Don't Trust The Authorities

Milgram a fraud?

… In the fifty years since publication of Milgram’s first journal article the obedience research continues to be cited as evidence of an enduring psychological truth: inside all of us is a Nazi concentration camp guard waiting to be called into service. Yet my archival research and examination of primary sources and that of other scholars contradicts this claim.

Milgram himself was privately aware of the methodological weakness of his research and struggled with many of the issues about the validity of experiments and their generalisability beyond the lab. Privately Milgram reflected that his work was more art than science, and described himself as a “hopeful poet.” …

Positive Psychology? Smelling Bull.

Nick Brown Smelled Bull (via)

Peer Review – Not Worth The Paper

Amazing:

The present investigation was an attempt to study the peer-review process directly, in the natural setting of actual journal referee evaluations of submitted manuscripts. As test materials we selected 12 already published research articles by investigators from prestigious and highly productive American psychology departments, one article from each of 12 highly regarded and widely read American psychology journals with high rejection rates (80%) and nonblind refereeing practices.

With fictitious names and institutions substituted for the original ones (e.g., Tri-Valley Center for Human Potential), the altered manuscripts were formally resubmitted to the journals that had originally refereed and published them 18 to 32 months earlier. Of the sample of 38 editors and reviewers, only three (8%) detected the resubmissions. This result allowed nine of the 12 articles to continue through the review process to receive an actual evaluation: eight of the nine were rejected. Sixteen of the 18 referees (89%) recommended against publication and the editors concurred. The grounds for rejection were in many cases described as “serious methodological flaws.” A number of possible interpretations of these data are reviewed and evaluated.

(via WUWT)

Psychiatry Kills – Just Say No

David Healy:

Patients with psychosis, just as they were 100 years ago, are now 4 times more likely to be dead after 5 years of treatment than the rest of us. Patients with schizophrenia are 11 times more likely to be dead – this is much worse than 100 years ago.

Patients with schizophrenia are 10 times more likely to be dead at the end of the first year of treatment than they were 100 years ago. There is no other illness in medicine where such a statement could be made.

Death in the early years of schizophrenia does not come from heart attacks or strokes – it comes from suicide. In their first year of treatment, patients with schizophrenia are over a hundred times more likely to commit suicide than the rest of us.

This is shocking. When I have written about the social function of psychology, I seriously underestimated what harm these psycho*s from the psychiatry department are doing.

A Diagnosis Is For The Patient, Not For The Doctor

1 Boring Old Man:

… The hostility towards psychiatrists about diagnostic labeling is actually in sympathy to the mentally ill who can be actually harmed by being diagnosed – in all kinds of ways. Saying a person has a DSM diagnosis isn’t like coding appendicitis – it may make a person uninsurable or unemployable for life. That’s a big hurt. And there are other subtle consequences. These days, there’s a big suspicion that diagnostic inflation is partially motivated by people drumming up business. With the DSM-5 diagnostic inflation, that’s hard to refute.

In this reaction to the reaction Dr. Pies makes what I consider a weak point – that doctors need to make diagnoses. Of course they do, but not in the Managed Care/DSM-5 way it’s done these days. I didn’t deal with insurance companies as a practitioner and was on no panels. When patients wanted to file insurance themselves, I producing bills with the diagnosis [ICD-9-CM] and session [CPT] codes. And I often saw it important to discuss this topic with the naive, as informed consent [do no harm has lots of meanings]. Diagnosis is something one does for a patient, not to or with a patient. Our diagnoses are more in the range of opinion than anyone would like to admit, at least the ones used for outpatients.

Stephen Ralph on Psychiatry, Behçet's, ME/CFS and Misdiagnosis

The achilles heel of liaison psychiatry

Stephen Ralph DCR(D) Retired.

30th March 2013

Hello there,

In recent years I have been considering the reliability of the whole “CFS/ME” diagnostic process.

From personal experience I have encountered numerous doctors who failed to possess the detailed specialist knowledge they needed to make a diagnosis of Behçet’s disease at both GP and specialist level.

From personal experience I have learned that standard blood tests or even CT/MRI scans or indeed other diagnostic tests such as endoscopy can and do fail to detect a complex clinical disease present in a patient.

I have no doubt that there is a diagnostic black hole between the insufficient knowledge of the doctor and pathologies that are not detectable by the basic tests they choose to request which produce negative results they then choose to rely on.

The diagnoses of “CFS/ME” and now Somatic Symptom Disorder have in my view been deployed by liaison psychiatry to exploit that black hole.

Once a diagnosis has been made, that diagnosis is presumed to be accurate by subsequent doctors but in reality there is no standard of diagnosis from one doctor to another which means that the whole diagnostic system – especially for complex clinical presentations – is a total lottery.

The system to challenge a given diagnosis has not been changed in decades.

In the UK a patient has a right to ask for a 2nd opinion but there is no guarantee that the doctor who gives a 2nd opinion will have sufficient knowledge to correctly assess a complex clinical presentation where the usual round of simple tests come back negative.

And, having been given a first opinion of “CFS/ME”; the doctor who considers that patient for a 2nd opinion already has a subjective view of what could be wrong with that patient because they have been re-referred by a GP who will give a medical history that may lean towards a CFS/ME diagnosis because the GP has insufficient knowledge to write an accurate 2nd opinion referral listing all the relevant symptoms that could add up to a rare disease such as Behçet’s disease.

In my own case as an example, my GP had no appreciation that my episode of Epididymitis was relevant to a possible case of Behçet’s and so this issue was not referred to when I was sent to another out of area doctor who formed that 2nd opinion.

With regards to “CFS/ME” a GP or a psychiatrist or a general rheumatologist will give the patient a diagnosis based upon the repeated reporting of a set of “invisible” symptoms over a period of months.

At present, “invisible” symptoms are being ascribed as “medically unexplained” or as a sign of somatisation.

The doctors who make these diagnoses are not specialists in rare and complex diseases such as Behçet’s disease where there is a significant crossover of “invisible” symptoms.

In the case of Behçet’s disease the bulk of Behçet’s research is focused upon those who show all the physical signs yet the majority of those who have Behçet’s do not have to show those physical signs and indeed patients with Behçet’s may show few or no visible symptoms at an outpatient examination.

There is in fact a research black hole representing the majority of Behçet’s patients who do not have all the obvious signs of the disease which in turn misinforms those who rely upon such research to inform them about other potential cases.

In short, the diagnostic system presently in place is stacked heavily against the patient.

Having thought about this for a considerable period of time I have come to the conclusion that the pyramid built by liaison psychiatry that fuels their involvement in “CFS/ME” revolves around a simple foundation assumption that a “CFS/ME” diagnosis handed to a patient must be the correct diagnosis.

If a GP or a psychiatrist carries out tests in conjunction with an immunologist or a rheumatologist; a set of negative test results is all that GP/psychiatrist/rheumatologist needs to give a “CFS/ME” diagnosis.

If that diagnosis has been handed to a patient by doctors who have little or no knowledge of complex sero-negative clinical presentations relating to rare medical diseases then there is a significant risk that the diagnosis he or she is giving their patient is in fact the wrong diagnosis.

As people reading this will know, I was subjected to a medical misdiagnosis by a number of doctor’s including GP’s and specialists.

The number of doctors involved went into double figures over a period of 12 years in total.

Over that period, my many individual symptoms were wrongly ascribed to conditions other than Behçet’s disease but in the end when all those symptoms were put together and compared to the correct diagnostic criteria for Behçet’s disease; a doctor finally looked at the evidence and came to the conclusion that I had been misdiagnosed and that I did in fact have Behçet’s disease.

In recent months I have asked pretty well all the liaison psychiatrists in the UK if they have encountered cases of Behçet’s disease passing through their out-patient clinics and none of them has replied that they had.

Professor Sir Simon Wessely for example told me that he was no Behçet’s specialist and that he would have to phone a colleague who was. Professor Wessely did not know if he had seen cases of Behçet’s pass through his clinic wrongly diagnosed as “CFS/ME”.

I recently e.mailed Professor Wessely to ask him about the outcome of his enquiries that were aided by one of his medical students but in spite of a rapid reply to my previous sequence of e.mails; Professor Sir Simon Wessely has not replied to my query regarding his findings.

I sincerely believe that I have homed in upon the Achilles heel of liaison psychiatry and their dominance of “medically unexplained” CFS/ME or indeed their latest diagnosis of Somatic Symptom Disorder.

It is my view from the evidence that liaison psychiatry; by providing doctors with the diagnostic option of CFS/ME and SSD have been responsible for the dumbing down of the clinical diagnostic process within our NHS and indeed around the world.

It is my view from the evidence that liaison psychiatry has made the potential for medical misdiagnosis acceptable practice within the medical profession as a whole.

Instead of considering rare sero-negative auto-immune disease explanations for cases of what end up as CFS/ME, a doctor now has an easy pathway to give a benign diagnosis of CFS/ME on the grounds that their set of negative test results together with a certain set of “invisible” symptoms means that the condition they are looking at is “medically unexplained” or an example of somatised symptom disorder.

Once medically misdiagnosed, the patient is disqualified from being in receipt of medications and therapies that would have been prescribed had that patient been correctly diagnosed in the first instance.

Disqualification of access to treatment will lead to that patient suffering considerably yet the doctors concerned will not recognise the severity of that patients suffering because that suffering will be put into the wrong context by that medical misdiagnosis.

I have known a case of Behçet’s disease where a patient was wrongly diagnosed as having “CFS/ME” for more than a decade and only had that misdiagnosis overturned when they suffered ocular micro-embolisms that caused permanent blindness in one eye and partial blindness in the other eye.

Away from Behçet’s we know of patients who suffered “diagnostic overshadowing” that lead to the late diagnosis of cancer and a rare heart condition.

The symptoms of cancer and the complex heart pathology were fatal in both situations and in both examples, the symptoms of neurological cancer and the heart pathology were almost certainly wrongly ascribed to the “invisible” symptoms of “CFS/ME”.

As far as the medical profession is concerned, a medical misdiagnosis or a medically missed diagnosis are considered as being “unfortunate”.

For the patient, a medical misdiagnosis or a medically missed diagnosis have profound and serious consequences and outcomes.

None of the doctors involved in making or perpetuating a medical misdiagnosis are subsequently held to account for what they have done to those patients.

In my own case, once I had been re-diagnosed I was treated as though I had simply failed back to the bottom of the pack.

There was no process of clinical education in that no investigation took place and no doctor involved was alerted to their poor clinical opinions that lead to me being medically misdiagnosed.

In short, it is my view that the clinical diagnostic process is in fact seriously flawed.

Patient’s are at risk from the medical profession at GP and specialist level.

In particular patients are at risk from an insufficient level of expertise used to make a complex diagnosis based on negative test results and a history of “invisible” physical symptoms.

Patients who present with a history of “invisible” symptoms and a set of negative routine test results are no longer referred to a super-specialist for the objective consideration of a set of relatively rare sero-negative medical diseases.

Instead, patients are given a benign diagnosis of “CFS/ME”; a diagnosis that by virtue of its own “somatisation” description – created by liaison psychiatry - is then incredibly hard or indeed impossible to overcome.

The present system seriously needs to be challenged and changed so that the patient has a fairer chance of being correctly diagnosed in the first instance and not medically misdiagnosed by inadequately qualified members of the medical profession.

The question is – how do we go about making a powerful effective challenge that effects such a change?

If we do nothing then nothing will change.

The medical profession have proven themselves happy to maintain the status quo.

As far as liaison psychiatry is concerned, it is imperative that the present system of a flawed diagnostic process stays exactly the same as it is today.

As far as immunology or rheumatology are concerned, they surely do not want their out-patient departments packed with patients who have discovered that they have been medically misdiagnosed.

A flawed diagnostic process fuels the creation of a base of “heterogeneous” patients who are subsequently involved in Cognitive Behavioural Therapy (CBT) or Graded Exercise Therapy (GET).

Those diagnosed as having “CFS/ME” are fodder for the exclusive “closed shop” self reinforcing research carried out by liaison psychiatry and no other parts of the medical profession.

One could argue that a totally unknown number of patients who are presently medically misdiagnosed with “CFS/ME” are in fact adding credence to the views of liaison psychiatry because a misdiagnosed patient will have a set of self perpetuating and untreated disabling symptoms (fueled by an unrecognised disease process) that the patient is unable to “cast off” or rid themselves of from a course of CBT or GET.

Those patients will reliably keep on reporting “somatised” “invisible” symptoms not because they have any mental impairment but because an auto-immune disease is producing those symptoms.

Such an unknown number of medically misdiagnosed patients can be accused by liaison psychiatry of being so neurotic or so somatised that they are unable to be “cured” by CBT.

Such misdiagnosed patients will be readily available year upon year for future “peer reviewed” research studies that go to reinforcing the validity of Somatised Symptom Disorder or “CFS/ME” using medically misdiagnosed patients to helpfully legitimise those artificial mental health labels.

Such misdiagnosed patients become – in the eyes of liaison psychiatry – desperately in need of even more psychiatric interventions and their sincere professional “help”.

Such patients become so firmly shunted into the somatisation cul-de-sac that they may never have their real diagnosis established unless they suffer a loss of sight or a pulmonary embolism or another “visible” crisis event such as a brain tumour or a fatal heart condition.

However, a pyramid can be reduced to rubble if the foundations are seen and recognised to be rotten.

Once it is realised that the pyramid is built on rotten foundations then when those foundations are condemned and removed, that pyramid will be reduced to rubble.

Sincerely,

Stephen Ralph DCR(D) Retired (diagnostic radiography)

See also…

http://www.meactionuk.org.uk/systemic-vasculitis-and-myalgic-encephalomyelitis.htm

The Difference between "Grief" and "Depression"

From 1 Boring Old Man:

…

• Phenomenology: This comment summarizes the phenomenologic differences; "the hallmark of grief is a blend of yearning and sadness, along with thoughts, memories and images of the deceased person, while in contrast, depressed people ‘see themselves and/or the world as fundamentally flawed, inadequate or worthless.’ In essence, the psychological pain in ‘normative grief’ emerges from loss of the ‘other’ – and self-esteem is almost invariably preserved in the early stages – while the central characteristic of depressed states is compromised self-worth. The phenomenological distinction is sharp."
• Natural History: Depressive illnesses tend to recur. He cites ample evidence to show that grief does not recur, nor does it predispose to future depressions.
• Staging: Another summary quote, well referenced; "Staging is another important distinction. While clinical depression may be presaged by warning signs or symptoms, and it may have a slow or abrupt onset, it generally lacks the stages integral to grief."
• Treatment Response: "Turning to treatment specificity, Shear expressed a common argument in stating that ‘depression requires treatment and grief requires reassurance and support’. The evidence base for antidepressant medication is convincing in relation to major depression – but is limited for the management of grief and often contingent on other factors, predictably including the presence or absence of a superimposed depression." If I may quote my friend who was prescribed Elavil when he was grief stricken, and I later asked him what it did for him, he replied, "It made me constipated."

I appreciate the clarity of this article. I wouldn’t have been able to parse the differences so crisply. To me, grief and depression are just different things [I think one can often distinguish them without even taking a history, though I'm not sure that such empathic communication is kosher in the DSMs].

The pandora’s box in this article is highlighted in red above. Parker suggests that many reactive depressions would fit better with grief than Major Depressive Disorder – that instead of broadening MDD, we should be moving in the other direction and limiting the use of this diagnostic category. He says this a suggestion, "Rather than drawing bereavement within the domain of the clinical depressive disorders (as DSM-5 appears still to favour), we might better lean the other way and consider whether many currently positioned clinical depressive disorders (especially the reactive depressive conditions) might fit more comfortably within a grief paradigm."

I would see this as more than a suggestion, rather something in the range of a mandate – an imperative. The removal of the Bereavement Exclusion is more than just a another goofy change to the DSM-5, it represents a bias that pervades the whole enterprise – diagnostic expansions that don’t medicalize the DSM-5, they dehumanize it…

What I find worthy to note is that "reactive depression" is basically "grief", or put in other words it is an depressive reaction to an cause of grief (which can be a chronic disease). And that this "reactive depression" may look similar at first glance to "depression" (as in "Major Depressive Disorder"), but is something different.

If you have an chronic disease and a co-morbid "reactive depression" (possibly caused by the disease), you can learn to cope. Learning to cope with your chronic disease. And learning to cope with your grief over your chronic disease.

If on the other hand you have a chronic disease and a co-morbid "major depression", trying to cope will not help you much with the depression.

And same as with the distinction between "fatigue" and "sleepiness", the distinction between "grief" and "depression" is an important one.

(However I don't have the impression that medical science knows how to deal with depression, no do I think that medical science has a clue about it causes. I'm confident that the causes of depression are nutritional in many cases, so we'll see how that plays out.)

The Psychological Stress Confussion

NPR interview on the topic of GWI:

DANKOSKY: So Dr. Steele, what do we know about the causes? Because there have been a number that we've heard about over the years. Maybe we can run through a few of them. One of the things that is mentioned sometimes is stress or PTSD, something that we've heard a lot about from these last few wars, Iraq and Afghanistan. How much does stress have to do with it, do you think?

STEELE: That's a really good question. I think for many years after 1991, after the war got over, a lot of folks really didn't know what to make of Gulf War Illness or Gulf War Syndrome. But at this point, now 22 years later, we actually have a lot of students that tell us a lot about what may have caused Gulf War Illness.

Most of the studies early on looked at things like stress and post-traumatic stress disorder, but we now know very definitely that Gulf War Illness, specifically in 1991 Gulf War veterans, is not a stress-induced or trauma-induced kind of disorder. The rates of things like post-traumatic stress disorder are very low in 1991 Gulf War veterans, much lower than we're seeing in current returning veterans from Iraq and Afghanistan.

However, there is a long list of potential causes that different people have looked at over the years, many things like the vaccines that veterans receive, the oil well fires that many of us remember from that time, all kinds of chemical toxicants that they were exposed to.

And just looking over the broad range of studies, at the many epidemiologic studies that have been conducted in this population, we know that several of these risk factors or toxicants have risen to the top in terms of the strength of evidence that suggests that they are connected with Gulf War Illness.

And at this point we can say that the highest risk factors relate to use of prophylactic medication given to veterans to protect them from nerve agents. That pill was called pyridostigmine bromide. In addition, there was extreme overuse of pesticides in some groups of veterans during the 1991 Gulf War. And so those are also linked to higher rates of Gulf War Illness.

And then we also know that some veterans were exposed to very low levels of nerve agents during the Gulf War, and there's also some evidence supporting an association between Gulf War Illness and the nerve agent exposures that happened during and after the war.

Overall, though, the studies consistently show no link between for example serving in combat and higher rates of Gulf War Illness.

Why is it, that if someone postulate that "stress" (or "lack of resilience" or some other "psychological fault" of the patient) is causative for a (hard to grab) disease, that there is so little scepticism? Why are people not challenged more if they spread their "psycho-stress confusion"? And we are not talking here about physical stress, no here supposed psychological stress (combined with some sort of supposed defect of the patient) should be able to cause physical disease like GWI? A disease that is unique to the gulf war veterans?

I'm sure the Theologians of the Wessely School have an explanation for why there are so many gulf war veterans have GWI – this will be an explanation however that does not create clarity, but an explanation that creates confusion instead…

The Problem With "Resiliency"

1 Boring Old Man:

No matter how it’s framed, seeing the traumatized person as not resilient implies that there’s something they could’ve done. That’s what they already think and the notion of resiliency reinforces that belief, which I think is false. If they could’ve, they would’ve. The essence of the post-traumatic illness itself is an attempt to "prevent the past" – eg become more resilient going forward through hypervigilance and other maladaptive mechanisms. Traumatic symptoms are often perceived by the afflicted as a defect, something bad about themselves. It’s hard enough to help them accept that it was something that happened "to them" rather than a weakness or something they did without throwing in un-resiliency to needlessly complicate matters.

It is always the same. The doctor, when faced with problems that are hard to grab, is tempted to see it as a fault of that person (instead of an lack of knowledge) – so if that person does not get better, it is the person's fault, and the doctor is vindicated. And if the person does get better, it is as well vindication of the doctor. The doctor can't loose with "blame the patient".

(Furthermore, having experienced personally, and read many anecdotes on how our "modern" nutrition drives anxiety, I strongly suspect that nutrition might play a substantially contributing role in diseases from the psychological/psychiatric/mental/neurologic/whatever spectrum like PTSD.)

"Vanishingly Small"

Michael Sharpe: The first thing is it’s a big problem, it’s a big problem in primary care and primary care chooses who they send to secondary care and it is across medical specialities about a quarter to a third of the patients seen fall into this category, so it’s a big problem. The second question is, do these people all go on to have [sic] disease that to have the symptoms explained if you just wait. And again the evidence is and our studies in neurology suggest even after a year very, very few people once they’ve been assessed by a neurologist turn out [sic] to have a disease. So it isn’t that if you wait the disease will always become clear, it usually doesn’t.

Norman Swan: And if you go and see a better neurologist?

Michael Sharpe: And if you go and see a better neurologist, people of course do end up doing this, they go and see multiple doctors in the hope that one of them will find a symptom [sic], but once you’ve seen a competent specialist doctor the chance of a second [specialist] finding something becomes vanishingly small.

Hear hear!

In the United States, a disease is defined as “rare” if it affects fewer than 200,000 individuals, or roughly one in 1500. Rare diseases are often poorly understood, with symptoms that can be difficult to diagnose, and can be life-threatening. Around 6,800 rare diseases have been identified and the large majority of them — up to 80% — are thought to have a genetic origin. Most rare diseases can’t be cured and many lack effective treatments because research on rare conditions is often hampered by a scarcity of study participants and poor funding.

If you add up all the rare diseases it turns out that about 30 million Americans suffer from a rare disease. That’s nearly 10% of the population — suddenly rare is not so rare!

I would say no doctor knows all of these 6,800 identified rare disease – the chances that any doctor misses a disease in a patient are very high if it is something the doctor does not deal with everyday. Given a patient with a random rare disease, every doctor will fail to make proper diagnosis, even if he is specialized in neurology. The only chance the patient has is to find the doctor who knows the disease.

And then there are the not so rare diseases (mediums diseases? well done diseases?), where I seriously doubt that most specialists know all diseases. Some doctors don't even know Behçet’s, for crying out loud!

To dismiss the utter importance of a proper differential diagnosis for supposedly "medically unexplained" symptoms is not acceptable behaviour for any doctor.

Plus, on average it takes 2 years for a patient with a chronic disease to receive a diagnosis (without any guarantee whatsoever that it is the correct diagnosis). The long tail is made up of people who have a disease that could be identified with current medical knowledge, however the medical profession is unable to deliver them a diagnosis in an acceptable time-frame. So equalling "Patient has no diagnosis after 1 year" with "Patient has no disease" is a highly unethical shell game by the good doctor – these fucking clueless butchers malicious psychoquacks very fine disciples of the Wessely school always try to move the pea when you are not looking carefully.

Leaving behind what is currently known, there are people who have diseases that are – gasp! – currently unknown to medical science. Who here would stand up and claim that every disease and every disease mechanism has been identified, that medical science knows it all, has all tests needed to identify diseases in a patient, and that there is nothing new to learn for medical science any more? If you are standing now, you are an idiot.

I will not dignify the rest of the bullshit that Michael Sharpe bloviates, except to remark that Sharpe is throwing lots of sand in everybody's eyes – including his own in his confirmation bias frenzy – to intentionally blur many medical concepts, psychological concepts and appealing to what he presents as some sort of "common sense" to push the psycho-woo of the Wessely School. If Sharpe were really interested in the reality of diseases with their peripheral fatigue and peripheral pain (and not his make-believe confirmation-bias psychological-woo "It's the brain who makes the symptom"), he would heed to look at the scientific work of people like Alan Light or Christopher Snell. Sharpe works very hard so patients with demonstrable physical disease should receive treatment by psychologist, and by psychologists alone – that this may be in his financial interest, but not in the medical interest of his patients, that he is unable to realize. Alas, as Thomas Kuhn and Max Planck have remarked before, we have to wait until they have died of old age and a new generation not entangled in idealistic BS has replaced these jokers.

To finish, I would say the chances that Michael Sharpe is a competent doctor, who acts in the interest of his patients, these chances are vanishingly small. However the chances that he is a psychoquack look more like on the order of being 1.0 (p<0.0000001).

My personal advise: Stay away from psychoquacks. First of all they feel harassed if you demand attention for your medical problems – medical problems are not their department, after all. And secondly it it might be bad for your health.

Psychiatric conditions in Behçet’s

Psychiatric conditions in Behçet’s

Psychiatric conditions occur only very rarely in Behçet’s syndrome, when parts of the brain which look after emotion and thought are affected by the meningoencephalitis noted above. Occasionally patients may present with hallucinations, and abnormal thoughts such as paranoia, and difficulty thinking and remembering. This is most uncommon and normally settles down well with the correct treatment.

Separate to this is the syndrome of fatigue, anxiety and depression which can also cause thinking and memory problems, but which is not related to a problem within the brain. This, in contrast, is very much more common, not just in Behçet’s syndrome but in most chronic and difficult conditions. This is not surprising, but some Doctors, even GPs, fail to recognise this and I have found that this is frustrating to patients. It has been shown that patients with Behçet’s syndrome show higher ratings on depression and anxiety scores, and that these scores vary with the severity of the underlying illness. So-called fibromyalgia symptoms (aches and pains with tiredness) also correlate with how the Behçet’s is behaving, but it is also true that the symptoms of anxiety and depression can make the Behçet’s feel worse when it is not actually in relapse. So it is a very complicated problem. Fatigue management and a positive outlook to the disease are best. Avoidance of overtiredness and planning of the day, to allow rest before and after an activity, work well, and most find that fatigue improves and memory becomes more efficient. It’s easy for Doctors to prescribe and hard for the patients to do!

Stephen Ralph on Behçet’s, ME/CFS and Misdiagnosis by Psychologists (2)

See part 1 here.

Permission to Repost

Hello there,

In the background during my absence from campaigning, I have been plugging away at trying to get individuals of influence aware of the associations between the invisible symptom set of ME and the invisible symptom set of Behçet’s syndrome.

I was recently told by one doctor dealing with “CFS” that he could only find 11 research papers on Behçet’s syndrome and that one of those was in German.

This doctor then proceeded to give me all the classic stereotypical presentations of Behçet’s syndrome including patients having clusters of mouth ulcers, genital ulcers, eye involvement in the form of uveitis.

And together with this I discussed the fact that the HLA B51 blood test that can show positive for a case of Behçet’s is more often than not negative for a patient who has Behçet’s.

I then pointed out the following which will become crucially important in the coming months.

If you take a look at this link.... http://bit.ly/V5tLAe you will see the various levels of symptom certainty needed to make a diagnosis of Behçet's Syndrome.

The certainty level exists for the purposes of clinical research which means that anyone who participates in clinical research will have the top level of certainty diagnosis and many of the easily visible and detectable signs of Behçet’s disease.

However, you will also see on that web page that it is still viable to have Behçet’s disease without all the obvious classic signs.

Even if you do not have those classic signs, you can still be diagnosed as having Behçet’s syndrome.

The fact is that nobody appears to have carried out any research into the other end of the scale…. The end of the scale where patients who can have Behçet’s have hardly any or indeed no visible signs that would be observable by a specialist at an out-patient appointment.

…

Stephen Ralph on Behçet’s, ME/CFS and Misdiagnosis by Psychologists (1)

See part 2 here.

Permission to Repost

Dear Reader,

As some of you reading this will know, I was dragged into the world of Myalgic Encephalomyelitis and Chronic Fatigue Syndrome way back in 1996/1997. At around this time I jointly set up MEActionUK and the companion website www.meactionuk.org.uk

At that time I had been a practicing diagnostic Radiographer at a busy district general hospital in Dorset.

During the three years of my training and subsequently over the period of practice I extensively covered human anatomy, physiology, pathology, patient care and hospital practice as well as radiographic photography, equipment and radiation physics.

Some of our lectures mirrored those of medical students.

We were familiar with “Gray’s Anatomy” for the sort of detail we needed to cover.

Although optional, I attended an autopsy during my training to enable me to appreciate the internal anatomy that we had been studying for many months.

I also observed open heart valve replacement surgery – the anaesthetist let me stand where he usually stood so I could see what was where and how the surgery proceeded.

Our education and my subsequent career was comprehensive until I was forced to retire due to ill health.

Over the 10 years of my education and career in diagnostic radiography, it was drummed into me that there was an overriding importance within my profession to provide the best quality radiography possible to enable the doctor to form the correct diagnosis with thanks to the information presented to the radiologist (a doctor specialising in reading x-ray’s and performing x-ray examinations) or indeed any generic doctor or even medical students examining our work in a busy A&E.

If our work wasn’t to the highest of standards then we understood that there was a sliding scale of risk that a radiologist or non-specialist doctor could draw the wrong conclusions – missing a pathology from poor radiographic technique and then forming the wrong diagnostic opinions about what they were looking at.

…

Informed Consent? Psychologists Don't Need No Stinking Informed Consent

The function of ‘functional’: a mixed methods investigation

Abstract

Objective The term ‘functional’ has a distinguished history, embodying a number of physiological concepts, but has increasingly come to mean ‘hysterical’. The DSM-V working group proposes to use ‘functional’ as the official diagnostic term for medically unexplained neurological symptoms (currently known as ‘conversion disorder’). This study aimed to explore the current neurological meanings of the term and to understand its resilience.

Design Mixed methods were used, first interviewing the neurologists in a large UK region and then surveying all neurologists in the UK on their use of the term.

Results The interviews revealed four dominant uses—‘not organic’, a physical disability, a brain disorder and a psychiatric problem—as well as considerable ambiguity. Although there was much dissatisfaction with the term, the ambiguity was also seen as useful when engaging with patients. The survey confirmed these findings, with a majority adhering to a strict interpretation of ‘functional’ to mean only ‘not organic’, but a minority employing it to mean different things in different contexts – and endorsing the view that ‘functional’ would one day be a neurological construct again.

Conclusions ‘Functional’ embodies real divisions in neurologists' conceptualisation of unexplained symptoms and, perhaps, between those of patients and neurologists: its diversity of meanings allows it to be a common term while meaning different things to different people, or at different times, and thus conceal some of the conflict in a particularly contentious area. This flexibility may help explain the term's longevity.

Honestly, who doesn't love it when psychologists mislead patients, and lie to them?

HIIILARIOUUUUS, I tell you.

"First do no harm?" Hippocrates, shmoppocrates.

Trust us!

Give up your anti-psychological attitude!

We mean you no harm!

Now do as I say and calmly take your pills for your *cough* functional *cough* disorder.

If the psychologist does not understand what is wrong with the patient, the first order is to blame the patient and the second order is to lie to him. And then put the patient on anti-depressents, or even better anti-psychotics, for good measure – that'll teach those unruly patients, foolishly seeking help for their medical problems at a psychologist.

Informed consent, to god-damned hell with informed consent!

We don't use informed consent. In fact, we don't need informed consent.

We treat patients without any stinking informed consent, you god-damned cabrón and chinga tu madre!

Physical activity is not a adequate treatment for depression

BMJ: Facilitated physical activity as a treatment for depressed adults: randomised controlled trial

Conclusions

The addition of a facilitated physical activity intervention to usual care did not improve depression outcome or reduce use of antidepressants compared with usual care alone.

Who would have thought? You can't simply "walk off" your depression. Now what does that tell us about GET, which seems to be equally common sense to psycho-quacks?

Wolfgang Lutz on Anxiety

(Adapted from a comment of mine at the blog Ad Libitum)

A consistent theme I notice (which for me started with my personal experience) when I read in blogs/forums about personal nutrition experience is that people with anxiety problems, who go Paleo/Atkins/Lutz/VLC/whatever diet, is that they get rid of their anxiety problems after a change in nutrition.

People talk a lot about nutrition in the context of obesity and diabetes and cardiovascular disease and what not – the elephant in the room is to which mental/psychological problems/diseases does nutrition contribute, and by how much?

E.g. Wolfgang Lutz mentioned in the german edition of his book that he got rid of anxiety. However it is only one short paragraph and it is hidden in the back of the book. As this passage is only in the german edition of Wolfgang Lutz's book, I think it is important to translate the passage into english.

It is a bit difficult to translate, as he uses an older idiom for his psychological ailments, which tends to be a bit ornate and flowery. In addition there were (due to the pre-scientific nature of psychology) a few changes in meaning of words, both in german and in english, and I am not really intimate with the history of each term  – how do you translate "seelisch" in the context of that short passage? As emotional, psychological, mental? What were the "Komplexe" that plagued him? I have a vague idea what he meant, but unfortunately he choose not to elaborate on that topic and did not deliver a more precise description (I guess the social stigma of not being able to handle your psychological problems…).

So take my translation with some grains of salt.

… I was [before my change in nutrition] in a constant state of emotional agitation and imbalance, which might have not been visible by others though. Somehow I was always plagued by complexes, anxious about something, expected bad news, and had the feeling to be constantly driven/pushed.

[After the change in nutrition] … Generally, my mood was much more balanced, and I could enjoy my life more than before; the feeling of inner arousal was gone. Only now I could recognize that palpitations in dangerous situations were gone – such as in traffic – and that I no longer broke out in sweat so easily. Making decisions was now much easier for me, which especially benefited the time I spent on radiology and giving dictations. Suddenly I had time for my hobbies, which I had to abandon because I had no energy left to spare for them.

Wolfgang Lutz – "Leben ohne Brot" ("Life without bread"), page 247

He makes good observation about obesity ("male" obesity pattern vs. "female" obesity pattern), he fails to record his (and his patients!) improvement on the "psychological front" in more detail however. Getting rid of anxiety and increasing energy was – at least for me – by far me more important than getting rid of a few (or even many) pounds. Was this "mental energy" he couldn't spare for his hobbies, or was this full blown fatigue (or even CFS?) that dragged him down? We'll never know.

Here is the passage in the german original, for all you kraut-speaking schweinhunde :-)

… Schließlich befand ich mich [vor der Kostumstellung], gemessen an heutigen Maßstäben, in einem ständigen seelischen Erregungszustand und Ungleichgewicht, was allerdings nach außen vielleicht nicht so sehr in Erscheinung trat. Ich war immer irgendwie geplagt von Komplexen, hatte vor irgendetwas Angst, erwartete eine unangenehme Nachricht, und hatte das Gefühl ständig angetrieben zu sein.

[Nach der Kostumstellung] … Überhaupt war meine Stimmung viel ausgeglichener, und ich konnte mein Leben nun mehr als früher genießen; das Gefühl der inneren Erregung war verschwunden. Jetzt erst merkte ich, dass ich in gefährlichen Situation, z.B. im Straßenverkehr, kein Herzklopfen mehr bekam und dass ich nicht mehr so leicht schwitzte. Ich konnte mich viel schneller entschließen als vorher, was sich besonders in einer Verkürzung der Durchleuchtungs- und Diktatzeiten äußerte. Plötzlich hatte ich wieder Zeit für meine alten Hobbies, die ich vorher eines nach dem anderen aufgegeben hatte, weil ich hierfür keine Energien mehr erübrigen konnte.

Wolfgang Lutz – "Leben ohne Brot", Seite 247

Take the Meds – We have nothing else

It feels wrong, somehow, and that feeling of wrongness-but-I-can't-explain it is what prompts a national dialogue, but what Dr. Anderson really did that causes the consternation isn't prescribing the Adderall but saying out loud that it isn't for ADHD-- breaking the unspoken rules of the system by telling the press what none of use dare say even to our patients: that we're not medicating a diagnosis, we're using a diagnosis to justify the medication we have to use anyway because we have nothing else to do but give out medications.

Where is the Evolution in Medicine?

The sequencing of the human genotype promised a lot, but it delivers only slowly and in small doses. Maybe gene expression studies will change that, but I won't hold my breath. I heard the gut microbiome is the latest rage and it will solve all our problems (it may be important, but not that important).

Meanwhile medicine seems to be wholly incapable to tackle massive problems like obesity, diabetes and cardiovascular disease. In diseases like MS progress seems glacial, despite the resources dedicated to its research.

What I am relatively hopeful however is that an better understanding of the evolutionary context of our nutrition (aka "The Paleo Diet" and somesuch) will be a game changer in medicine – and surely bring us a much needed improvement for our health.

So it brings me pleasure that I found a new blog from that area, Ad Libitum, of which I post just this one snippet:

You know, the first time I read Good Calories, Bad Calories, it struck me that there was a missing chapter right after the dementia chapter. There should have been one on psychiatric illness. It is no coincidence that our epidemic of metabolic derangement has coincided with a huge explosion of anxiety and depression, especially of the atypical kind. My bet is that whatever is making us fat is making us miserable too. Processed carbs? Hyperinsulinaemia? I don’t know. Whatever it is, it’s killing us in multiple ways.

The "Gold Standard" in ME/CFS Care

Currently, when the question comes to what ME/CFS* patients should receive as treatment, it is recommend that "Cognitive Behavioral Therapy" (CBT) and "Graded Exercise Therapy" (GET) be used – this was supposedly established in the "PACE trial".

Now, which data was collected in the "PACE trial" with regards to recovery rates and positive outcomes, when CBT and GET are used to treat ME/CFS?

“The requested data relating to recovery rates and positive outcomes do not exist. That is to say that such analyses have not been done and there is no intention to do so. The reason for this is that the analysis strategy has changed from the original protocol.”

Come again?

There is no data on recovery rates and positive outcomes with CBT and GET as therapy?

So this is the gold standard in ME/CFS care?

This is the best that these psychology-quacks can come up with?

As the Americans say: You gotta be shittin me.

--

* ME/CFS is an syndrome, most possibly a group of several disease, with demonstrable primary physical pathologies not due to deconditioning nor caused by mental/psychological problems.

Nutritional Causes for "Somatoform Disorders"?

This came in via dxrevisionwatch.com

… Finally, even though the investigated groups did not differ in their health habits, a tendency to always live and eat healthy had a specific and adverse effect on physical impairment in somatoform patients. This result is rather counterintuitive, but may be explained with an increased selective attention to bodily processes in general and somatosensory amplification [30,52]. Therefore, the respectable attempt to improve one's health may contribute to a vicious cycle of symptom perpetuation. …

Hmm, a person eats "healthy" – cereal grains instead of meat, seed oils instead of saturated fat, and lot's of dairy to top it off – and their "somatoform" impairment gets worse?

Truly a paradox.

If you accept that "healthy" food is healthy, that is.

If you have reason to believe that "healthy" food is actually bad for health and can cause disease – because most of the "healthy" food is evolutionary novel – this paradox goes away. And one can suspect that "somatoform disorders" are actually bodily diseases caused or at least perpetuated by unwise nutritional choices…

Of course these psycho*s will ignore any of this and continue to believe in their psychosomatic/somatoform woo.