ME/CFS and the biopsychosocial model: a review of patient harm and distress in the medical encounter - Geraghty et al. 2018

Very interesting. I wonder if NICE will include this in evidence for harms? There needs to be a proper assessment of studies that suggest potential harm from treatments as well as those that look at the positive effects of treatments too.

 

Does anybody have access to the paper? [Edit 2018/07/06: full text now available:
https://www.tandfonline.com/doi/full/10.1080/09638288.2018.1481149?scroll=top&needAccess=true]

I find the abstract very promising.

I am a bit worried about this, though:

Yes, I too reject the BPS model, but would not reject an BPS apporach per se, if it weren't presented as a "model", especially a model of causation how it is commonly applied to ME.

I wouldn't reject a biopsychosocial approach of my illness, though, when the 3 columns of the model would be addressed appropriately, i.e. the P part being probably, and formemost the S part being strongly affected by the chronic disability caused by the B part, and not the other way round.

Don't know if an BPS approach like this exists at all in the medical world, but would be interested whether there exist patients' narratives similiar to this idea.

Also am curious to know if the analyzed narratives in the paper included the rare cases of encounters with supportive doctors or whether the "preferred model" is only articulated as a desire? (not because I am obsessed with positivity, but to demonstrate that it actually is possible for doctors to do no additional harm.)

(Edited for clarity.)

 

It's available through sci-hub, http://sci-hub.tw/10.1080/09638288.2018.1481149?journalCode=idre20

 

I'm with you. It's hard to argue against because it's unobjectionable at first glance. It sounds to the uninitiated like a perspective (even though it says model - it's not) that tries to provide a corrective to purported overly-narrow 'biomedical' views of illness and approaches to treatment. Other than that it doesn't really make specific assertions. But the quote provided from Moss-Morris -

is full of very arguable (but irresponsibly unsubstantiated...) assertions. When Sharpe twitters something like 'bps is widely accepted stop bitching' he's hiding these sorts of assertions behind something unobjectionable and - I like your word choice - 'progressive'. To me, BPS for ME/CFS really is just a euphemism for psychogenic. I would call it the psychogenic model. Or psycho-perpetuated.

On the other hand I'm not sure what good BPS does in other diseases. If it's only used mischievously, it needn't be saved and enough people are pretty capable of understanding the euphemism if it's explained.

 

"Psychosomatic" is a word that should be avoided, as advocates of this approach have rebranded it so that it merely refers to the psychological component of any disease.

"Dysfunctional Beliefs and Behaviours Model" is good. And gets around that whole psychology vs/ physical thing.

 

It doesn’t matter how beautiful the words are. They are aimed at denying people from competent medical care. ‘Holistic’ is currently being used instead of bio-psycho-social. It caters to the current demand, and it fools people to believe they are receiving good care.

 

Perhaps I should clarify.

I was commenting on what words are most effective to use when critiquing these ideas. And 'psychosomatic' isn't an effective word, because it is commonly used nowadays to refer to the role that a person's mental state plays in any illness. Using it therefore diverts any points you make into endless arguments about mind-body relations and cartesian dualism, and away from the real problem - which is the idea that PwMEs have the delusional belief that they're ill.

 

I like that. More 'academic'-sounding might be 'cognitive-behavioral model', but I prefer how how yours spells it out very plainly. Hard to weasel around the basic assertions there.

 

I tripped up over that phrase as well. It makes me feel uncomfortable. My immediate reaction to the word "role" is that it is connected with acting i.e. someone is pretending to be ill.

Despite my first impressions I can guess what it means (I think) i.e. a person who is ill needs space and time to be ill. Getting that person to wade through appointments and interviews while being severely ill is simply torture.

 

It means time to be ill, but also things like accessing benefits and support, if I'm understanding it properly.

 

Yes.

https://sociologydictionary.org/sick-role/

'those who take care of them' includes institutions like the NHS and the DWP.

 

Dr Mark Guthridge made a summary in ten points:

https://twitter.com/user/status/1010539290747695106

https://twitter.com/user/status/1010539292270178305

https://twitter.com/user/status/1010539293780205569

https://twitter.com/user/status/1010539295357263873

https://twitter.com/user/status/1010539296930127872

 

https://twitter.com/user/status/1010539298595201024

https://twitter.com/user/status/1010539300096827392

https://twitter.com/user/status/1010539301489332225

 

https://twitter.com/user/status/1010539302978310144

https://twitter.com/user/status/1010539304731504641

https://twitter.com/user/status/1010539306304331777

 

Biopsychosocial approaches are very specific. They distinguish between disease, which is what goes wrong in the body and illness, which is the behaviour that comes from that. A behaviour can be changed by using psychological therapies. It has no place in medicine as it is a political tool rather than anything meant to help the patient.

A holistic approach, in the sense of taking a person's whole life into account can help a patient (someone with young children may need more help after an operation than someone who can rest) but that is not what this is at all.

One of it's main premises is that work makes people healthy so getting people back to work is a good thing. This has been used as the basis for the UK's government to bring down and restrict benefits alongside the reasoning that benefits "encourage" people to remain ill. If they had their way there would be no benefits for sick people for the most compassionate of reasons!

I am not very good at explaining my thoughts but going right back to the earliest days of BPS it was a whole theory of health and never a consideration of biological, psychological and social concerns around a patient. I could believe that some people practise it in a compassionate manner, but they are taught that pushing patients is helping them.

The thinking has permeated much of medicine and social work with universally dire results for sick people. It is now being rolled out for MUS and functional neurological disorders directly from the "model" for CFS by citing the successes they have achieved in that disease which is one of the reasons they can't admit to any failings. It promises lots and lots of savings for government but it will only help people despite itself.

 

I know Keith Geraghty is very good, and not looked at the whole paper yet so this may just be a context issue.

"There are conflicting models of ME/CFS; we highlight two divergent models, a biopsychosocial model and a biomedical model that is preferred by patients." [My bold]

The biomedical model is surely also favoured by a lot of scientists also?

Edit: Corrected misspelling of Keith's name