ME/CFS in UK medical textbooks (Psychiatry)

[Simbindi]

I have been going through my old books from the loft and came across one on Psychiatry (bought at the time I was deciding on whether to go for an autism diagnostic assessment, rather than to look up what it contained on M.E.).

So for the first time, before putting it aside on my 'to sell' pile, I made the mistake of seeing if it says anything on M.E. Well, it does - under the chapter 'Medically Unexplained Symptoms'. The chapter is 8 pages in total, and the content on 'CFS/ME' is half a page. Since the text book is nearly 500 pages in total, I am assuming it is fine to reproduce the 3 paragraphs on M.E. on the forum for discussion.

The textbook is the fourth edition of 'Psychiatry' by John Geddes, Jonathan Price and Rebecca McKnight with Michael Gelder and Richard Mayou, published in 2012 by Oxford University Press.

Chronic fatigue syndrome/myalgic encephalomyelitis

Depression, fatigue, and malaise are common following influenza, hepatitis, infectious mononucleosis, and other viral infections, but these usually improve over days and weeks. Chronic fatigue syndrome, which is also known as myalgic encephalomyelitis, and shortened to CFS-ME, is characterised by (i) more persistent fatigue, and aching limbs with muscle and joint pains and, (i) the absence of physical or mental disorder sufficient to explain the symptoms. Mild physical exertion is often followed by increased fatigue and pain so that patients alternate brief periods of activity with prolonged rest, in a ‘stop-start’ pattern. Many patients are convinced that their symptoms are caused by a chronic virus infection or another, as yet undetected, medical condition. However, after thorough physical assessment, few cases are found to have a specific medical cause such as anaemia, persistent infection, or endocrinopathy.

In most cases, the causes of the syndrome are neither wholly psychological nor wholly physical, but a mixture of the two, with psychological factors becoming increasingly common over time. A common triad at the outset is a viral illness (physical), presenting at a time of personal stress (social), in an individual with a driven personality (psychological). Recovery from the viral illness is slow, and inactivity and resultant deconditioning start to play an important role. As the person senses that they are recovering, they may suddenly return to their former lifestyle, only to relapse quickly because their physical condition is still impaired. Morale may well suffer and, in some, a depressive syndrome may emerge, which may merit antidepressant treatment.

The treatment of this disorder is challenging, not least because it arouses passionate feelings among sufferers and their carers. The clinician should explain that the syndrome is real, common, and familiar, and although there is no specific medical treatment, there are ways of improving outcome. A graded programme of slowly increasing activity should be started with regular monitoring. Considerable effort is needed to ensure patients practice progressively rather than alternating erratically between excessive activity and resting in bed. It is often appropriate to seek specialist advice for these patients. Cognitive behavioural therapy and graded exercise therapy have both been shown to be helpful in clinical trials. The role of pacing, in which patients adapt their lifestyle to the energy that they have available, is currently uncertain, but a large trial funded by the UK’s Medical Research Council will provide helpful advice in the near future.

 

[Snow Leopard]

Have you considered burning it?

A common triad at the outset is a viral illness (physical), presenting at a time of personal stress (social), in an individual with a driven personality (psychological). Recovery from the viral illness is slow, and inactivity and resultant deconditioning start to play an important role. As the person senses that they are recovering, they may suddenly return to their former lifestyle

Literally none of these points apply to me.

 

[Esther12]

Wonder if that's the same Jonathan Price who did Cochrane's CFS reviews?

 

[Simbindi]

Wonder if that's the same Jonathan Price who did Cochrane's CFS reviews?

This guy:

https://www.neuroscience.ox.ac.uk/research-directory/jonathan-price

Looking through his list of publications, it appears so.

 

[alex3619]

Have you considered burning it?

Its a pity they do not use degradable paper. Otherwise it could be in pride of place on a little shelf in the lavatory. Unfortunately most paper today will just clog the plumbing.

 

[Sean]

A common triad at the outset is a viral illness (physical), presenting at a time of personal stress (social), in an individual with a driven personality (psychological). Recovery from the viral illness is slow, and inactivity and resultant deconditioning start to play an important role. As the person senses that they are recovering, they may suddenly return to their former lifestyle

Nor me. More or less the complete opposite.

The 'deconditioning' meme in particular is now so implausible (by which I mean, totally discredited) that any further citing of it should be regarded as either gross incompetence or straight fraud. Either way, those doing the citing clearly need to be promptly removed from any position of power.

 

[Simbindi]

What's concerning is that this is the material that is being fed to (UK) medical students.

Following the links from J Price's web page, I came across the following (2016) articles in the journal 'Medicine' - the first on 'Medically Unexplained Symptoms' by Price, immediately followed by an article on 'CFS' by another author, one of whom was on the 2007 CFS/ME NICE guideline committee:

https://sci-hub.tw/https://www.medicinejournal.co.uk/article/S1357-3039(16)30195-5/fulltext

https://sci-hub.tw/https://www.medicinejournal.co.uk/article/S1357-3039(16)30198-0/fulltext

https://sci-hub.tw/https://www.medicinejournal.co.uk/article/S1357-3039(16)30207-9/fulltext

This is how the journal 'Medicine' markets itself:

Aims and Scope

Stay on track with your career development with our tailored and trustworthy expertise.
Medicine is a continually updated, evidence-based resource covering internal medicine and its specialties. It’s an authoritative and comprehensive resource that provides all trainees, irrespective of medical specialty, with up-to-date information on the mechanisms of disease, effective diagnosis and today’s correct management options so that patient care can be optimized. Given its comprehensive coverage of internal medicine, this resource is also an ideal companion for consultants in the acute medicine setting and for GPs.

Designed to provide trainees with a trustworthy source of medical knowledge, each article covers basic sciences and clinical management. All content is written on an invite-only basis by respected medical professionals, commissioned by our editorial board of experts, examiners and research professors. As a trainee you have plenty to do – trying to compile your own revision and learning resources from lots of medical journals shouldn’t be one of them. Stay focused on what you need to achieve and let us provide the medical knowledge you need.

To ensure you are confident and competent, all Medicine articles are written with the most recent medical knowledge. Just to make it easier, our content follows the Core Medical Training Curriculum, ensuring that you stay on track.

Clinical content you can trust
Each article is commissioned by specialist Chapter Editors along with the Editorial Board. Authors are eminent specialists in their field, and the articles are reviewed by the Chapter Editors, an Editorial Board Member, the Clinical Pharmacology and Therapeutics Editor (when appropriate) and an in-house editor.

Medicine’s mission is to ensure medical trainees become confident and competent specialists.

 

[JemPD]

Well spotted @Simbindi
I haven't the heart to read those 3 articles, but I agree its very disturbing that this is what they're being taught.

Its a pity they do not use degradable paper. Otherwise it could be in pride of place on a little shelf in the lavatory. Unfortunately most paper today will just clog the plumbing.

oh that did make me laugh I really needed that this morning. thank you

 

[rvallee]

I have been going through my old books from the loft and came across one on Psychiatry (bought at the time I was deciding on whether to go for an autism diagnostic assessment, rather than to look up what it contained on M.E.).

So for the first time, before putting it aside on my 'to sell' pile, I made the mistake of seeing if it says anything on M.E. Well, it does - under the chapter 'Medically Unexplained Symptoms'. The chapter is 8 pages in total, and the content on 'CFS/ME' is half a page. Since the text book is nearly 500 pages in total, I am assuming it is fine to reproduce the 3 paragraphs on M.E. on the forum for discussion.

The textbook is the fourth edition of 'Psychiatry' by John Geddes, Jonathan Price and Rebecca McKnight with Michael Gelder and Richard Mayou, published in 2012 by Oxford University Press.

This is like the poster child of "it's better to keep your mouth shut and appear ignorant than open it and remove all doubt". Well, there's basically a whole orphanage system of those poster children but this is one of them anyway.

"I don't know" is OK. It is the default. It should always be the default. There is no situation that is improved by rejecting "I don't know" and choosing to make stuff up instead.

Great job giving solid ammunition to luddites and anti-science folks. There will not be a legitimate defense to trust in experts when this tripe is given legitimacy and official blessing. How can there be an eventual defense of the credibility of psychiatry when this all blows up? It will be wrong but a natural position to basically distrust everything, and it will be hard to blame those pushing this.

 

[Theresa]

This is like the poster child of "it's better to keep your mouth shut and appear ignorant than open it and remove all doubt". Well, there's basically a whole orphanage system of those poster children but this is one of them anyway.

"I don't know" is OK. It is the default. It should always be the default. There is no situation that is improved by rejecting "I don't know" and choosing to make stuff up instead.

Great job giving solid ammunition to luddites and anti-science folks. There will not be a legitimate defense to trust in experts when this tripe is given legitimacy and official blessing. How can there be an eventual defense of the credibility of psychiatry when this all blows up? It will be wrong but a natural position to basically distrust everything, and it will be hard to blame those pushing this.

Doctors are definitely too quick to diagnose sometimes or to assume psychological causes, however I think a diagnosis that says they don't know what is wrong is also likely to lead to disbelief of sufferers and make it impossible to take sick leave or claim disability so I don't know what the solution is really.

 

[alex3619]

don't know what is wrong is also likely to lead to disbelief of sufferers and make it impossible to take sick leave or claim disability

NOS, not otherwise specified, is an open diagnosis, and comes in many flavours. I do know some ME patients have accepted a diagnosis of depression just to get disability benefits though.

 

[Mithriel]

influenza, hepatitis, infectious mononucleosis, and other viral infections

Carefully omitting enteroviruses despite epidemics of enteroviral infection being the basis for the name myalgic encephalomyelitis. Never let it be known this illness came in epidemics because that is proof that they do not have psychological causation.

 

[chrisb]

Never let it be known this illness came in epidemics because that is proof that they do not have psychological causation.

It should not be forgotten that the cause of epidemics was "mass hysteria". .. Allegedly.