Sick of the Sick Role: Narratives of What “Recovery” Means to People With CFS/ME, 2020, White et al

Andy

Retired committee member
Little is known about what recovery means to those with chronic fatigue syndrome/myalgic encephalomyelitis, a poorly understood, disabling chronic health condition. To explore this issue, semi-structured interviews were conducted with patients reporting improvement (n = 9) and deterioration (n = 10) after a guided self-help intervention, and analyzed via “constant comparison.” The meaning of recovery differed between participants—expectations for improvement and deployment of the sick role (and associated stigma) were key influences. While some saw recovery as complete freedom from symptoms, many defined it as freedom from the “sick role,” with functionality prioritized. Others redefined recovery, reluctant to return to the lifestyle that may have contributed to their illness, or rejected the concept as unhelpful. Recovery is not always about eliminating all symptoms. Rather, it is a nexus between the reality of limited opportunities for full recovery, yet a strong desire to leave the illness behind and regain a sense of “normality.”
Open access, https://journals.sagepub.com/doi/10.1177/1049732320969395
 
:emoji_face_palm:

The article continues the usual confusion of the people in the pro-CBT bubble between PEM and the hypothetical "boom-bust" activity patterns.

Narratives from our participants suggest that ideas from mindfulness (living in the present moment without judgment), the body positivity or neutrality movements (which advocate the acceptance of all bodies no matter what their appearance or functionality), and focusing on happiness or meaning in life (e.g., Seligman) could provide alternative frameworks to explore with patients. Research has also shown that acceptance and commitment therapy, which has a focus on the individual’s life values and goals, can be helpful for CFS/ME (Jonsjö et al., 2019).

Sure, but that has nothing to do with recovery!
 
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The meaning of recovery differed between participants—expectations for improvement and deployment of the sick role (and associated stigma) were key influences. While some saw recovery as complete freedom from symptoms, many defined it as freedom from the “sick role",

I would be astonished if any of the participants had any idea of the concept of "the sick role" before being primed. Presumably the quotation marks are to indicate something other than quotation.
 
I would be astonished if any of the participants had any idea of the concept of "the sick role" before being primed. Presumably the quotation marks are to indicate something other than quotation.

Exactly right. Here is one of the patient quotes where the authors interpret as a desire to 'leave the sick-role'

You said to me do you consider yourself to have ME and my initial reaction was like, oh God no I’m fine and in reality, I obviously am managing it but maybe I, I hate the label because of the stigma. So for me it’s like I manage the symptoms that my body presents me with but I can’t bear that bloody label because it’s got such a bad stigma. I had a school friend who had it when she was a teenager . . . and my parents . . . just went on about what a fake illness it was.
 
Recovery is not always about eliminating all symptoms. Rather, it is a nexus between the reality of limited opportunities for full recovery, yet a strong desire to leave the illness behind and regain a sense of “normality.”

So "recovery" is not "full recovery". Now there's a bit of self-serving word play. We were wrong, know we were wrong, don't intend to admit we were wrong, so will instead redefine the meaning of right, and try to convince you enough so you buy into our bullshit.

I do feel this more recent spate of papers from the BPS folk is more about shapeshifting get-out-of-jail carding, than actually trying to improve the lives of patients - I think it is their own lives they are trying to improve. Their boats are burnt, and they and are now trying to convince the natives they really were on their side all the time, and on the side of righteousness.
 

:D:D:D:D:D:D:D:D

Not read the paper itself, so had not seen this. You really could not make it up could you ...
While some of these participants with little hope found describing their recovery challenging, others appeared to respond by moving their “recovery goal posts”—highlighting the achievement of obtainable goals over a full return to health.

Their very act of writing this is an exercise in moving goalposts, trying to redefine their own threshold for credibility as scientists. Well I'm afraid they have got their goalpost move completely wrong, because they have scored a huge own goal.
 
The article continues the usual confusion of the people in the pro-CBT bubble between PEM and the hypothetical "boom-bust" activity patterns.

There is also a conflation of PEM with fatigue: "A characteristic feature [singular] is postexertional malaise or fatigue." Do they not know that these terms are not interchangeable?

And then: "The key CFS/ME symptom, postexertional malaise, may be partially responsible for this [boom-bust] cycle as it leaves individuals unsure as to how far they can push themselves (as symptoms may be delayed). However, this research suggests that a desire to leave the sick role behind may cause those with the condition to adopt unhelpful management approaches."

Aargh!
 
These guys seem unable to distinguish between recovered, and adapted to or accommodated.

And who in their right mind would want the ME/CFS label? I totally get why the long-haul COVID patients are running a mile from it when they see what has happened to us.

Because he’s moved his retirement goalposts.
He's not retired, he's resting.

"However, this research suggests that a desire to leave the sick role behind may cause those with the condition to adopt unhelpful management approaches."
Heads they win, tails we lose.

The primary feature of their 'model' is that it makes no difference how we behave, we cannot win. Our behaviour is always going to be interpreted as pathological.
 
They excluded patients who "had physical contraindications to exercise", so in a paper on ME, they excluded ME-patients. Brilliant!

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"Others came to consider their life before CFS/ME an undesirable state, which had contributed to their becoming ill in the first place, a place they did not want or need to return to"

Strange, so these participants without ME, does not want to be healthy?

"These participants’ accounts appear to be consistent with Parsonian theory in terms of being able to largely leave the sick role behind through resumption of societal roles rather than the freedom from symptoms."

Bizarre conclusion , when they said they still have symptoms!

"Devendorf et al. (2019) found that physicians conceptualized recovery as a complete remission of symptoms and a return to premorbid functioning."

And thank god they do, instead of a "nexus between the reality of limited opportunities", the latter is called coping.

"Indeed, science philosopher Canguilhem believed that a return to the pre-illness state was not possible because the experience of being ill inevitably alters the person, even their memory of being unwell will have some sort of impact"

Well thats helpful psychology for ya

"Such expectations are in line with the literature which suggests that the longer individuals have been ill when they receive treatment, the less successful it is likely to be"

Yea maybe because there is no treatment that works? Ever thought about that?

"Parsons considered being sick an undesirable social role. Although the role excuses the sick from some societal responsibilities (e.g., work), there is the expectation that those occupying the role should seek to leave it as soon as possible"

Yes shame on the faking ill

"all approaches (graded exercise therapy, cognitive behavioral therapy, pacing) agree that the boom and bust cycle is undesirable"

Not in practice

"Any outcomes related to participant-defined recovery would need to be interpreted with the complexity that self-definition raises, where patient interpretations of recovery are grounded in their own personal circumstances and belief"

That would be an disaster for research
 
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