Holistic or harmful? Examining socio-structural factors in biopsychosocial model of chronic illness,‘MUS’& disability, 2022, Hunt

He partly answered this himself in that interview in on The Life Scientific (the one where he claimed that nobody liked people with ME/CFS):

A “stroke of luck” for SW. A hammer blow for people with ME/CFS.

Full transcript of interview: https://meassociation.org.uk/2017/0...life-scientific-bbc-radio-4-13-february-2017/

I can’t find the S4ME thread on the interview but I’m sure it was discussed.

Meanwhile, welcome to the forum @Josefina. I’ve not been able to contribute much for a while but great to have you here unmasked.

 

Basically: "here, wing it". It's absurd how casually it's admitted that psychiatry is a dumping ground for medicine, and yet everyone pretends otherwise. And of course this is because there is no accountability. If there were accountability this practice would end quickly. But making psychiatry accountable would end the dumping practice, which would reveal the massive negligence.

 

https://www.s4me.info/threads/who-is-simon-wessely.9364/#post-16841

 

I have been trying to read up on Hunt’s publications lately, and I must say that I’m a bit surprised by the reception of this paper.

My background is economics so some of the topics are familiar to me, and I admit that Hunt’s analyses mostly align with my own perceptions, but I have not been able to find any significant and detrimental flaws in the arguments or reasonings.

I understand that some of the comments are focused on the inaccessibility of the paper due to the language that’s used, and that is something I agree with. It’s an unfortunate consequence of the requirements of academia.

But I don’t agree that the paper can be easily dismissed by politicians, practitioners, and/or BPS supporters based on the descriptions of BPS or policies, because all of the descriptions are factually accurate. They deviate from «normal» descriptions of the same concepts because «normal» descriptions almost exclusively are framed in a positive way (e.g. what you see from spin doctors).

As an example of something I disagree with, is this excerpt regarding how the social might affect the bio:

I don’t think it’s necessary to invoke specific speculative and unproven concepts like allostatic load. It would have been sufficient to says that the original BPS model itself assumes that social aspects can influence biological aspects, and that it’s illogical to arbitrarily exclude that as a possibility for some social aspects while maintaining it for others (like how ME/CFS is supposed to be socially contagious). They can’t have their cake and eat it too.

But this disagreement on the examples being used doesn’t weaken the essence of the argument (the cake).

As an example of how I believe this paper gets it right, is the subsection on healthcare under the section on the implications for practice, policy and research:

Spoiler: Healthcare

Healthcare policies and provision should meet the needs of all chronically ill and disabled people, as opposed to privileging the most prevalent conditions, reflecting the needs of more socially advantaged patients, or reflecting the interests of power structures. In the field of long Covid, advocates are foregrounding patient narrative in pushing for multi-disciplinary services to accommodate multi-system conditions, thorough biomedical investigations, and patient involvement in research and clinical service commissioning (Alwan et al. Citation2020; Nurek et al. Citation2021). It is important that any strategies of inclusion for people with long Covid, likely facilitated by the prevalence of long Covid and relative social power of advocates, are extended to the wider disability and chronic illness community (see Hunt, Blease, and Geraghty Citation2022). Current healthcare resource allocation (allegedly needs-based) requires critical scrutiny: there is somewhat of an inverse or disproportionate care law as regards chronic illness provision within many health systems, including the UK NHS, whereby conditions with comparatively low quality of life, such as ME/CFS (Falk Hvidberg et al. Citation2015), receive amongst the lowest levels of biomedical research funding and appropriate healthcare (Radford and Chowdhury Citation2016). Systems such as the Quality and Outcomes framework (NHS Digital Citation2021), which may contribute to the neglect of certain chronically ill and disabled people (Hannon et al. Citation2012), require scrutiny in this regard.

Health interventions that are currently typically considered biopsychosocial and holistic should include recognition of socio-structural influences in chronic illness and disability (see Karadzhov Citation2021b). For example, psychoeducation, psychosocial health management and talking therapies should acknowledge socio-structural injustices, where appropriate ‘normalising’ (as opposed to pathologising) psychological distress as an understandable response (Johnstone and Boyle Citation2018). Such interventions should also assist chronically ill and disabled people in asserting their rights, in recognising and addressing internalised oppression and self-stigma, whilst encouraging positive identity-building through connections with empathetic others (Olkin Citation2017; Reeve Citation2002). Patient-centred care is of course crucial, though critically reflexive approaches might shed light onto why hitherto that has been so difficult to achieve. Finally, for people with primarily physical conditions (mind-body interface debates acknowledged), psycho-social-structural interventions should be considered a supportive adjunct to biomedical care, as opposed to a treatment. A bio-psycho-socio-structural approach to chronic illness and disability is thus consistent with bringing the body back into disability studies, whilst integrating disability studies’ focus on social oppression into the medical sociological (mainstream healthcare) conceptualisation of disability.