Energy Conservation Management for People With Multiple Sclerosis–Related Fatigue: Who Benefits? (Blikman et al, 2019)

[Sean]

Whatever the flaws in the Australian 2003 Clinical Guidelines, and they sure have them, they did end with this emphatic statement on the whole notion of 'secondary gain':

In the absence of evidence of malingering, speculative judgements about unconscious motivation should be avoided. The psychoanalytic concept of “secondary gain” has been misused in medicolegal settings and does not rest on a solid empirical base. In evaluating patients with CFS, hypothesised secondary gains should be weighed against manifest secondary losses. The notion of “abnormal illness behaviour” is contentious, and the term should not be used as a diagnostic label.

https://www.mja.com.au/system/files/issues/cfs2_2.pdf

 

[Snow Leopard]

Basically questionnaire answers were correlated with questionnaire answers. The mistake the researchers are making is assuming these questionnaire answers are not biased.

 

[Mithriel]

The narratives of BPS are easily understood and use a sort of shorthand by feeding into prejudices. That is why they are so easily accepted. Too lazy to work yet wanting handouts by trying to make out that their fatigue is an illness yet I am expected to give them some of the money I earned by forcing myself out of bed.

The researchers offer papers laden with initials and complex biology which makes your eyes cross. We don't stand a chance.

Demanding they make what they are saying explicit would show up these prejudices.

 

[rvallee]

Basically questionnaire answers were correlated with questionnaire answers. The mistake the researchers are making is assuming these questionnaire answers are not biased.

But the questionnaires tell them what they want to hear so of course they're not biased.

smirks in Dunning-Kruger

 

[rvallee]

The narratives of BPS are easily understood and use a sort of shorthand by feeding into prejudices. That is why they are so easily accepted. Too lazy to work yet wanting handouts by trying to make out that their fatigue is an illness yet I am expected to give them some of the money I earned by forcing myself out of bed.

The researchers offer papers laden with initials and complex biology which makes your eyes cross. We don't stand a chance.

Demanding they make what they are saying explicit would show up these prejudices.

And they so fearful of saying their true intent that they don't mind pretending to be stupid, knowing people in the know hear the dog whistle.

 

[DokaGirl]

@Sean, I think the Australian guidelines are right on with the illness gains bit.

Not to criticize you, not at all, but where the guidelines say: " In the absence of evidence of malingering" - how does one prove malingering?

One way would be by hiring a PI to sneak around and film people. And another, query the neighbours.

And ask for objective evidence of physiological abnormalities.

Or, maybe throw a wheelchair bound pwME in the deep end of a pool.

That might show whether they're malingering or not.


Excellent quote though from the Australian guidelines.

I would imagine there is some medical training about how to ascertain malingering.

It doesn't include throwing people into a pool or whatever.

ETA: changed last sentence.