Psychological therapists' judgements of pain and treatment decisions: The impact of ‘medically unexplained symptoms’, 2020, Jones & Williams

https://www.sciencedirect.com/science/article/abs/pii/S002239991930666X#!

 

I can't access the full text at the moment. This is what a Google Scholar alert shows me:

 

Sci hub link, https://sci-hub.se/10.1016/j.jpsychores.2020.109937

 

I see there was a specific option about CFS.

 

I am interested in understanding how people who believe in psychogenic illness think.

This is an interesting study. It appears to show that a lack of medical explanation for pain, incombination with a diagnosis of CFS, has the following effects when compared to a patient with medically explained pain:

The patient's pain is rated as less severe (-.648 points difference on a 0-10 scale).
The patient is more likely to be suspected of exaggerating their pain (.93 points difference).
The cause of the patient's pain is more likely to be suspected a mental health problem (2.27 points difference).
The cause of the patient's pain is less likely to be suspected a physical health problem (-2.10 points difference).

Unfortunately it's rather easy to criticize this study, because I have doubts that such an experiment accurately reflects reality. The participants could be altering their responses due to being observed (hiding their own ugly biases), and because it doesn't replicate a patient talking face to face with a health care worker.

 

Arguably they haven't the appropriate skill set to assess these patients effectively anyway.

 

I don't think its arguable. NOBODY has the skills yet, we need objective tests for that and objective pain tests are still needing better research. You might think that under this condition that the precautionary principle, where physicians don't jump to conclusions, should dominate. Its clear this is not the case with many physicians.

I still think psychogenic medicine functions as an escape clause so physicians can pass patients along and absolve themselves of responsibility. Yes, its hard, that is no excuse.

 

If there ever was a way to objectively show just how wrong they are at assessing whether someone is exaggerating, or hiding, I wonder if they would be horrified or insist that the test must be wrong. Literally no human ever has had those skills when detached from a confident diagnosis expressly accounting for pain. I don't know where the misplaced confidence comes from that they are nailing it, but in reality this ideology tends to do far worse than chance (I consider incorrectly labeling pain as psychological as an error, recognition as such isn't useful) when there is a strong belief in psychogenic stuff.

I don't know how well a photo can capture the real experience, it would be worth doing more in-depth, but there's still no objective value that can be compared to. Cognitive problems leading to difficulty expressing and responding to questions likely plays a huge role in deciding someone is exaggerating, that requires in-person dialogue. There are certain types that are probably more identifiable, but even then the belief that CBT has any impact beyond answers on a questionnaire is itself a problem.

False attribution error syndrome strikes again.

This is a pretty sober, and accurate, realization:

I agree with the "for some". This is essentially the same excuse with PACE. Problem is we have no means to accurately diagnose and many are negatively impacted under the current approach of "yeah yeah, for some, but you still have to do it and if you don't get better it's still your fault". And the "for some" is likely an almost infinitesimal number, likely a low single-digit % that have very different features outside of superficial similarity.