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Making and managing medical anomalies: Exploring the classification of ‘medically unexplained symptoms’, 2020, Rasmussen

Discussion in 'PsychoSocial ME/CFS Research' started by Andy, Jul 16, 2020.

  1. Andy

    Andy Committee Member & Outreach

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    Yeah, I'm not going to worry about the profession getting justice..
    Paywall, https://journals.sagepub.com/doi/10.1177/0306312720940405
    Sci hub, https://sci-hub.tw/10.1177/0306312720940405
     
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  2. Trish

    Trish Moderator Staff Member

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  3. Trish

    Trish Moderator Staff Member

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    I've drifted at high speed through this rather dense article that seems to use a lot of words to say that MUS is a problem, that it's an anomaly in biomedicine because it's symptoms without signs, that this is solved by passing it over to psychiatry who can't explain it either, but that's OK so long as they can help the patients.

    Is this another version of the Sharpe/Grecko 'illness without disease' paper? I'm confused. Here's my attempt at picking out some relevant bits. I might have completely missed the point.

    Here's my version with some quotes.

    Start by assuming MUS is a real category worth researching and claim there's lots of research happening:
    Then waffle a lot about classification and anomalies to confuse your reader and sound erudite, then do a limited literature search and discover most of is it in psychosomatic journals:
    Draw some conclusions from the research you've sampled:
    Various definitions of MUS listed, all summed up as
    Waffle some more about categories and paradigms:
    And conclude that MUS is only anomalous if we try to explain it with biomedicine.

    The implication being that biomedicine may be the wrong model, so bring in psychiatry instead and talk about the problem that patients don't like this?
    And trick patients into accepting psych treatment in order to show them it works?
    And if that doesn't work, keep experimenting?
    And perhaps try harder to refine the definition of MUS to make a more homogeneous research cohort?
    But what if you disagree about what is explained and what is unexplained?
    So maybe this whole field is a mess and you need to throw out all that psychosomatic stuff and think again?
     
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  4. rvallee

    rvallee Senior Member (Voting Rights)

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    I am not even shocked anymore but still, the reality of this is so grotesque as to be unbelievable. Because this is exactly the reason why no progress can be made on those issues. It's a circular problem, where the problem cannot be solved because it fixes itself into the same position and refuses to budge, like two interlocked gears.

    The only professional comparison that can be made is the similarly grotesque display of police violence on US streets, where police beat up and murder innocent people in cold blood with no accountability, even when it's captured on camera. There is no other comparable display of base unprofessionalism in any other profession, especially one leading to mass suffering and death.

    But I think a prison camp would be a more apt metaphor. The diagnoses may be junked in a drawer but behind those diagnoses are tens of millions real people whose lives are effectively bound, tortured and killed. Legally. By medical professionals. This can't happen without full dehumanization, which is incompatible with the practice of medicine, or just basic morality.

    Because worse of all is the rejection of consent, the trampling over not only informed consent but actual firm and rational dissent. Any government behaving this way would be labeled as ruthless and tyrannical, probably on the receiving end of massive international sanctions. But complaining only brings more binding and more torture and more death. The beatings will continue until morale is shown to have statistically improved on an arbitrary questionnaire.
     
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  5. strategist

    strategist Senior Member (Voting Rights)

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    "MUS is only anomalous if we try to explain it with biomedicine."

    If you asked a homeopath, naturopath, traditional chinese medicine practitioner, faith healer, and similar alternative medicine practitioners to explain why a patient has MUS, I'm sure they would often be able to come up with an explanation that makes perfect sense in the theoretical framework of their discipline.

    Coming up with some sort of theoretical explanation is easy and people do it all the time. Finding the correct explanation is hard.

    PS: like that psychoanalyst who explained CFS in a psychoanalystical framework as one's sexual energy not being expressed or something to that extent, I don't recall the exact details.
     
    Last edited: Jul 17, 2020
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  6. Trish

    Trish Moderator Staff Member

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    I have just been thinking a bit more about this bit:
    This method of categorisation seems to me at about the same scientific level as this:
    [​IMG]

    Edit: Crossposted with Strategist. Looks like we agree.
     
  7. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    It seems that Erik Rasmussen is a young social worker with a pony tail and shaggy beard who has perhaps realised that he has wandered into the doo-doo of liaison psychiatry and pass-the-buckology.

    Maybe this is his attempt at saying as politely as he can, i.e. not to get himself sacked next week, that MUS is drivel.
    Maybe not.
     
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  8. Invisible Woman

    Invisible Woman Senior Member (Voting Rights)

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    Take your metaphor out of your junk drawer, shove it into the waste basket & put it out where it belongs. In the trash.

    Edit - spelling
     
    Last edited: Jul 16, 2020
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  9. MEMarge

    MEMarge Senior Member (Voting Rights)

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    And I thought you were going to suggest shoving it somewhere else @Invisible Woman!!
     
  10. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    Ye cannae shove yer Granny off a Bus
    And ye cannae shove a metaphor for MUS
    Tis a mere abstraction
    A mental malefaction
    Nay, ye cannae shove a metaphor for MUS.
     
  11. Trish

    Trish Moderator Staff Member

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    You shouldn't make a silly metaphor
    That shoves a sickly patient in a drawer
    So if psychs are talking bunkum
    Tear their papers up and junk 'em
    And shove the silly pschos out the door.
     
  12. shak8

    shak8 Senior Member (Voting Rights)

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    I used to have the diagnosis of fibromyalgia for which the rheum at the time (1996) said merely: use heat, heat, heat. Still good advice.

    But now the ICD-10 code for fibromyalgia is termed Widespread Chronic Pain, which tells you less, much less. Another tiny compartment of the junk drawer.

    At least with fibromyalga (for which I discerned I was going to have to come up with every suggestion of med or treatment, which I succesfully did, as the rebellious disabled nurse that I was and am) you have a category that contains all sorts of associated symptoms, which is useful. Is 'widespread chronic pain' somehow more accurate, or finely delineating a wide-assortment of symptoms seen in fibro? No, it isn't and doesn't.

    MUS basket is a nightmare for the patient, a joke for the so-called 'professionals.' Only when the doctor's wife or daughter or son or nephew comes down with a disease hidden in the MUS junk drawer (if they can find it in there with all the muck), will that sole clinician change his mind about this nonsense nomenclature.
     
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  13. Kalliope

    Kalliope Senior Member (Voting Rights)

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    There was an article about Rasmussen last year on a news site about research, where he says chronic fatigue syndrome is included in his drawer. Don't know if that's stated also in the now published paper. We discussed it a bit in the Scandinavia thread here

    I'll insert the first post about that news article in this thread, so people don't have to click to read it.
    I translated the word he uses in Norwegian (roteskuff) as "clutter drawer", I can't believe he went for "junk drawer". Well, it's bad either way..

     
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  14. DigitalDrifter

    DigitalDrifter Senior Member (Voting Rights)

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    I've always thought that psych explanations of my illness make about as much sense as misaligned chakras or negative chi energy. Only difference is that doctors and psychs get to parade their ideas around as "Evidence based medicine".
     
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  15. Ravn

    Ravn Senior Member (Voting Rights)

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    I'm inclined to agree with @Jonathan Edwards on this (though the language is so dense I couldn't be sure).

    The article looks at how the terms MUS, Somatisation, FSS, etc are used in the literature and operationalised in research.
    Conclusion: very inconsistently, basically everybody makes up their own definition.
    Worse, few researchers even realise this and merrily go on to compare apples with oranges.
    So this paper is actually quite important in pointing out the mess. Pity it's written in such dense language few will bother to plough through it (it always seems ironic to me that the social sciences, of all disciplines, should favour such impenetrable expression - not very socially minded).

    The author surveys what's out there; the fact that much of it is horrifying is not his fault. He gives little indication of what he thinks of it himself, apart from his main point that the whole MUS construct is highly inconsistent. There's a hint here though:
     
  16. rvallee

    rvallee Senior Member (Voting Rights)

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    [​IMG]
     
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  17. MSEsperanza

    MSEsperanza Senior Member (Voting Rights)

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    From the same author:

    Rasmussen, Erik & Ro, Karin. (2018). How general practitioners understand and handle medically unexplained symptoms: A focus group study. BMC Family Practice. 19. 10.1186/s12875-018-0745-2.

    "The biomedical frame emphasised the lack of objective evidence, problematized subjective patient testimony, and manifested [general practitioners'] feelings of uncertainty, doubt and powerlessness. This in turn complicated [general practitioners'] patient handling.


    "In contrast, the biopsychosocial frame emphasised clinical experience, turned patient testimony into a valuable source of information, and manifested [general practitioners'] feelings of confidence and competence. This in turn made them [= general practitioners] feel empowered. [...]

    "The biopsychosocial frame helps GPs to understand and handle MUS better than the biomedical frame does. Medical students should spend more time learning biopsychosocial medicine, and to integrate the clinical knowledge of their peers with their own."


    Reserach Gate link here.

    Link to PDF here.
     
    Last edited: Jul 17, 2020
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  18. Invisible Woman

    Invisible Woman Senior Member (Voting Rights)

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    Are they having a laugh? BPS turned patient testimony into a valuable source of information?

    I don't give a rat's a$$ if my GP feels empowered. My appointment is about me not him. If he wants it to be about him he shoukd go make his own appointment with someone else!

    FFS!
     
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  19. Grigor

    Grigor Senior Member (Voting Rights)

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    I didn't read this but what does he mean by cautious indications. For me this researchers talks in riddles...

    https://www.researchgate.net/public...ally_unexplained_symptoms_A_focus_group_study

    I do feel he's pro MUS etc but he feels the science is messy. Much like his own stuff?
     
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  20. rvallee

    rvallee Senior Member (Voting Rights)

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    Literally the exact opposite. Fascinating. Down is up. Success is failure. Death is life. Pain is too much joy trying to burst out all at once.

    BPS is basically a hagiographic story physicians tell themselves, a narrative where they are the hero and nothing else matters. The patients certainly don't matter, we could be replaced with blocks of wood for all that it matters.

    Then they are in turn frustrated because it's all a delusion and it doesn't work at all, but the frustration is further taken on the patients. Which, somehow, usually ends up concluding that it further validates the BPS model, because it needs constant affirmation of its glory.

    I'm very interested in politics and how weird it can get, especially in authoritarianism, and frankly this is right up there with the weirdest stuff of all, real Death of Stalin stuff, except not actual satire but actual death and suffering.
     
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