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

Discussion in 'Psychosomatic news - ME/CFS and Long Covid' started by Cheshire, Mar 21, 2019.

  1. wigglethemouse

    wigglethemouse Senior Member (Voting Rights)

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    954
    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
    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......
     
    Last edited: Mar 22, 2019
    MEMarge, Hutan, Snowdrop and 16 others like this.
  2. wigglethemouse

    wigglethemouse Senior Member (Voting Rights)

    Messages:
    954
    Okay, here is another one lumping Fibromyalgia and Chronic Fatigue as Malingerers
    Blimey that's only page 17. Nooooooooooooooooooooooooooo I can't go any further.............
     
    MEMarge, TiredSam, rvallee and 8 others like this.
  3. wigglethemouse

    wigglethemouse Senior Member (Voting Rights)

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    954
    Note sure what this one on P35 means.
     
    MEMarge, rvallee, JohnM and 2 others like this.
  4. wigglethemouse

    wigglethemouse Senior Member (Voting Rights)

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    954
    Shall I go on? All right I wonder what is next P158
    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"
     
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  5. wigglethemouse

    wigglethemouse Senior Member (Voting Rights)

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    954
    Where are my nausea meds :sick:. Page 295
     
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  6. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    Location:
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    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.
     
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  7. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    13,273
    Location:
    London, UK
    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.
     
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  8. Trish

    Trish Moderator Staff Member

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    51,871
    Location:
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    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.
     
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  9. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    Location:
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    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.
     
  10. chrisb

    chrisb Senior Member (Voting Rights)

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    4,602
    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.
     
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  11. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    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)
     
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  12. chrisb

    chrisb Senior Member (Voting Rights)

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

    Cheshire Moderator Staff Member

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    4,675
    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....
     
  14. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    13,273
    Location:
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    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.'
     
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  15. chrisb

    chrisb Senior Member (Voting Rights)

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

    Barry Senior Member (Voting Rights)

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    8,385
    Quite so. Misquoting to imply untruths would rightly undermine our credibility, so we have to not do it.
     
  17. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    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.
     
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  18. Barry

    Barry Senior Member (Voting Rights)

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    Sort of bipolar.
     
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  19. Barry

    Barry Senior Member (Voting Rights)

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    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 :p. 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 .
     
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  20. alex3619

    alex3619 Senior Member (Voting Rights)

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    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.
     
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