in CFS research and clinical use that it will have to be retired.
My answer is an unqualified "Yes."
The key is the association with ANOTHER questionable concept in psychiatry:=
"inappropriate illness beliefs."
"Inappropriate illness beliefs" is itself a type of ideology, a type of bel=
ief system. It requires the assumption that if there is no APPROVED objecti=
ve test for a medical condition, then the condition must belong in the doma=
in of psychiatry. In the history of medicine, the reverse has always been =
the case. Charcot's hysterics were epileptics and victims of third-stage s=
yphillis. Women with hysterical paralysis turned out to have Multiple Scle=
rosis. "Cold Mother Syndrome" is now called autism. =20
I have no quarrel with psychiatry as a profession. There is no doubt that =
the profession of psychiatry has saved patients with such biological disord=
ers as bipolar syndrome and schizophrenia from myths of demons or self-indu=
lgence. And many who would have dropped by the wayside have been saved by =
the counseling they received from intelligent and caring therapists.
But psychiatry as a profession is also a minefield of confused and inapprop=
riate diagnoses.=20
It is exceedingly ironic that White, Wessely, Sharpe, and Chalder, the most=
visible psychiatrists pushing this particular brand of sophistry on the pu=
blic, always open their presentations (in print or lecture) with the claim =
that they are breaking down Cartesian mind-body dualism. They then proceed =
with a dualistic theory as to what is wrong with the patient and how to fix=
it.
One has to reach back to the "four humors" to find such a thoroughly theory=
-driven model of how the body works.=20
Yet article after article is published, the "peer reviewers" apparently los=
ing all their critical reasoning skills. The same research is repeated; the=
authors all cite each other frequently. The result is the appearance of s=
cholarship with no scholarship.
Here is an example of the excesses to which the theory of "cognitive behavi=
our therapy" coupled with "inappropriate illness beliefs" has taken us, fro=
m the King's College, London, website on CFS for professionals:
<http://www.kcl.ac.uk/projects/cfs/health/>=20
"Many clients have built up an infrastructure of support, a coping network,=
to help them manage their illness. One of my clients had, over the years, =
established a rota of friends and volunteers, who visited two or three time=
s daily to help her with meals, washing, housework etc. Mostly she was in a=
wheelchair, and walked only with crutches. She wore a neck-collar to suppo=
rt her head. For her, the road to recovery involved the gradual dropping of=
each one of these props. To put it in her words, she had to "wean herself =
of" her network of support, her chair, her crutches, her collar.
"Each new reduction in her dependence was a step into the unknown. This req=
uired enormous courage and persistence. Each move back into (her words) 're=
al life' was potentially that step too far that would send her into relapse=
. The spectre of the bed and the wheelchair is never far from the mind of m=
any sufferers.
"This weaning is not quick. Two years later we carry on the journey, though=
her strides are that much firmer and more confident. Therapists used to wo=
rking with anxiety must acquaint themselves with a far slower pace of chang=
e, much less spectacular progress. They must acquire patience, and lower th=
eir own unrealistic expectations of speedy recovery. In short, we must fall=
into pace with the client."
If these psychiatrists are wrong - if so-called "chronic fatigue syndrome" =
really is caused by biomedical phenomena - and if the vast majority of pati=
ents with "CFS" who are confined to wheelchairs are there because of medica=
lly verifiable physical limitations, the scenario described on the King's C=
ollege website is unspeakably cruel. The reader is reminded of scenes from=
"Elmer Gantry."
As long as that practice remains; as long as patients are grossly mistreate=
d in the name of a false science; as long as insurance companies and gover=
nment institutions rely on such advice - how can a thinking person take the=
chance of dignifying such practices by promoting the phrase "cognitive beh=
aviour therapy"?
No matter how well meaning, in the end the author risks having his/her own =
words used in an act of unspeakable cruelty. Why would you take that chanc=
e?
Psychiatry as a profession should be so embarassed by this performance to a=
ssign the phrase "Cognitive Behaviour Therapy" to the dustbin of history, a=
long with eugenics and phrenology (the belief that a person's character can=
be assessed by looking at the shape of his/her head). Do not say it "could=
" mean something different. A set of rogue psychiatrists has given a fixed =
meaning to this concept, and it has been applied to extend the suffering of=
patients with a severe disease. AND THE PROFESSION OF PSYCHIATRY HAS DONE=
NOTHING TO STOP THIS.
Why the profession itself has not risen up in anger against this false scho=
larship is, frankly, beyond me. Perhaps it has to do with the patient in t=
he above scenario almost always being a woman. Neurasthenia, like hysteria=
, has historically been considered a "woman's" disease - attributed by such=
as Simon Wessely to men only when they fail in the most manly of duties, w=
arfare. Perhaps lingering prejudices against women's internal makeup have =
provided the loophole through which these clearly absurd ideas have spread =
unchecked. But neurasthenia does not have the most respectable history. I=
n the nineteenth century, it was paired with hysteria to create the medical=
view that young women should not be permitted to study science or math in =
high school (if they were permitted to attend high school at all). Freud's=
version of "neurasthenia" came from the case of Anna O, whom he concluded =
secretly wished to have sexual relations with her father as a child. Only =
the release of Freud's private papers showed the opposite: Anna O herself =
had come to Freud because her father HAD sexually abused her. After extens=
ive efforts to treat her, the good doctor decided that her claim was too gr=
otesque to be true. Only then did he create the OTHER version of the story=
- that she had imagined it because she wished it to be so. =20
With such a history, I would think psychiatrists would be doubly careful to=
police their profession for such misguided theories.
We are not talking about something hidden away in a corner. The CBT/GET pu=
shers and proponents of "biopsychosocial" medicine have been unusually prol=
ific - often publishing more than one paper on the basis of a single study.=
They cite each other frequently, so they would show up on the citation in=
dex as highly regarded, too. Highly regarded by themselves alone, perhaps,=
but the citation index does not make these distinctions. It simplies coun=
ts the citations - the more, the better, no matter why.
Do you really expect bureaucrats to make the fine distinctions between one =
form of CBT and another? They do not, as a rule, and the money is behind t=
he cruel version. Children and young people have been taken from their fam=
ilies and placed in foster homes or psychiatric institutions on the beliefs=
bolstered by proponents of CBT and GET. It has taken its time getting to =
the United States, but with the help of Emory's psychiatry department and R=
eeves' "empiric [sic]" questionnaires, the U.S. has finally arrived at a pu=
rely psychiatric view of CFS.=20
As long as psychiatry refuses to clamp down on the con artists of Cogitive =
Behaviour Therapy and "CFS/ME" as they sometimes call it, a thinking profes=
sional should run, not walk, from their terminology. The dangers are too g=
reat: the risk lies in legitimizing an inherently illegitimate activity.
Has CBT as a concept been sufficiently polluted in CFS research and clinica=
l use that it will have to be retired?
My answer is an unqualified "Yes."
Mary M. Schweitzer, Ph.D.
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