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

Keela Too said:
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.
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Spot on
 
.. a lovely book written in 1912 by a man called Jamieson Hurry (?) called vicious circles of neuresthenia 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
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One can "look inside" this book on Amazon. The pathology of neurasthenia is described as one of defective aerobic energy production of the brain (not using these exact words, but one gets the impression that this is what the author is proposing).

Much of the remaining sections seem to describe vicious circles that allegedly perpetuate neurasthenia. I haven't been able to read any of them.

The neurasthenia described here seems very different from the first description of neurasthenia in the literature. The concept of what it was seems to have changed a lot over time.
 
Just checking out an earlier book, the 1913 Vicious Circles of disease. Don't know who Hurry is (Sharpe seems to have an affinity for early-20th century writings with unproven, ideological theories that fit his views.), but his theories seem just as theoretical and unconnected to actual medical science as Sharpe's own, and that is even before mentioning that this is over 100 years ago, pre-dating huge advances in medical science:

"No medical lexicon defines the Vicious Circle ; no text-book of medicine discusses its pernicious influence on the progress of disease ; no system of therapeutics guides the practitioner in his search for the locus minoris resistentice."

according to the introduction.


In the neurasthenia version the diagrams are laughable and gimmicky: the "vicious circles" are literal circles, and just terms with arrows between them, implying direction. (see example)


(@strategist and others who are interested, the book can be accessed here)

The transcript is really disturbing (unsurprising but terrifying that this is held in The Netherlands), the way he talks about them being "the normal people". It's also the aggrieved tone you find in psychiatrists throughout history whose views regarding physical illness (namely that psychiatry was a large part of it) were set aside as outdated and irrelevant: it's a red thread throughout.

From 1989 to 2019 it rounds off 30 years of Sharpe relentlessly working towards a big revolution where antique pre-Great War psychiatric views of physical illness and the more modern wrapping of it, the CBM, are (re)introduced and accepted in medical care as equally important as any biomedical stuff, or even central to it. What has changed is the scope (he went from already a broad chunk of medical patients with mood issues and/or medically unexplained to applying it to virtually every illness they can get their hands on), but it's so strange to read him talk in the same near-future, medicine-has-to-see-this-awesome-truth-I-found way as they did 30 years ago. Like it's new/fresh, unaccepted and about to happen.
 

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