Chronic fatigue syndrome: is the biopsychosocial model responsible for patient dissatisfaction and harm?

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'.

Contesting the psychiatric framing of ME/CFS

“…In 2014 it received less research funding than hay fever and significantly less than diseases with a similar or lesser disease burden (NIH 2015). In addition, studies have shown that patients with CFS/ME routinely feel disbelieved and deeply dissatisfied with their medical care, especially when doctors ignore or challenge the legitimacy of their illness experience (Blease et al 2016;Deale and Wessely 2001;Geraghty & Esmail 2016;Jason et al 2002). It is clear that the response of health practitioners to the condition can have an impact on the well-being of patients and sociological research has explored the consequences of living with an illness which lacks medical legitimacy on the sense of self and identities of individual sufferers (Millen and Walker 2002;Travers and Lawler 2008;Whitehead 2006).…”

“…Since the 1980's treatment of ME/CFS came under the auspices of psychiatry and mental health services and most research has been undertaken within a psychiatric paradigm, conducted by psychiatrists and psychologists (David et al 1988;Jason et al 1998;Torres-Harding et al 2005;NAM 2015). During this time, there was an underlying belief amongst some psychiatrists, the general public, and even social science scholars that ME/CFS is 'psychological' and might even be related to 'mass hysteria' (Petrie and Wessely 2002;Showalter 1997;Geraghty & Esmail 2016). This assumption has been criticised due to the predominance of women ME/CFS sufferers and the chequered history of the psychiatric and medical profession's mistreatment of women (Richman and Jason 2001;Wright 2016).…”

“…A dominant psychiatric approach to ME/CFS emerged that accepted that whilst the illness may be 'triggered' by an illness, such as a viral infection, it is prolonged over time by unhelpful and inaccurate thoughts, feelings and behaviours or 'abnormal illness beliefs' leading to selfperpetuating vicious circles of fatigue, behaviour, beliefs and disability (Geraghty & Esmail 6 2016; Mountstephen and Sharpe 1997;Page and Wessely 2003). Medical practitioners often assume that CFS/ME is primarily a psychological or psychiatric problem and that symptoms can be alleviated by modifying patients 'perception' of their illness using methods such as Cognitive Behavioural Therapy and 'Graded Exercise' (Jason et al 2001;Steven et al 2000;Geraghty & Esmail 2016). Despite a heavily contested evidence base (ME Association 2015; Tuller 2015), these have been endorsed in health policy guidelines (e.g.…”

“…In addition, ME/CFS support groups have been criticized by the psychiatric establishment for: supporting 'false illness beliefs', 'stimulating chronicity'; being over-represented by chronic sufferers; denying patients effective treatments; not wanting people to recover; and even creating a 'mass psychogenic illness' by transmitting unsubstantiated health worries via the internet (Petrie and Wessely 2002). Yet many sufferers find specialist ME/CFS support groups and services offer invaluable information and support, especially when they have little support from mainstream services (Broughton et al 2017); Millen et al 1998;Geraghty & Esmail 2016). Indeed one consistent finding is that patient's value having their illness experience accepted and validated (Broughton et al 2017).…”

Treating medically unexplained symptoms via improving access to psychological therapy (IAPT): major limitations identified

“…This may be true for patients with a range of mental health complaints, but it is not a transferable argument for patients with medically unexplained symptoms. ME/CFS patients for instance, reject psychiatric framing of the illness [25] and many perceive cognitive behavioural therapies to be both unhelpful and harmful [41,56,67]. Such facts should not be ignored by IAPT supporters.…”