GAS (Goal Attainment Scaling in Rehabilitation), GAS-light, and gaslighting.

[chrisb]

Yes. Sorry. I meant more her expression when she mentions it. Is there a "knowing" tone, a faux-naif manner.

 

[Snow Leopard]

Think you may be misunderstanding what is being done here @chrisb.

This is a perfectly legitimate and very intelligent approach to genuinely complicated and heterogeneous clinical problems. I published a trial of steroid infusion in lupus using this approach in the 1980s.

Don't see any risk of problems? The outcomes aren't what the patient chooses, they are negotiated with the "multidisciplinary team" (see Turner-Stokes' guide), which leaves in a strong risk of the choice of outcomes being coerced by the specialist. "Yes doctor/specialist, you know best"...
Patient choices are overruled if they are deemed "unrealistic". But what if a patient says, I my goal is to back to work full time and have a full social life without symptoms and the rehabilitation specialist says that is "unrealistic"?

Since the rating is usually verbal, it can be influenced by the opinions of the person doing the assessment (social desirability bias etc).

Similarly, the weighing of the results is also dependent on "the opinion of the therapist or team on the difficulty of achieving the goal".

If your response is along the lines of: okay, I would do it a bit different, describe specifically how you would do it differently.

 

[MSEsperanza]

Maybe a particular problem arises when neither impairments are assessed properly nor the estimation of possible improvements are based on any good evidence but only on non-evidenced assumptions on the nature of the impairments?

So on what scales would you base a rehabilitation goal for a pwME if there doesn't exist any realistic estimation for relevant improvements from any intervention?

And what will the multidisciplinary team decide if the patient's goal is to find out what they can realistically do without payback but the health care practitioners' team thinks that the patients' thinking about getting paybacks has to be altered instead?

(Apologies if this point was made already by others -- didn't read through the thread.)

 

[Sean]

The outcomes aren't what the patient chooses,

Nor has much choice about, due to the demands of the disease.

This whole 'negotiated agreed plan and goals' stuff is just a dangerous dishonest farce, with any failure to stick to the plan and meet those goals being blamed on patients not trying hard enough when it inevitably fails due to being unrealistic in the first place.

This is what has been happening all along, and will go on happening if allowed.

 

[Barry]

I would estimate it's been perhaps four to five years since this term exploded into popular use; I certainly don't recall it being used as early as 2006-2010.

It was in common use within forums for victims of such predatory behaviour 20+ years ago, and may well be where it emerged from into more popular usage later.

 

[Joan Crawford]

Flora had the below correspondence with Lynne. She's happy for me to share.


Lynne Turner-Stokes,
Any chance you would spare a thought for all the gaslighted people in the world before you prepare your teaching slides? That would be too much to expect wouldn't it? In case you aren't aware, many women wait several years for a diagnosis of Endometriosis and it's comorbid conditions which affords misogynistic Drs ample opportunity to gaslight them without you or your BPS colleagues in KCL intervention. I'm including some links for your perusal in the event that you have an ounce of empathy or integrity left.
Flora Christian
https://www.endofound.org/endometriosis-ancient-disease...
https://www.webmd.com/.../endometriosis-linked-to-other...
https://www.nichd.nih.gov/newsroom/releases/endometriosis
https://www.womenshealth.gov/a-z-topics/endometriosis
https://www.rheumatologyadvisor.com/.../significant.../
https://blog.possover.com/.../endometriosis-the-praying...
https://www.frontiersin.org/.../10.3389/fped.2019.00195/full
Lynne Turner-Stokes lynne.turner-stokes@dial.pipex.com
11:59 AM (2 hours ago)
to me

Dear Flora
Thank you for sending these links which I read with interest.
I must confess that I feel deeply hurt by the misrepresentation in the twitter feed that I think triggered your communication.
I have spent my career promoting holistic person-centred approaches to both clinical care and research. The twitter feed took the slides from a talk that I gave back in 2002 - nearly 20 years ago - at an RCP conference associated with the publication of the RCP report on Psychological Care of Medical Patients (2003).
Back in the 1990s, many doctors dismissed medically unexplained symptoms as either ‘hysteria’ or ‘malingering’ (as one of your links notes), and consequently many patients were very badly managed. The report and the talk sought to the dispel some of the misperceptions and misuse of language that were then commonly applied in this area, and instead offered a framework to help clinicians to explore these aspects in a more sympathetic manner, placing emphasis on a personalised approach to rehabilitation, care and support that promoted patient choice and autonomy. It is a sign of the success of the report that language has moved on in the two decades since it was published, and we would use very different language now, but the originator of the twitter feed has implied this was a talk about ME/CFS and given recently - neither of which is correct. It was a stage in the development of our understanding of complex long term conditions that doctors encounter on a daily basis.
Of particular concern was that some selected slides were taken out of context, suggesting that the talk promoted some of the very language that we were trying to dispel even at that time. I am concerned that this misinformation has caused distress to a lot of people.
So I am sorry if this was also the case with you, but I am extremely grateful to you for taking time to send me the links. Endometriosis is not an area that I come across a lot (as I work mainly with patients with severe brain injury), but I know that it is a very distressing condition that is poorly understood by doctors in general, so I am grateful to you for enhancing my understanding of it, even in this small way.
With best wishes and many thanks
Lynne
Professor Lynne Turner-Stokes DM FRCP MBE
Northwick Park Professor of Rehabilitation Medicine, King’s College London
Director, Regional Hyper-acute Rehabilitation Unit,
Northwick Park Hospital
Watford Road
Harrow
Middlesex
HA1 3UJ
Mobile: 07889-046699
Tel:
NHS sec: +44(0)-208-869-2800
Academic sec / PA: +44(0)-869-5161

 

[rvallee]

So she has no idea what she's doing and is completely oblivious to what she leaves behind. The simple truth is that on this front, things are worse than ever, certainly worse than they were 20 years ago, in large part thanks to the systemic usage of deceitful language that makes the excessive cruelty of systemic gaslighting sound benign, which only serves to encourage the worst behavior.

Basically: we stopped explicitly using ethnic slurs, therefore you can't call us racists, when what they are doing is making systemic racism far more insidious and impactful. But, hey, no explicit slurs, or usually anyway. Don't look, though, certainly not in forums where physicians think only other physicians are present, where they make it clear that only the packaging has changed slightly but the substance is actually more problematic than ever, after having been allowed to operate unchecked for decades.

They just have this romanticized version of what they are doing in their minds and never let reality pierce the delusional bubble. This is what happens when the stakes are completely unbalanced, where for millions of us it's our entire lives, to them it's literally nothing, they never even have to face the consequences of their failures. They don't think about what happens to us anymore than medieval aristocrats thought of the rabble, it just has no impact on their lives, they are completely detached from reality.

Notice that they never ever admit having done anything wrong? It's always other people misinterpreting them. Somehow, it's always people misinterpreting what they are doing, never what they are actually doing.

 

[Caroline Struthers]

Don't look, though, certainly not in forums where physicians think only other physicians are present, where they make it clear that only the packaging has changed slightly but the substance is actually more problematic than ever, after having been allowed to operate unchecked for decades.

I have been on such a physician dominated forum recently, and this was exactly my impression

 

[rvallee]

I have been on such a physician dominated forum recently, and this was exactly my impression

I've also observed lately just how common those beliefs are in the general population, likely a major factor. I think it plays into the revulsion humans have for cheaters, well, certain cheaters anyway. People want to believe that those kind of scams aren't just a thing, they're very common.

There was an article, I think yesterday, about another "mass hysteria" thing, something about people doing tik-toks who may or may not have Tourette's, using the usual very bad self-serving arguments that Wessely uses. It was posted on Reddit and about 90-95% of comments were basically fully receptive that this is not only a thing but a very common one, absolutely zero skepticism applied, anything derived from those beliefs is immediately believed without evidence, complete with tropes about the "sick role" and everything.

I'm pretty sure those are related, that most people are willing to accept those caricatures and the environment of medical training only cements those beliefs into a formal paradigm, but essentially already present in full.

Which is ironic because one major aspect of this belief system is how people reject this idea, are gung-ho firm believers who simply reject any notion of anything psychological, when in fact you can easily find that 90%+ not only accept it but will demand anyone to prove otherwise. I guess the argument would be that we are the exception, but the idea is that it's the rule, but it's not as if there is any substance to the claims.

One thing for sure that can be said about the crisis of validity in psychological research is that it has had exactly zero impact on people's willingness to accept every new bad claim built from the same spurious process. Absolutely none. Not within psychology, not within the general population. Hell, even Stockholm Syndrome is still repeated as a valid trope, which is incredibly absurd. It just feeds into the need for easy magical solutions to complex problems, it's basically a new religion of some kind.