Two part article on cognitive therapies, mindfulness, Garner etc., 2025, Long Covid Advocacy Substack article

[Utsikt]

You simply decide. That's only requirement.

That simply isn’t how things work. Everyone can’t just decide to not react to something. And you certainly can’t expect that to go well. Try telling someone with violent anger issues that they should just stop being violent and angry, and letting them continue on their journey in life on their own. Clearly there are situations where guidance and training is appropriate - and the Buddhists seem to think so too.

The post makes issue of conflating mindfulness with meditation. Seems like you are conflating too.

No, it does not. It is what the western medicalised version describes.

That is not what I'm discussing. I'm talking about mindfulness, not medicalized whatever that conflates mindfulness with meditation. Of course Buddhism is relevant. That is where the concept of mindfulness originates, medicalized or not. That's the point of the article after all.

This post is about the western medicalised version, and how it compares to different versions of Buddhism, but with the aim to answer the question of: is the western medicalised version of mindfullness appropriate for chronic illness:

Welcome to this critical exploration of therapeutic uses of mindfulness and meditation in medicine.

It is comparable since there is nothing you can do about in either situation. You can't put out the fire; you can only react/not react to your best benefit.

But you said a version of Buddhism says you shouldn’t react. Moving away from the fire in a controlled fashion is a reaction to something external - and it’s done on a completely egoistic basis. So clearly there are situations where a reaction is appropriate by most standards.

 

[Trish]

Part 2:

Behind the Biological Veneer: A Closer Look at the BMJ, SIRPA and Garner’s Framing of Chronic Illness
The Weaponisation of Cognitive Therapies in Mind-Body Medicine

LONG COVID ADVOCACY
MAY 22, 2025
1
TL;DR


So far in Part One, we have explored mindfulness and meditation and the sociological, philosophic and pragmatic issues that arise with their unquestioning acceptance.

This article explores how cognitive therapies contribute to a dangerous medical paradigm for chronic illness. We shall focus on Paul, ‘he’s not the messiah, he’s a very naughty boy’, Garner’s opinion piece for the BMJ and his appearance at the SIRPA conference.

We examine the historical, rhetorical, and systemic forces behind mind-body medicine and how they obscure harm through compassion-washing, concept laundering, and misplaced optimism.

When chronically ill, one is presented, with a whole smorgasbord of cognitive therapies that promise to help and offer hope. This can include traditional CBT and mindfulness-based stress reduction; “third wave” therapies like ACT (Acceptance and Commitment Therapy) and MBCT (Mindfulness-Based Cognitive Therapy); brain retraining programmes; six-week digital recovery courses; yoga-for-trauma classes; “Your COVID Recovery” platforms; self-help books; and the ever-expanding catalogue of mind-body medicine. It’s a psycho-industrial complex.

Buckle your seat belts, this should be quite the ride…

More at link.

 

[Trish]

I have just read Paul Garner's summary slide from the SIRPA conference screenshot in this article. It says:

Quote:

In Summary:

• Biomedical ideology/dogma/fanaticism has trumped EVIDENCE
• Medical establishment is a complicit
• NICE should be ashamed
• ME/CFS Activist Societies should be CHALLENGED
• Research is being misdirected
• DHSC should be told that government policy is causing disability

end quote.

That is so outrageous it's would be funny if he had no influence.

I think we are getting a clearer idea of just how far people like Garner and Busse, both incidentally influential in Cochrane, are prepared to go in their attack on pwME. There is a level of sheer and overt nastiness I don't think we've seen before.

 

[Yann04]

There is a level of sheer and overt nastiness I don't think we've seen before.

Yes. If they are willing to write slides like that at public conferences. You can imagine the lengths they are going to to establish their views institutionally behind closed doors. They are treating this like a fight.

 

[Eleanor]

• Biomedical ideology/dogma/fanaticism has trumped EVIDENCE
• Medical establishment is a complicit
• NICE should be ashamed
• ME/CFS Activist Societies should be CHALLENGED
• Research is being misdirected
• DHSC should be told that government policy is causing disability

end quote.

That is so outrageous it's would be funny if he had no influence.

It's the same kind of style you see from any Youtube crank ranting about how the earth is flat or vaccines cause autism or whatever. But because he has some past professional eminence he gets treated as a non-crank.

 

[V.R.T.]

I have just read Paul Garner's summary slide from the SIRPA conference screenshot in this article. It says:

Quote:

In Summary:

• Biomedical ideology/dogma/fanaticism has trumped EVIDENCE
• Medical establishment is a complicit
• NICE should be ashamed
• ME/CFS Activist Societies should be CHALLENGED
• Research is being misdirected
• DHSC should be told that government policy is causing disability

end quote.

That is so outrageous it's would be funny if he had no influence.

I think we are getting a clearer idea of just how far people like Garner and Busse, both incidentally influential in Cochrane, are prepared to go in their attack on pwME. There is a level of sheer and overt nastiness I don't think we've seen before.

I'm hoping the deranged tone is a sign they are losing the argument.

But I am so sick of the claim that telling people the truth is in fact causing disability. The BPS approach literally caused my disability in the sense that while I was technically disabled before (and absolutely support mild pwME who refer to themselves as disabled), I was able to function and be out in the world regularly and care for myself, and considered myself chronically ill, if anything. Severe is a whole other ballpark as we all know.

The promotion of the idea that being told you are sick is what has made you sick by the very people responsible for unquantifiable harm and deterioration among pwME is utterly Kafkaesque, in the true nightmarish sense.

 

[Midnattsol]

On the topic of being told about your prognosis, a recent study on Alzheimers claim being told about your risk does not cause worse health.

Emotional response to amyloid beta status disclosure among research participants at high dementia risk

 

[Friendswithme]

Part 2:

Behind the Biological Veneer: A Closer Look at the BMJ, SIRPA and Garner’s Framing of Chronic Illness
The Weaponisation of Cognitive Therapies in Mind-Body Medicine

LONG COVID ADVOCACY

More at link.

There is very little here that unpicks why this is problematic. It is descriptive 'Paul Garner says this, SIRPA says this' but nothing about why it's wrong. This is a shame.

SIRPA has thousands of clients reached through their practitioners, is my understanding. Thousands of recoveries from all kinds of chronic symptoms. I appreciate that is anecdotes but those people deserve to be believed.

 

[Sean]

I have just read Paul Garner's summary slide from the SIRPA conference screenshot in this article. It says:

Quote:

In Summary:

• Biomedical ideology/dogma/fanaticism has trumped EVIDENCE
• Medical establishment is a complicit
• NICE should be ashamed
• ME/CFS Activist Societies should be CHALLENGED
• Research is being misdirected
• DHSC should be told that government policy is causing disability

end quote.

DARVO, par excellence, indeed.

I think we are getting a clearer idea of just how far people like Garner and Busse, both incidentally influential in Cochrane, are prepared to go in their attack on pwME. There is a level of sheer and overt nastiness I don't think we've seen before.

Edward Shorter.

Essentially the same sentiments and pseudo arguments and shameless perversions of the truth have been expressed by many of the leading lights in the BPS school over the years. But they usually have more political smarts and hide it much better.

What has changed is that some, like Garner, are now feeling more emboldened, now believe that they are beyond accountability for this abusive behaviour. And so far they are correct. They have not faced any real accountability.

 

[Utsikt]

I appreciate that is anecdotes but those people deserve to be believed.

Should we also believe the millions of people that have not gotten better, or even gotten worse, from the same methods?

 

[Eleanor]

It's a fluctuating and unpredictable illness from which a percentage of people recover with no intervention at all. Anecdotes of recovery attributed to any one particular method deserve to be afforded just as much belief as anecdotes of recovery by any other method (graded exercise, experimental drugs, folk remedies, expensive supplements, restricted diets, coloured light rays, oxygen chambers, TCM, LSD, electrical stimulation, crystal healing, the power of prayer, etc etc etc.).

Those seeking to influence the care and treatment of sick and disabled people by promoting any particular one of those methods (and seeking to gain from it professionally and financially themselves) need to provide more in the way of evidence than anecdotes.

 

[Peter T]

Those seeking to influence the care and treatment of sick and disabled people by promoting any particular one of those methods (and seeking to gain from it professionally and financially themselves) need to provide more in the way of evidence than anecdotes.

When I first developed ME I was training as a yoga teacher and had a long standing regular meditation practice, perhaps I should argue that these were the reasons my acute EBV infection (glandular fever, mono) triggered my initial onset. When I had my first remission, I no longer had a yoga practice, but did try for six months prior a raw food vegetarian diet, perhaps I had discovered a cure: raw food and not doing yoga. My subsequent relapse was associated with developing a bout of seasonal flue whilst hosting a house party for the Millennium New Year. Perhaps mixing socially with people should be completely avoided if you don’t want to develop or redevelop ME, indeed how many hermits develop the condition?

As @Eleanor points out you need a lot more than anecdote to identify an aetiology or develop a treatment for a specific condition. Garner is also being selective on which factor he attributes his recovery too, he could just as well prescribe scuba diving in the Caribbean or deep and meaningful phone calls to Norwegians with as much anecdotal evidence as a cure for Long Covid. (Is it Norway or Sweden that have the telephone service where you can telephone volunteer citizens to find out about the country? If Norway, perhaps this should be encouraged as a treatment for ME.)

 

[Peter T]

The more I think about this being a hermit to prevent ME/CFS the more it seems to make sense, neither Julian of Norwich nor Simeon Stylites seemed to have the condition, and it does not seem to be a religion specific association as Milarepa, though turning green from a diet of nettles, did not develop ME/CFS in his Tibetan cave.

Further people with very severe ME/CFS report social interaction can worsen the condition. Gosh this arguement from anecdote leads to infinite possibilities.

 

[Trish]

I have just read Paul Garner's summary slide from the SIRPA conference screenshot in this article. It says:

Quote:

In Summary:

• Biomedical ideology/dogma/fanaticism has trumped EVIDENCE
• Medical establishment is a complicit
• NICE should be ashamed
• ME/CFS Activist Societies should be CHALLENGED
• Research is being misdirected
• DHSC should be told that government policy is causing disability

end quote.

That is so outrageous it's would be funny if he had no influence.

I think we are getting a clearer idea of just how far people like Garner and Busse, both incidentally influential in Cochrane, are prepared to go in their attack on pwME. There is a level of sheer and overt nastiness I don't think we've seen before.

There is very little here that unpicks why this is problematic. It is descriptive 'Paul Garner says this, SIRPA says this' but nothing about why it's wrong. This is a shame.

SIRPA has thousands of clients reached through their practitioners, is my understanding. Thousands of recoveries from all kinds of chronic symptoms. I appreciate that is anecdotes but those people deserve to be believed.

My problem with Paul Garner's statements is that he has no evidence from clinical trials to support his statements. It's all prejudice based on his own beliefs about why he recovered from a brief spell of Long Covid.

This forum was set up to examine evidence. So far we have seen NO evidence from clinical trials that any of the brain training methods being promoted by Garner and his new friends are promoting. Instead they choose to attack pwME, and flood the media, conferences and medical journals with their opinions.

Taking Garner's summary line by line:

Biomedical ideology/dogma/fanaticism has trumped EVIDENCE

NICE examined the evidence for GET and CBT in great detail using recognised methods and concluded that they are not clinically effective, cost effective and may cause harm. The supporters of them have failed to provide any evidence that NICE got it wrong.
Far from biomedical research being an ideology, dogma or fanaticism, it has been underfunded for ME/CFS for decades thanks largely to the stigma and BPS people's influence.
On this forum we take a critical approach to all research, whether biomedical or psychobehavioural. We hold them to the same high standards. See for example, our discussion of the Abilify 'research' paper.

Medical establishment is a complicit

On the contrary, the medical establishment, at least in the UK is complicit to a large extent with the BPS approach, see their attempts to undermine the NICE guidelines.

NICE should be ashamed

NO. Cochrane should be ashamed. NICE leaders had the courage to stand up to the attempts, overt and covert, to scupper the 2021 guideline. Garner likes to spin it that it was pressure from activist pwME that made NICE change its guidance on ME/CFS. Not true. The evidence review was done by evidence review experts nothing to do with patients, and there was only a small minority of pwME on the guideline committee. There was no way pwME could influence the guideline.

ME/CFS Activist Societies should be CHALLENGED

I don't appreciate being shouted at by Garner. On what grounds does he think we should be CHALLENGED? I'm not even sure what an Activist Society is, except a group of sick people trying to support each other and get better care and research.

Research is being misdirected

Which research? DecodeME? Biomedical studies to try to get to the bottom of what is going on biologically in ME/CFS? Does he think the same for cancer research? Or does he single out ME/CFS as not worthy of investigation?
It's true far too much research is being directed yet again at failed rehab approaches for ME/CFS and Long Covid.

DHSC should be told that government policy is causing disability

That is a disgusting thing to say about sick people. Garner should be CHALLENGED.
_____________________

If people promoting brain training methods want to help people with ME/CFS, the best thing they can do is raise funds for proper clinical trials of the methods, with all the ethical safeguards, objective outcome measures and control group with equipoise that would be required of a clinical trial of a drug treatment, just as Fluge and Mella did with Rituximab.

Until and unless that is done, we have no reason to believe claims of efficacy for the treatment, no matter how many people chatting to each other in private online groups are claimed to have recovered, nor how many SIRPA patients are alleged to be cured. Why haven't the SIRPA people done a clinical trial and published it, as biomedical doctors are expected to do before they make claims of efficacy of a drug treatment?

 

[Snow Leopard]

but those people deserve to be believed.

Anecdotes from strangers don't deserve anything. They could be a tiny proportion of people whom recovered naturally/due to other reasons.

Only people we know personally deserve to be believed.

I've noticed a huge difference in recovery/remission stories (over 25+ years) between those who've I've known retrospectively (before they tried whatever therapy) and those who I've only known afterwards.

There is a good reason why evidence based medicine demands randomised placebo controlled trials - to avoid selection bias and response biases.

 

[MrMagoo]

I have just read Paul Garner's summary slide from the SIRPA conference screenshot in this article. It says:

Quote:

In Summary:

• Biomedical ideology/dogma/fanaticism has trumped EVIDENCE
• Medical establishment is a complicit
• NICE should be ashamed
• ME/CFS Activist Societies should be CHALLENGED
• Research is being misdirected
• DHSC should be told that government policy is causing disability

end quote.

That is so outrageous it's would be funny if he had no influence.

I think we are getting a clearer idea of just how far people like Garner and Busse, both incidentally influential in Cochrane, are prepared to go in their attack on pwME. There is a level of sheer and overt nastiness I don't think we've seen before.

The DARVO is so triggering.

 

[Eleanor]

Milarepa, though turning green from a diet of nettles, did not develop ME/CFS in his Tibetan cave.

I know somebody who swears she was cured of Long Covid overnight by drinking nettle tea, so maybe that's the charm after all! (Except I also drank the nettle tea which she was kind enough to give me, and it did not cure me )

 

[Trish]

Paul Garner used to be an infectious diseases specialist. I wonder what he would think of a doctor who caught malaria and recovered, going around the world, saturating the media, medical journals and conferences with claims that they cured their malaria with positive thoughts. What would he think if they went around telling governments that they should stop supplying mosquito nets and spending money on research, and should instead tell all the people with malaria that they should do some online brain retraining?

I would say his behaviour about ME/CFS is just as irresponsible and irrational as that.

 

[Peter T]

I know somebody who swears she was cured of Long Covid overnight by drinking nettle tea, so maybe that's the charm after all! (Except I also drank the nettle tea which she was kind enough to give me, and it did not cure me )

Gathering nettles in quantity is hard work. Though I love the taste, like spinach the new shoots boil down to almost nothing. I once made a nettle lasagne for twenty people. It was a culinary success, but never again as I needed a large sack full of stinging nettles and the nettle prep took a long time and it was hard to avoid being repeatedly stung.

(added - of those twenty people two have developed ME, one Lyme’s, two a heart condition, one died in a car crash, another develop leukaemia and another MS, so perhaps nettles are best avoided in a world of medicine by anecdotes.)

 

[Eleanor]

Gathering nettles in quantity is hard work. Though I love the taste, like spinach the new shoots boil down to almost nothing. I once made a nettle lasagne for twenty people. It was a culinary success, but never again as I needed a large sack full of stinging nettles and the nettle prep took a long time and it was hard to avoid being repeatedly stung.

Respect! I once made nettle soup for two and that was trouble enough.