Fantastic how they go from Objective to Conclusions without all those annoying steps of Methods and Results. Sums up BPS perfectly.
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Long COVID – Can we deny a diagnosis without denying a person’s reality?, 2024, Little et al.
- Thread starter Yann04
- Start date
The Little et al paper is very shallow stuff. And does a lot of insinuating.
It means that there are two allowable findings.
1. The patient admits that their illness is psychosomatic, in which case they have a psychosomatic illness.
2. Or the patient denies that their illness is psychosomatic, in which case they have a psychosomatic illness, and some denial issues.
I find it frightening that someone willing to commit that kind of logic to paper, with that kind of certainty in the rightness of their opinions, would have been put in charge of an electroconvulsive therapy service.
About the Royal Free Hospital. While not precisely wrong - some patients were affected for up to a year, it slides over the fact that some patients also suffered lifelong effects. I wonder if that misleading use of words was an error or deliberate. And the use of 'Benign' in the name was only to indicate it didn't kill people; some people suffered greatly.
This is horrendous. The more you are convinced that your particular situation is not psychosomatic, the more likely you are to be psychosomatic? So, in my case, where I and my two children developed similar ME/CFS symptoms at the same time following infections, leaving me convinced that we were suffering from a physical health condition, we must all have undergone simultaneous delusions?
It means that there are two allowable findings.
1. The patient admits that their illness is psychosomatic, in which case they have a psychosomatic illness.
2. Or the patient denies that their illness is psychosomatic, in which case they have a psychosomatic illness, and some denial issues.
I find it frightening that someone willing to commit that kind of logic to paper, with that kind of certainty in the rightness of their opinions, would have been put in charge of an electroconvulsive therapy service.
Another "paper" by John Little
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On unearned privilege in clinical practice
Authors: John Little- Capital & Coast District Health Board
Objective: To explore what it might mean to be a white psychiatrist working in a white culture. Conclusions: Inequalities and power imbalances are maintained by person-blaming and the invisibility of structural inequality. Opportunities to recognise the effects of being privileged and working within a medical culture that compounds such inequality may be squandered without curiosity and action.
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"opportunities to recognise the effects of being privileged and working within a medical culture that compounds such inequality may be squandered without curiosity and action"
Well, yes. I wonder how that curiosity might be employed? Perhaps actually talking to people with the health condition you put down as hysteria, rather than dismissing their disagreement with your conclusion as yet more evidence of their minds not working properly?
Perhaps I will have to send him an email.
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On unearned privilege in clinical practice
- September 2020
- Australasian Psychiatry 29(1):1039856220956469
Authors: John Little- Capital & Coast District Health Board
Objective: To explore what it might mean to be a white psychiatrist working in a white culture. Conclusions: Inequalities and power imbalances are maintained by person-blaming and the invisibility of structural inequality. Opportunities to recognise the effects of being privileged and working within a medical culture that compounds such inequality may be squandered without curiosity and action.
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"opportunities to recognise the effects of being privileged and working within a medical culture that compounds such inequality may be squandered without curiosity and action"
Well, yes. I wonder how that curiosity might be employed? Perhaps actually talking to people with the health condition you put down as hysteria, rather than dismissing their disagreement with your conclusion as yet more evidence of their minds not working properly?
Perhaps I will have to send him an email.
hibiscuswahine
Senior Member (Voting Rights)
There are two journals put out by the RANZCP - this is the lesser one, does not require scientific research or clinical experience and is often used as a way to get published. It is a vehicle for members of the college to express opinions on all sorts of things that interest them (but also new initiatives they are trying in the mental health service (not ME or Long Covid just general psychiatry).
I am not sure what their roles are in the mental health service in Wellington. Although the article comes under Consultation Liaison Psychiatry but I don't know if they work there. I would be very disappointed if they do and hold these views.
I am not sure how other psychiatrists would be influenced by this paper. To me, it is farcical and outdated and also seems a bit sensationalist eg. by listing various "psychogenic" outbreaks. They elude to ME/CFS researchers only doing research because they know someone with ME/CFS. What's that got to do with anything? does that affect the validity of their research?
So much of this paper is cherry picking a few references from the psychosocial and psychosomatic schools of thought and lacks any rigour or scientific review of the literature.
They feel uneasy writing it....then why did you? I have been pondering this. It is like they are trying to say "hey everyone - why aren't you talking about what is so obvious to us". I am afraid this is not the first time doctors have written saying Long Covid (and ME/CFS and every other illness with multiple symptoms and unclear pathophysiology) is basically neurasthenia. So many articles have been written and discussed here when the illness was becoming more prevalent and reported on but these authors haven't spent much time looking at all the scientific research going on into Long Covid and ME/CFS. All this research seems pretty inconvenient to their view.
There appears to be a lot of discussion on freedom of speech in the latest Australasian Psychiatry (during my brief look at the most recent issues). They have another article in the most recent issue titled "Silent reflections remain unheard"
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There are actually too many concerning papers by John Little for me to copy across. I'd hate to be in that man's head. Or anywhere near him for that matter.
Here's a few:
On being paternalistic
Objective What does ‘being paternalistic’ mean? Conclusion Being paternalistic embodies a complex set of ideas that are currently viewed pejoratively, but which retain at its core, the goal of doing something good.
Clockwatching - Is that really hate?
To consider experiences of hate, which occur in clinical encounters. A review of the electronic and manual literatures. Hate has become diluted to a euphemism, the 'difficult patient'. Retaining use of the word hate avoids overlooking subtle cues in the unfolding relationship. © The Royal Australian and New Zealand College of Psychiatrists 2015.
Clinically, what ought we to believe?
Objective:: To question the status of the randomised controlled trial (RCT) in the hierarchy of evidence. Conclusions:: The RCT provides important and clinically relevant information, particularly in psychopharmacology. However, and as with other methodologies, RCTs too are flawed and automatic abdication to their conclusions, especially in complex social interventions, is unwise. A clinical example with conflicting and polarising views, each with their evidence base, is described alongside a suggested clinical strategy for resolving differences of opinion.
Coercive care and human rights; a complex juxtaposition – part 1
Objective: To explore the clinical implications associated with the United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD), and coercive practice. Conclusions: Both human rights and clinical perspectives are necessary in the management of the mentally ill.
Coercive care and human rights; a complex juxtaposition – part 2
Objective To examine capacity assessment, coercive care and principles by which a seemingly reasonable request for the discontinuation of treatment may be considered. Conclusions A clinical and socio-legal case may be made for ‘coercive care’.
It's not that I reject the need for people with mental illnesses to sometimes be compelled to do things they don't want to do.
It's the common thread that comes through these papers of 'It doesn't matter if the RCTs suggest otherwise, it doesn't matter if my actions might appear paternalistic, it doesn't matter if the patient doesn't want it. I can divine what is the right action and impose that on my patient.'*
*'but every now and then I feel uneasy about it, and then I write another paper for the Journal to bolster my confidence.'
Here's a few:
On being paternalistic
Objective What does ‘being paternalistic’ mean? Conclusion Being paternalistic embodies a complex set of ideas that are currently viewed pejoratively, but which retain at its core, the goal of doing something good.
Clockwatching - Is that really hate?
To consider experiences of hate, which occur in clinical encounters. A review of the electronic and manual literatures. Hate has become diluted to a euphemism, the 'difficult patient'. Retaining use of the word hate avoids overlooking subtle cues in the unfolding relationship. © The Royal Australian and New Zealand College of Psychiatrists 2015.
Clinically, what ought we to believe?
Objective:: To question the status of the randomised controlled trial (RCT) in the hierarchy of evidence. Conclusions:: The RCT provides important and clinically relevant information, particularly in psychopharmacology. However, and as with other methodologies, RCTs too are flawed and automatic abdication to their conclusions, especially in complex social interventions, is unwise. A clinical example with conflicting and polarising views, each with their evidence base, is described alongside a suggested clinical strategy for resolving differences of opinion.
Coercive care and human rights; a complex juxtaposition – part 1
Objective: To explore the clinical implications associated with the United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD), and coercive practice. Conclusions: Both human rights and clinical perspectives are necessary in the management of the mentally ill.
Coercive care and human rights; a complex juxtaposition – part 2
Objective To examine capacity assessment, coercive care and principles by which a seemingly reasonable request for the discontinuation of treatment may be considered. Conclusions A clinical and socio-legal case may be made for ‘coercive care’.
It's not that I reject the need for people with mental illnesses to sometimes be compelled to do things they don't want to do.
It's the common thread that comes through these papers of 'It doesn't matter if the RCTs suggest otherwise, it doesn't matter if my actions might appear paternalistic, it doesn't matter if the patient doesn't want it. I can divine what is the right action and impose that on my patient.'*
*'but every now and then I feel uneasy about it, and then I write another paper for the Journal to bolster my confidence.'
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Ravn
Senior Member (Voting Rights)
I wouldn't bother, it would just encourage the buggers. Next there'll be an article saying "felt an uneasiness in writing an article equating CFS/ME and Long Covid with neurasthenia and hysteria - and received hysterical emails from hysterical females, point proven". Or something in that vein. You can't reason with true believers
From what I hear not many in the profession take those incoherent ramblings seriously - I really hope my informant is correct on this - so a better strategy and use of energy would be to ignore this and instead try and encourage more sensible people to publish more sensible pieces (not that I know how to go about this, lacking the necessary personal contacts)
We do not know what causes ME, we do not have specific mechanisms. What we have is multiple triggers and lots of hypotheses.
We know what triggers LC for probably the majority of cases, though a small percentage might have had multiple potential triggers at the same time. We do not have specific causal mechanisms. We are testing hypotheses in current global research.
What these kinds of papers miss is that we have literally thousands of known biochemical and physiological abnormalities. We do not understand them, but they are measurable. At least one, or several if you prefer, relate to how people with ME or LC respond to exercise, and some of that is measurable on the repeat CPET.
We have objective physical evidence that something physical is wrong. There does not appear to be any concrete evidence of substantial cognitive causality. Its functional in the sense of biochemical and physiological abnormalities, not abnormalities of thoughts and behaviours, according to hard evidence. There are cognitive processing issues, but nothing to show they are cause and not consequence.
Its time psychiatry stopped accepting explanations that are grounded in 19th century scientific methods. Its absurd. Its time these people started reading the existing science.
We know what triggers LC for probably the majority of cases, though a small percentage might have had multiple potential triggers at the same time. We do not have specific causal mechanisms. We are testing hypotheses in current global research.
What these kinds of papers miss is that we have literally thousands of known biochemical and physiological abnormalities. We do not understand them, but they are measurable. At least one, or several if you prefer, relate to how people with ME or LC respond to exercise, and some of that is measurable on the repeat CPET.
We have objective physical evidence that something physical is wrong. There does not appear to be any concrete evidence of substantial cognitive causality. Its functional in the sense of biochemical and physiological abnormalities, not abnormalities of thoughts and behaviours, according to hard evidence. There are cognitive processing issues, but nothing to show they are cause and not consequence.
Its time psychiatry stopped accepting explanations that are grounded in 19th century scientific methods. Its absurd. Its time these people started reading the existing science.
So articles ‘discussing’ whether hate, human rights and coercive care for the disabled need to be ‘balanced with clinicians judgement’. And then an article suggesting a clinicians judgment should be able to be more independent of clinical trials?
Is this the same one whose main area is Electro convulsive therapy?
This seems like a list of red flags. I’m sure all those ‘normal’ patients who ‘have nothing to worry about’ would be queuing up to see this doctor if they ever got really ill once they’d read this list ?
yep there is a right to free speech. But there shouldn’t be a right in a profession to keep a job title and powers if you have red flags regarding whether you use misinformation to back up ideology you sell. You can’t have both. Otherwise it isn’t ‘speech’ it’s ideology you are implementing?
A random man can get a soap box and stand in a park saying this. Or someone can be a doctor eg with niche religious beliefs but still confirm to their medical oath and responsibilities in who they treat and how being based on science. But they don’t get to write the policies on who’s welcome and how other doctors should deal with groups they think are hysterics or don’t like?
you can’t start using a title which doesn’t confer expertise along with non facts to sell dislike of individuals and expect someone not to question whether that means you shouldn’t / can’t have responsibility that would assume you ‘don’t bring that discrimination to work’?
just like someone cracking xenophobic jokes would expect as a doctor to have their past outcomes analysed and maybe feedback sought from patients to check they can leave it at the door. At least surely? But at least they aren’t writing in journals to other medics inferring knowledge and suggesting different ways to treat them with at best cherry-picked non-scientific snippets to try and sell those statements
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You are probably right.
As I said though, Radhika Palepu looks to be a rising star, and she's signed up to this thinking too, presumably for the rest of her career, unless there is some research breakthrough. The three are clinicians, they will be causing harm to any Long Covid and ME/CFS patients they come across.
And the RANZCP would surely have a policy against publishing what it thought was 'incoherent ramblings' in its journal. So, presumably the journal's editors thought the article was fine. I hope there are psychiatrists who will write some responses rather than letting that misleading article go unchallenged.
Peter T
Senior Member (Voting Rights)
I am not totally convinced that these explanations are even ‘grounded in 19th century scientific methods’. My knowledge of Freud and psychoanalysis is limited but my understanding is that he abandoned contemporary neurology/neuropsychology because it felt too limiting and, though perhaps charactering his approach a little unfairly, he essentially replaced it with an intuitive sense of what felt right in the light of his clinical experience and his personal beliefs.
This is exactly what we are seeing with the BPS approach to evidenced based medicine, where they allow themselves major leeway to move away from the scientific method because to them the conclusions they want to confirm are self evident truths.
Yann04
Senior Member (Voting Rights)
Yeah honestly the best technique might just be to let this guy go on and “study” some other stuff without reminding him/making him think more about Long Covid/ME.
They hate and fear us because our mere existence exposes their ignorance and incompetence, their technical and ethical bankruptcy, and the consequences of that for patients.
Then we delusional peasant scum add insult to injury by proactively, and accurately, pointing all that out out to the world, and refusing to bow down to their idiotic pronouncements.
There is certainly some hostile defensiveness and hardcore delusion and deep denial going here alright. All they have to do to locate its source is look in a mirror.
Which is the one thing they will never do. They clearly cannot fathom that it might be their interpretation that is wrong.
The whole thing is basically them declaring that their profession could not possibly have been that wrong for so long. It must be everybody else. Especially patients.
Then we delusional peasant scum add insult to injury by proactively, and accurately, pointing all that out out to the world, and refusing to bow down to their idiotic pronouncements.
There is certainly some hostile defensiveness and hardcore delusion and deep denial going here alright. All they have to do to locate its source is look in a mirror.
Which is the one thing they will never do. They clearly cannot fathom that it might be their interpretation that is wrong.
The whole thing is basically them declaring that their profession could not possibly have been that wrong for so long. It must be everybody else. Especially patients.
At that time a lot of medicine, and softer science, was about showing they are right, and its up to others to show if they are wrong. It was about confirmation, not testing. This is pre-Popper and the notion of falsifiability, or even trying to break hypotheses. There is a specific name for this in the literature but I forget what it is. If I recall correctly Popper first called this non-science. Psychiatry is the branch of medicine that has mostly not grown out of this. Some biological psychiatry has moved beyond this, but that often has other biases if money is involved.
Peter T
Senior Member (Voting Rights)
True but also part of nineteenth century ‘science’ was natural history, detailed thorough observation. However the BPS advocates are not even doing good natural history, they observe only what they want to see and some even consciously exclude observations that don’t fit in with what they already believe.
rvallee
Senior Member (Voting Rights)
Most baffling thing in this op-ed, as is tradition, is the notion that this is all promising, full of potential and never-before-tried, but it's also solidly tested and so on. Same old nonsense about central sensitization and other crap. The same old script, always new and promising, but also effective based on years of clinical implementation. They talk about hope for long haulers, and it's literally the thing that's been tried from the start and millions have been subjected to. There is zero effort at making sense here.
Small lies are bad enough. Big lies, though, how do professionals not understand that big lies are never legitimate? That none of this can be real simply because of this? There is no such thing as lying to the truth, all it leads to is more lies, and here, being health care, massive needless suffering and death. What garbage.