Michael Sharpe: Mind, Medicine and Morals: A Tale of Two Illnesses (2019) BMJ blog - and published responses

Skycloud said:
@rvallee are you able to provide a link to some of these responses?
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There are too many good ones to single out, it's worth reading the thread. Surprisingly the usual friends-of-Sharpe and sock puppets aren't in the likes.

A few tweets noted that Discus comments weren't approved and some excuse was given that this was just a preview, which is irrelevant. BMJ folks just stopped responding.

I noticed another tweet from them about the preview status:



Could be worth doing an official S4ME response. Question is who has the energy for it. I may give it a try once the full article but I'm not convinced anything going against Sharpe's narrative would be approved. It's clearly a circle jerk where dissent isn't allowed.
 
The thing is, there has already been very adequate well reasoned and thorough responses elsewhere. I can imagine that part of the BPS strategy was to wear us down (a thoroughly evil strategy too). How many more times must we repeat our stance. This is also a line that is co-opted by the BPS except their repetitions don't address any of our issues raised.

That's not to say that it isn't worth giving yet another response. I think it is. But at this point I'd want to just direct people to read the Journal of health psychology special issue. We shall have to see what kind of 'dialogue' BMJ is prepared to allow.
 
Simone said:
The title of the article has changed. It’s now called ‘Chronic Fatigue Syndrome and an Illness-Focused Approach to Care: Controversy, Morality, and Paradox’. The disgraceful focus on morality remains.
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That's a shame. I was preparing something on the lines of "It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us". But I found Dickens had got there first.

One can only assume that someone went away and looked at the book for possible danger. And found it.
 
Specifically we ask why are the *apparently benign* psychological and behavioural treatments for fatigue—cognitive behaviour therapy (CBT) and graded exercise therapy (GET)—so very controversial.

...disease-focussed treatment is commonly *ineffective* in relieving the fatigue, whereas, illness focussed treatments such as CBT and GET, *can be [effective]*.
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How ridiculous. These treatments are neither benign nor effective, and certainly not both. That's all I have to say on the subject.

However, whilst such treatments are readily accepted by patients with cancer-related fatigue, they may be strongly rejected by people with CFS; why is this?
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He really wants to know?!? This is puzzling him? Oh, sorry; it's probably rhetoric. Sharpe is a frustrated novelist, like Wessely.
 
Broken toe - disorder but not disease - needs organic, physical attention.
Deconditioning - ditto.

But a broken toe is not deconditioning and the treatments must be different.

Hence, even if we have a disorder which is not a disease but causes symptoms (illness), we can still press them on what the disorder is and HOW THEY KNOW (they don't). Focussing on illness does not mean that we can be treated as if deconditioned if that is not our actual disorder. CBT/GET doesn't work at all well. The results even without questions as to methodology were poor. Would you tout a surgical technique if it was that unreliable?


This bunch still need to answer the same old questions, even if we choose not to dispute the terminology. The bio work is being done to elicit the nature of our disorder/s and then we can decide whether "disease" is the right word, or for whom it is the right word. So why don't they encourage more bio work to help them with their linguistics?
 
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hinterland said:
He really wants to know?!? This is puzzling him? Oh, sorry; it's probably rhetoric. Sharpe is a frustrated novelist, like Wessely.
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Nah he's straight up lying. Dozens of us have argued with him very clearly and it's now clear that his most pressing grievance is that other academics see through his shit so he knows very well about the nature of the controversy, he is just working desperately to preserve his career until he retires. By then it will be too late to do anything more than symbolically pulling his medical license but until then he needs to preserve his position.
 
Their whole approach is based on non objectivity.
Get a liaison with the patients by talking up the "reality" of the "illness" or of "real symptoms etc". Relax the patients, get them a bit fitter and less anxious about exercise + activity and hey presto......
Add to that the idea that the illness is all nocebo anyway, biologically unjustifiable, illness without disease etc. and then, even if the CBT/GET explanations are propositionally hogwash, it doesn't matter - because it's a placebo vs nocebo situation and the magic words will work, if only they are believed. Hence unbelievers must be silenced, traduced, belittled, even sympathised with etc and all in the NICEST possible way, so to speak.
Nothing the CBT/GET advocates say can be taken at face value.
Even if they all turned into arch "bio-physicalists" they might still be after therapeutic liaison.

It's not so much that/whether Sharpe believes in what he says, he just believes in saying it.
 
Snow Leopard said:
What does this mean? Were these patients who submitted Disqus responses? Or did they deliberately invite patients who agree with Sharpe to respond?
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I think this means some tweets inviting responses to the moderated platform they use but their systematic censorship of all comments on the initial blog post makes it dubious that any dissenting voice will be published. And the process will of course be opaque. If the past is a guide, Sharpe will likely have a veto on acceptable responses from patients.

Of course those responses have to meet certain standards of academic discourse so this basically excludes 95% of responses from patients, or at best very delayed and therefore invisible to most. Many have commented so, that this is a platform in which there is the illusion of possible discourse but the deck is very stacked for an echo chamber.
 
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