Chapter in The American Psychiatric Association Publishing Textbook of Psychosomatic Medicine and Consultation-Liaison Psychiatry, Third Edition

I don't know any more about this - just copied from an incoming post:

Title: The American Psychiatric Association Publishing Textbook of Psychosomatic Medicine and Consultation-Liaison Psychiatry, Third Edition

Chapter: 25. Chronic Fatigue and Fibromyalgia Syndromes

Authors: Michael C. Sharpe & Patrick G. O'Malley

Pages 709-736

Editor: James L. Levenson, M.D.

Date: August 6, 2018 and 2019

Publisher: The American Psychiatric Association Publishing URL: http://books.google.com/books?id=-WZnDwAAQBAJ

Ref: http://www.appi.org

 

Ugh.

(I deleted my original stream of expletives.)

 

I couldn't access any text from the google books links above, but this worked: https://books.google.co.uk/books?id...8AKHWaNCTUQ6AEwAnoECAgQAQ#v=onepage&q&f=false

 

I can access some of the text of the book, but I can't read the MS and PGO'M chapter.

Sorry, but I found this whole post to be very confusing. For anyone else who is confused like I was...

The book is made up of 35 chapters with different authors or groups of authors. MS and PGO'M wrote chapter 25 which is NOT available to see in Preview. The entire book was edited by JLL. Of the chapters that are available in Preview several pages appear to be missing from each chapter.

Edit : Changing browser (from Firefox to Chrome) made this whole thread much more understandable for me.

 

edit: Full text is available here (@MeSci posted the link, put online by the person who first drew attention to the chapter): https://www.dropbox.com/s/54j6ya7u9...hael Sharpe & Patrick O'Malley (Aug 2018).pdf

I could see it all. I don't really have time to screen shot it all today, but here are a few excerpts:



From pages 720:



p722:


p726:



Their section on CBT and GET seemed pretty vague to me. The only citing of PACE I could see in the chapter was the mediation paper. They did cite GETSET.

 

How very odd! I'll try a different browser...

Edit : Yes, changing from Firefox to Chrome worked.

 

I don't know whether to swear or cry. Or pretend I haven't read this thread.

 

Perhaps one for Coyne ?

 

I'm not aware of evidence that CFS and FMS are perpetuated by psychological and behavioural factors. There are many researchers who have been trying to show this, but they don't have anything that's solid evidence. I would summarize their attempts as failure, not strong evidence.

 

I actually feel really good about this.

The recent years have been full of intellectual dishonesty from all the BPS proponents. I feel like this is one of the only times in recent memory where I have actually seen someone, in this case Sharpe, be brutally honest about the BPS view of ME/CFS. I commend him for this.

If all BPS proponents were this honest, I am sure their grip over ME/CFS in Europe would fade much faster. Instead we get something like the Danish 'Bodily Distress Syndrome' from Fink, which is just filled with lies, deceit and a faux biological approach that is much harder to fight in the court of public opinion.

 

Referring to the above, what is the likely effect of NOT telling a patient they have CFS or ME? It will mean that the patient goes backwards and forwards to the doctor hoping for help that will never be forthcoming. The patient won't know why they are being dismissed and treated so badly. The patient will get more and more distraught and depressed. Fobbing patients off may be easy for doctors to do, but if a patient has been fobbed off for some reason unknown to them for many years then it destroys their confidence and is likely to make them feel defeated, dismissed, distressed, and possibly even suicidal on top of all their other woes. It also, essentially, means that a patient has been tried, found guilty, and sentenced without ever being told that they won't be treated any more, and without the patient knowing why. And also means that they end up fighting phantoms trying to find out why they won't be treated because doctors won't tell them. It also means that the patient has no appeal against whatever has been said about them in their medical records - because how can someone appeal against a verdict they don't know about?

If someone has been tried and found guilty of some particular medical problem the doctors don't want to treat but they aren't told, the whole situation becomes Kafkaesque!

How do I know how this feels? Because it happened to me in the 70s. I don't know what doctors found me guilty of but I'm still feeling the effects of that trial I wasn't present at, 45 years later.

 

I can see what you mean, @Rick Sanchez. Just reading the first of the three pages listed shows what an unscientific idiot he is. And how prejudiced in his views.

He cites a whole lot of associations between things to do with patient beliefs and actions, and severity of illness. In every case he chooses to interpret the belief and/or action as causing the severity of illness. Not once does he even suggest that it could be the other way around - the severity of illness that is forcing the patient into rational beliefs and behaviours. School level lesson on correlation - correlation does not imply causation.

He then compounds the idiocy by making the completely unfounded deduction from his supposed causative factors to them being a suitable target for treatment - change the belief or the action, and the severity will reduce. Wrong again. No evidence. Pure speculation.

 

Some of data on CBT/GET show a change in beliefs (if we trust the instruments) but no improvement on cardiopulmonary exercise testing, employment, steps per day, or clinically meaningful improvement on walking distance.

 

Even by Sharpe's standards this is weak. It could mostly have been written verbatim 150 years ago, mentions of the immune and endocrine system aside, so about a single sentence in the whole. Science shouldn't be argued on the basis of "may bes" and "could bes" alone, this is ridiculous and beyond amateur.

What's concerning isn't so much that these arguments are being made, there will always be bad science at the fringes of any specialty. The issue is that these ideas are promoted by serious institutions, ideas that would fit as is in Victorian-era medicine.

One thing I can say for certain: they are supremely confident in their assumptions that the pathophysiology will never be discovered, because once it is, having published this drivel will be a major source of serious embarrassment and calls for reform. It has absolutely no grounds to stand on and yet is elevated as indisputable fact with clinical validity. It's as if not a single lesson from the history of medicine was learned.

 

If I had fewer morals and weaker ethics, I'd get into the psychosomatic industry.

There is much money to be made, reputations to be built, and careers to be advanced, by pushing forth a psychosomatic view of what ails you, especially for ME, as the great success of Sharpe attests.

It must be very hard for those of weak character and / or strong sociopathic tendencies to resist that road to riches.

Having said that, you have to strike while the irons hot, and the 'ME is psycho' narrative is about to implode. But they already have their fat bank accounts to retire on, so no skin off their backs.

 

It was this that first struck me. Perhaps it's my prior knowledge, but it leaps out of the page that he's mixed up correlation and causation. I'm not sure how it would be possible to miss, with a critical mind.

 

This books says that Sharpe stated he had "no competing interests during the year preceding manuscript submission". Does that mean he has stopped his insurance work? Or he just does not see it as a potential COI?

 

I thought I would try and go back to the beginning on the fear and uncertainty of illness model as a factor in ME. In:

Cognitive behavioural management of PVFS. Wessely, Butler, Chalder, David in Post-viral fatigue syndrome eds Jenkins/Mowbray 1991

they wrote "Fear plays an important part in PVFS. First we, and others, have found that clinical anxiety and phobias are common among patients. Second, fear of illness is an important part of PVFS, although this is not the exaggerated fear of illness found in hypochondriasis. This has been confirmed by Robbins et al(1990), who compared fibromyalgia patients with rheumatoid arthritis controls. They found no differences in fear of illness and illness worry between the two groups, the opposite of what would be predicted in hypochondriasis. Nevertheless, worry about illness did play a role in the fibromyalgia patients, and correlated highly with overall functional ability. The authors suggest that "feelings of vulnerability and apprehension about having an illness of unknown origin may contribute to sufferers' activity limitations, inability to sustain a work effort and varied somatic distress". This is in accordance with our own observations, that it is the lack of both guidance about, and information on, the nature of PVFS, and of the origins of symptoms repeatedly experienced that contribute to fear and hence disability.

It goes on in similar vein. The main drawback is the lack of evidence. Studies quoted relate to fibromyalgia or chronic pain. I may be a pernickety old bore but I do like to see the evidence. Everywhere you look the theories are built on sand.

 

If you suffer from a poorly understood condition lacking effective treatments then it doesn't seem surprising that more disability will be highly correlated with more worry about illness.