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

[James Morris-Lent]

I am seeing this narrative a lot just recently. Is it me or is this completely ar** over t*t.

When clinicians are unable to diagnose disease or correlate symptoms with measurable changes in biomarkers, patients experiencing such an illness are at increased risk for suspicion, misplaced questioning, or having their motives misinterpreted through damaging social and cultural narratives about gender, race, ethnicity, socioeconomic status, or disability. Adhering strictly to a biomedical model of thinking about disease and diagnosis can prevent clinicians from empathically engaging with patients and helping them navigate their illness experiences.

Surely what is being described is doctors deviating from there biomedical model and attributing symptoms to social and cultural narratives - exactly what the author seems to like.

It looks like a formulation designed to tar any criticism as comprehensive bigotry. The typical wesley/sharpe et al formulation is that those who criticize BPS are bigoted against mentally ill people; here it is against: women, non-whites, the disabled, the poor.

Of course the implication is that women, minorities, and the disabled simply can't be expected to have the same level of self-awareness and self-control as the rational, able-bodied white male. Which is, in fact, comprehensively bigoted.

Strangely, the article kind of points that out, as well, so... yeah.

 

[Sean]

Adhering strictly to a biomedical model of thinking about disease and diagnosis can prevent clinicians from empathically engaging with patients and helping them navigate their illness experiences.

To make biomedically-oriented doctors look like the bad guys

Gotta admire their sheer chutzpah. They will smear anybody.

Which is a very long list of enemies.

 

[TiredSam]

It looks like a formulation designed to tar any criticism as comprehensive bigotry. The typical wesley/sharpe et al formulation is that those who criticize BPS are bigoted against mentally ill people; here it is against: women, non-whites, the disabled, the poor.

Of course the implication is that women, minorities, and the disabled simply can't be expected to have the same level of self-awareness and self-control as the rational, able-bodied white male. Which is, in fact, comprehensively bigoted.

Strangely, the article kind of points that out, as well, so... yeah.

As a member of the patriarchy I'm trying to work out whether I'm going to end up at the top of the pile or the bottom of the pile once all these people have finished waffling.

 

[dave30th]

She seems rather hopelessly confused.

when you're a young academic, I assume these theories can come across as appealing and intuitive and can seem to explain lots of confusing things.

 

[Jonathan Edwards]

when you're a young academic, I assume these theories can come across as appealing and intuitive and can seem to explain lots of confusing things.

But would a young lass fro' Yorkshire have owt to do wi' it?
Maybe if she knew that where there's muck there's brass (to rhyme wi' the US pronunciation of ass).

 

[chrisb]

The anthropological view as espoused by, inter alia, Kleinman and which is suggested by this recent writer is interesting. I was refreshing memory on another matter and came upon this in the CIBA conference book.

McCluskey: How then do you explain the fact that most of us here would agree that about75% of CFS patients describe an acute pyrexial event(an influenza like illness) which started their symptoms?

Kleinman: This is the issue of whether or not there is a construction of the story itself, in order to prove a point.

@p125 in discussing RHT Edwards paper on Muscle histopathology and pathophysiology in CFS

That is indeed an issue, but is it the patient or Kleinman who is constructing a story to prove a point? The narrative approach is not without its difficulties.

 

[Hoopoe]

Repeatedly insinuating that patients are in denial about the psychosocial cause of their illness leads to patients emphasizing especially strongly how the cause is not psychosocial, which could appear like a confirmation that patients are in denial.

 

[Peter T]

Repeatedly insinuating that patients are in denial about the psychosocial cause of their illness leads to patients emphasizing especially strongly how the cause is not psychosocial, which could appear like a confirmation that patients are in denial.

Early on in the course of my ME, I was perfectly willing to consider a bio psychosocial model for my condition, indeed I did not really care what the aetiology was as long as I found a way to get it treated.

Participating in a research project looking at the impact of a specific diet supplement the psychiatrist leading it insisted on my agreeing that ME had a psychological cause and got more and more upset when I disagreed. Indeed it was her obvious emotional need for me to believe her psychological narrative, that lead me to consider what approach best fitted my symptoms and to reject a primary psychological explanations as causal or as a major maintaining factor.

Indeed her conduct was so bizarre for someone supposedly researching biological factors that for a while I wondered briefly if I was in fact a subject in a covert social psychology experiment, which I initially thought more likely than a lead researcher understanding so little about potential bias. Ultimately her need to belittle me each time I did not agree with her views lead to me dropping out of the research.

 

[chrisb]

I have always thought that if you fall into the hands of a psychiatrist in the US you do at least have the chance of being declared cured once the insurance runs out.

 

[Adam pwme]

Sharpe from European Association of Psychosomatic Medicine Annual Meeting 2019

"most illnesses that people have are not based in disease, disease is actually the minority sport, disease is very important in determining mortality, but determining morbidity in the population disease is less important"

 

[chrisb]

It is puzzling to hear Sharpe pronouncing on these new subjects. Almost Forty years new, in fact. It is strange that he does not make clear the history of these issues and exactly what is the basis of his ideas. I am sure he is aware of Eisenberg and Kleinman. Why is there no mention of Arthur Cott and McMaster.

 

[Sly Saint]

another self perpetuating circle:

dodgy bps research paper -> null results falsly hailed as success -> bps researcher gets more funding ->

 

[Medfeb]

It is strange that he does not make clear the history of these issues and exactly what is the basis of his ideas. I am sure he is aware of Eisenberg and Kleinman. Why is there no mention of Arthur Cott and McMaster.

Do you mean Arthur Kleinman from Harvard or someone else?

 

[chrisb]

Do you mean Arthur Kleinman from Harvard or someone else?

The Harvard one, who co-authored papers with Eisenberg, and who helped organise the 1985 Illness Behaviour Conference in Toronto which may have been the apotheosis of the movement until its reintroduction by Sharpe.

 

[Arvo]

I'm currently not in the mood to watch the video of post #430, but for those who are interested:


The sign on the left of the still says:

"Welcome! We wish you an inspiring meeting!",

followed by the quote from Steve Jobs:

"The difference between a leader and a follower is innovation."


Postillion is the name of the hotel chain that also lets conference spaces.


(@Adam pwme )

 

[Skycloud]

Sharpe from European Association of Psychosomatic Medicine Annual Meeting 2019

Transcript.

Spoiler

“... a lovely book written in 1912 by a man called Jamieson Hurry called “Vicious Circles of Neurasthenia” and he drew..it’s a little book of diagrams really that he drew..rather sweet really going from mind to body and back again

and I think we have some very interesting examples of how you can beget/ be...get (?) an illness and then behaviour you adopt serves to perpetuate the illness

So I guess do we need to think about a different paradigm? Should we be thinking about psychosomatic illness which was the old idea, asthma, so on, we’re psychosomatic illnesses; the other illnesses weren’t, they were I suppose kind of real illnesses

or should we be thinking about psychosomatic medicine and I thought the talks this afternoon were really interesting in putting these mechanisms in context,

and the context is its complex and that probably all symptoms have a psychological aspect to them

so that’s a shift isn’t it? And then you take this even further and we hear about IBS and we’re hearing about dizziness and we get a kind of figure ground flip here

because it used to be there was all those diseases out there and it was these little weird people, you guys here, that were interested in this psychosomatic stuff

and then suddenly we realise ‘no! We’re the normal people!’ We’re .. we are interested.. that’s most illnesses that people have, are not based in disease, disease is actually the minority sport.

Disease is very important in determining mortality, but determining morbidity in the population disease is less important than the the illnesses that are driven more predominately by these other factors

So I think we maybe need to be thinking... a lot of hints today about how we change paradigm um and I think for research that’s going to mean as we’re hearing today, they’re fantastic presentations - neurologists and psychiatrists endocrinologists...

so we’ve actually got to take a more joined up view. The idea that we can just have psychologists psychiatrists when it comes to anything like a medical condition study we’re going to have be mixed up together, we’re going to have to have a joined up approach and psychosomatic meaning body and mind, psychology and other biological factors, are the way to go

And I think the same’s going to be the case for clinical teams and when you think about obesity and about diabetes and about vestibular disease, you see some wonderful examples of how we have to put together what used to be called psychosomatic, and what used to be called medical.

So I think this is a really exciting time, I think this has crystallised well today, we’re on the edge of thinking about these things in a completely different way.

And as Judith said, you know, a lot of the the ways we think about these we have to change the way that we and other doctors think about illness

and rather than just think there’s a lot of normal patients and a few weird patients out there, there’s probably just a lot of weird doctors out there including us

OK any questions?

If anyone spots mistakes, please let me know and I’ll alter it. In a few places I was unsure of what I could hear and for theses I put a (?) or two likely options. For ease of reading I also added some punctuation where it seemed obvious and divided into short sections, so these are mine and not Sharpe’s.

Edit - removed my edit to add queries about Jamieson Hurry and his book.
In the text I have also made the book title more obviously a title. I’ve removed the (?) in the transcript by his name.

 

[Trish]

I think that's what I would call 'making stuff up'.
Where's the science? Where's the evidence?
It's not a paradigm it's a parody.

 

[Keela Too]

I think that's what I would call 'making stuff up'.
Where's the science? Where's the evidence?
It's not a paradigm it's a parody.

I was trying to work out what to say, and all I could come up with was “What mumbo-jumbo!”

You’ve said it better Trish!

 

[Keela Too]

Re Obesity. I suspect that obesity (long thought of as a personal failing) will one day be demonstrated as a response to our modern high-carb, highly processed diet. Perhaps it happens only in genetically susceptible individuals, or maybe some other factor triggers a dis-regulation of appetite. In my view hunger, like thirst and pain, is a bodily sensation that evolution has designed to be impossible to ignore. Blaming patients for not being able to ignore these sensations is as bonkers for hunger as it is for pain.

 

[Trish]

I forgot to say, thank you, @Skycloud for the transcript. It's saved the rest of us suffering through the talk!