' in hysteria. It is specifically not malingering. As the psychotherapists' saying might go 'Men malinger but women just have secondary gain.'

 

[chrisb]

I think that may be taking us into water too deep for me to enter. I can see how that might play out.

 

[Barry]

And not that I have any interest in defending MS, in the context of the specific quote he appeared to be disagreeing with the perspective that patients should be viewed that way. he seemed to be being sympathetic to the plight of patients being viewed that way. I don't like it when people cite that quote as an example of what Michael Sharpe thinks. whatever he does think, that's not how the quote presents it.

Quite so. Misquoting to imply untruths would rightly undermine our credibility, so we have to not do it.

 

[Dx Revision Watch]

Remember all the talk about "secondary gain". This is what they meant.

DSM-5 (May 2013)

Malingering was excluded from the index in DSM-5 but remains under "Other Conditions That May Be a Focus of Clinical Attention" (the DSM-5 equivalent of the DSM-IV "V" Codes).

External (secondary) gain is necessary for differentiating malingering from factitious disorder ("a disorder in which the patient consciously creates physical or psychological symptoms to assume the sick role, the primary gain").

For DSM-5, Factitious disorder is included under the category block:

"Somatic Symptom and Related Disorders"

under which Somatic symptom disorder is located

Factitious disorder is a Differential diagnosis to Somatic symptom disorder.

 

[Barry]

Psychiatry is in a sense two completely incompatible groups of people under one roof.

Sort of bipolar.

 

[Barry]

Malingering occurs, but it is pretty rare in hospital clinics because it requires either very good acting or collusion on the part of the doctor. It was probably common in the army.

When I was a young apprentice in the RAF, and we had an outbreak of a highly infectious chest infection, loads of people were reporting to sick bay, me included. Most were genuinely feeling pretty dreadful, but not all. How did I know? Because they couldn't help bragging about it after.

It was actually when I had glandular fever coming on, but the symptoms were superficially similar. I'd been sitting down in the waiting room and I suddenly felt fine, and thought they would not believe me. But the last few minutes had to stand in the queue and felt terrible. When it was my turn the medical orderly was a total bully, and was hollering at me for pretending I was ill, but I got my own back and proved my case at the same time ... threw up all over him . Tried to stop it with my hand, and then realised (as did he) how powerful the vomiting reflex is. He was then even more put out, and shouting at me to clear it up, at which point a doctor then intervened and sorted him out. Never felt bad about doing that to him .

 

[alex3619]

Indeed. Much of this is about an already existing deep divide within psychiatry between the Feudian psychotherapy tradition and the biomedical psychiatry tradition. Psychiatry is in a sense two completely incompatible groups of people under one roof.

More than two. Psychopsychiatry is deeply fractured. However Freudian thinking was being put to rest and had to be reinvented. This reinvention continues today with things like functional syndromes and unexplained symptoms, though the labels vary.

Many non-biopsych psychiatrists do not like BPS either.