Friday, 30 January 2015

James David Chapman on Dangers of Psychological Therapies for ME.

James is well known for his astute Twitter comments on all matters ME, but when he takes to writing more than 140 characters at a time, it is well worth listening to what he has to say.

He wrote this on Facebook today and I'm delighted to be able to share it here as a guest post:

James David Chapman on Dangers of Psychological Therapies for ME. 

"It has been suggested ME patients actively resist psychological management and that this, our supposed prejudice, works to our detriment.

In 30 years with the illness, there have been times when I thought not to go on. So, I personally, strongly, believe that there is a place for psychological support in ME.

It is clear that many ME patients benefit greatly from the support of close friends, groups, or from the wider ME community online. Non-judgmental, validating, support isn't a talking cure but it is a valuable coping strategy for patients while research is being done.

Unfortunately ME patients do not find the same form of support from British Medicine as they do from their peers.

ME patients are subject to two strong institutional biases: firstly towards psychological treatment and, secondly, within psychology, towards behaviorism.

I would suggest that behaviorism is the polar opposite form of support to traditional therapeutic counseling. Of course it can be highly effective however, the very first thing ME should teach medicine is that behaviorism is not a universal panacea nor magic bullet. There are dangers here (as with all treatments)...if only we can bring ourselves to see them.

Many ME patients have dutifully undergone CBT/GET therapies but find exertion still hurts. In fact, many state that such treatment has greatly worsened their illness long term. These experiences are however routinely challenged or ignored. For, while patient behavior can be questioned, seemingly no questioning can be allowed of behavioral methodology, or indeed suitability to the condition, ME.

At its most extreme, behaviorism for ME has the capacity to relentlessly invalidate patient symptoms and experience and can ruthlessly challenge and break effective coping strategies.

Worst of all, impossible expectations in combination with reversal of responsibility from doctor to patient can create feelings of being abused or tricked: On attending their physician many ME patients could be forgiven for thinking "There is no way to win this game."

Through extreme behavioral bias I believe British Medicine is rapidly burning through its most precious resource of all: Patient trust."

James posts on Twitter as @batteredoldbook

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