Discussion in 'Health News and Research unrelated to ME/CFS' started by Andy, Jul 10, 2019.
I agree with their end-point, but not how they got there, at least not completely. Masking the role of trauma and adverse events? Wasn't it this emphasis that was in part responsible for how the psych world got to this dilemma in the first place?
I pretty much can fall in line with the other three main findings.
I still have a hard time accepting that the 'everything is caused by trauma' crowd isn't some sort of satirical take on psychology.
Thank you very much to these authors.
This is what pwME experience. Assumptions made about our reaction to symptoms. Assumptions made about what is normal in the face of the terrible, debilitating multiple symptoms we have. And attachment of a stigmatizing diagnostic label with no treatment, or ineffective/harmful treatment applied.
From the article:
"Professor Peter Kinderman, University of Liverpool, said: “This study provides yet more evidence that the biomedical diagnostic approach in psychiatry is not fit for purpose. Diagnoses frequently and uncritically reported as ‘real illnesses’ are in fact made on the basis of internally inconsistent, confused and contradictory patterns of largely arbitrary criteria. The diagnostic system wrongly assumes that all distress results from disorder, and relies heavily on subjective judgments about what is normal.”
I think these labels categorize many if not all who receive them into the garbage bin of medical treatment. That's one of my take-aways from this article. The label is more or less the end of "treatment", not the beginning. Example - horrendous home life, much abuse of various kinds - finally free of that situation - develop symptoms of anxiety and depression - receive some sort of psych label - whatever the therapist is inclined to choose; now the focus is on the label, and brushes aside the reason for the symptoms. That being said, I don't know how to fix the situation for that person, and in a number of circumstances neither do therapists.
Back to CBT - trying to convince people their "abnormal" reaction to trauma and adverse events is not normal, and should be more positively spun, in order for the person to accept the poor/dangerous/harmful situation as a good thing, or not so bad after all. A potentially very dangerous tactic in therapy.
Many years ago* I found myself sitting in front of a CBT therapist - my first encounter with one (it was not M.E. related). I had asked my GP to refer me for counselling and thought that was what I was there for. At the time I was going through an extremely difficult divorce, facing homelessness (with my two daughters) and discovering that I had in fact been married to a sociopath (in the true meaning of the term - not an exaggeration). At the time of my first appointment I was feeling severely depressed but by the end of the second session I was suicidal. I quit the 'therapy' and managed to get myself back to being able to cope with my emotional and physical state.
Since that time I have met a number of other people who have also been made to feel suicidal by CBT 'therapy'. The thing that I have discovered (not scientifically of course but through conversation) is that the one thing we all had in common was the experience of significant, severe abuse in either adulthood or childhood or both.
How CBT is still passing as a 'neutral' therapy that carries no risk of harm is absolutely criminal.
Edit: *This experience of CBT was before the introduction of IAPT into the NHS.
I think this isn't really a study but an opinion piece.
Psychiatric diagnoses are problematic because they lack a biological marker such as CFS. That creates heterogeneity and overlap with other disorders, but I don't see what the better alternative is. I suspect the authors favor a psychodynamic view where symptoms are viewed in relation to childhood trauma. I don't think that's a better alternative. The medicine seems worse than the disease in this case.
Original research paper is available on Sci-hub:
It all comes down to falsifiability. Those diagnoses cannot be falsified, they depend on personal judgment and those are prone to bias and all sorts of influencing factors. Even worse with the trauma thing, since everyone reacts differently to it and there is no standard method of assessment.
And seeing how obsessed some segments of psychiatry are with us and MUS, it's pretty clear that as a whole the profession does not have the ability to tell apart their own patients from people who have no psychiatric issues. This is a massive problem, especially when psychiatry has the power to essentially overrule all other care on a mere say-so. IMO it invalidates most of its standing and should lead to psychiatry being downgraded and severely limited in its ability to intervene without specific consent. A little knowledge is even more dangerous when it is abused with utmost confidence by people who reject the very notion they may ever be mistaken.
Sadly it seems the real problem is not fully understood. Asking and answering the wrong questions instead of solving the problem.
I suspect that the senior people in the pysch world understand the problem very well, but just can't face the consequences of admitting it.
Ultimately this looks like it boils down to promoting interrogation of patients until they admit to some 'trauma' or 'adversity', which is then used to justify unrestricted delivery of various psychotherapies suiting the whim of providers.
The lead author said
"I hope these findings will encourage mental health professionals to think beyond diagnoses and consider other explanations of mental distress, such as trauma and other adverse life experiences."
Or alternatively she might consider the 2013 criticism of the DSM-5 made by the director of NIH's National Institute of Mental Health
"The weakness [of the DSM] is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever."
"....it is critical to realize that we cannot succeed if we use DSM categories as the “gold standard.” The diagnostic system has to be based on the emerging research data, not on the current symptom-based categories. Imagine deciding that EKGs were not useful because many patients with chest pain did not have EKG changes. That is what we have been doing for decades when we reject a biomarker because it does not detect a DSM category."
"That is why NIMH will be re-orienting its research away from DSM categories. Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system."
I remember an interesting paper from the time that examined the biomarkers found in patients with three different DSM illnesses. The researchers did find three distinct groups by biomarker - but those biomarker-defined groups did not correlate with the DSM diagnoses.
I have not followed this work so I cant say what progress they have made on this since then
"That is what we have been doing for decades when we reject a biomarker because it does not detect a DSM category."
Whole problem in a nutshell.
Trying to force real round pegs into imaginary square holes, then blaming the peg when it doesn't fit.
Very much so.
My daughter had cbt via CAHMS for anxiety. The second session was a fishing trip for early childhood trauma which she found very upsetting. The therapist simply could not accept what she was telling them .CBT was a disaster and left her no better for it and thinking she had " failed"
Given psychology' s bad rap for creating memories that didn't t exist it leaves little confidence in what passes for therapeutic provision.
I agree. This is just propaganda for those who want to think they know how mental illness works - all due to Neo-Freudian idea about trauma. It is one side of psychiatry bitching about the other.
Psychiatric diagnoses are far from perfect but most of the time they serve a useful purpose - at least if used by experienced level headed people who do not want everything to be explained by trauma.
The last bullet point gives away the fact that the authors are far less 'scientific' than the people they criticise. They like to think each individual patient's illness can be understood but asking leading questions - no doubt followed by psychotherapy to solve the problems diagnosed in that case. No science there at all.
Everything is due to trauma. Isn't this basically Freud again? Maybe with less sex obsession.
I agree with the suggestion that there are problems with often arbitrary diagnostic categories based on often overlapping symptoms.
Sod all to do with 'trauma' though :
Summary from the full paper if anyone is interested (my para breaks and bolding):
This is partly right. Some senior psychs do realise, but its been publicly admitted, even written up in books. The issue is then, what can be done about it? Psych diagnoses are best guess, not scientific, but without diagnoses you are operating outside of medical norms. Of course even with diagnoses of this quality you are operating outside of medical norms. There appears to be no easy way forward.
Which is why I have been saying for many years now that the medical profession needs to find ways to embrace uncertainty.
A question I have been concerned with for a long time, and plagues ME research as well, is how good is "science" when you have no idea of the actual diagnostic entity of the patients in a study? We are trying to deal with this in ME right now using deep data on highly selected patients, like in the severe patient study. We are also aware even ME may be more than one disease, or some kind of spectrum.
Highly selected to exclude conditions which may be directly biologically relevant?
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