From the British Journal of General Practice, 1 August 2016.
Chronic fatigue syndrome: is the biopsychosocial model responsible for patient dissatisfaction and harm
Keith J Geraghty, Honorary Research Fellow
Aneez Esmail, Professor of General Practice
Centre for Primary Care, Institute of Population Health, School of Community Based Medicine, University of Manchester, Manchester.
Correspondence: Keith J Geraghty, Honorary Research Fellow, Centre for Primary Care, Institute of Population Health, School of Community Based Medicine, 7.29, Williamson Building, University of Manchester, Brunswick Street, Manchester M13 9PL, UK. E-mail: keith.geraghty@manchester.ac.uk
Abstract
In 1977 George Engel wrote about the need for an ‘integrated approach’ in medicine that moved the focus beyond biological mechanisms of disease to include all pertinent aspects of illness presentation, setting out a ‘biopsychosocial model’.(1)
Around the same time, McEvedy and Beard asserted that the disease ‘benign myalgic encephalomyelitis’, described by Ramsay at the Royal Free Hospital, London, was nothing more than a case of ‘mass hysteria’.(2)
In the 1980s, doctors combined theories of neurasthenia, hysteria, and somatoform illness, to reconstitute ME as ‘chronic fatigue syndrome’. Psychiatrists argued that CFS was best understood using a biopsychosocial (BPS) framework, being perhaps triggered by viral illness (biology), but maintained by certain personality traits (psychology) and social conditions (sociology).(3)
Although the BPS model holds much utility in understanding ‘illness’ in a wider context, many sufferers of CFS reject the notion that their illness is psychologically or socially derived. Significant numbers of patients report difficult interactions with doctors that leave them feeling dissatisfied, disbelieved, and distressed.
In this article, we question whether or not the BPS model generates ‘harms’ for CFS patients, and we ask if other, alternative approaches might be more preferable to both patients and GPs.
Yes.
Biospsychosocial is more a viewpoint than a model and its first object of study is itself. What does BPS mean according to the BPS viewpoint?
Judging by its practice in ME/CFS, BPS means viewing bio thru the prism of the psycho social, emphasising the psychosocial above the physical with greta consistency.
Do this to see how you can curb smoking, dangerous tanning, injury from car accident – fine, a good viewpoint for that. But for many things INCLUDING, perhaps ironically much MENTAL ILLNESS, it is wholly inadequate and at times absolutely inappropriate, as BPS advocates know.
A reductionist BPS view of depression would be thrown out of court by all but the most obsessed idiots of the psychiatric world. And yet CBT/GET represents just such an obsession.
Assume a CBT/GET model for depression and you would have to ignore neurotransmission, neuromodulation, hormonal irregularities, mitochondria, immunology, antioxidant status, gut bacteria even. What is more you would have to assume the person had a false illness belief or was after secondary benefits, and block all treatemts except for CBT, on the ground that to consider and investigate the patient would convince them they were ill. “You are mad because you are biomedically ill” becomes “You are ill because you are mad for psychosocial reasons and to find any organic problem would only convince you that you are ill, which we cannot allow because you are mad, and being mad you will believe you are ill, which you are in no fit state to believe”. Utter absurdity.
The mentally ill are not subjected to this type of guff including by psychiatric advocates of CBT/GET. But CBT/GET represents just such a subjection of ME/CFS/misdiagnosded wastebasket sufferers and indeed FM if they can get their hands on them.
At the same time advocates of CBT/GET bemoan the poor standard of treatment for depression compared with, say diabetes, while supporting,in CBT/GET, something which is conceptually and practically far worse than what is offered to depressives.
We are told by the same peopel and some of their journalist friends that we fear the stigma of mental illness. We object that our symptoms are physical and that nowadays mental illness is considered organic in many cases anyway, so why the heck when we have an illness with physical symptoms and organic markers (albeit, as in depression a variety reflecting heterogeneity) should we be put in the mental box anyway, and even more so in the BPS mental box? Then we are told that we ourselves are contributing to such stigma and indeed to contempt for the mentally ill. While they offer us a “therapy” which, if analogous were offered to the mentally nill, would be deemed utterly contemptuous.
Who is mad?
The BPS model has wrecked my life from 1986 onwards and in 2014 could have cost me my life. Mistakes, misdiagnosis and neglect have followed me for the last 10 years and when a UTI from an E coli infection sent me into a state of confusion from Sepsis and into the hands of psychiatrists instead of a course of anti biotics, I was left terrorised and now suffering from PTSD.
No one has taken responsibility for this mistake and past mistakes.
My whole family have had their lives wrecked from this false assumption that ME is psychological or psychiatric. It is a biological disease and BPS should be removed from ME. It costs lives!