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Cognitive Behaviour Therapy By Mary Schweitzer, Ph D
marymsch@COMCAST.NET
Carl
Graham asks us whether CBT as a concept has been sufficiently polluted 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 belief system. It requires the assumption
that if there is no APPROVED objective test for a medical condition, then
the condition must belong in the domain of psychiatry. In the
history of medicine, the reverse has always been the case. Charcot's
hysterics were epileptics and victims of third-stage syphillis. Women with
hysterical paralysis turned out to have Multiple Sclerosis. "Cold Mother
Syndrome" is now called autism.I have no quarrel with psychiatry
as a profession. There is no doubt that the profession of psychiatry
has saved patients with such biological disorders as bipolar syndrome
and schizophrenia from myths of demons or self-indulgence. 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 inappropriate
diagnoses.It is exceedingly ironic that White, Wessely,
Sharpe, and Chalder, the most visible psychiatrists pushing this
particular brand of sophistry on the public, 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.Yet article after article is published, the
"peer reviewers" apparently losing all their critical reasoning skills.
The same research is repeated; the authors all cite each other frequently.
The result is the appearance of scholarship with no
scholarship.Here is an example of the excesses to which the
theory of "cognitive behaviour therapy" coupled with "inappropriate
illness beliefs" has taken us, from the King's College, London, website on
CFS for professionals:( http://www.kcl.ac.uk/projects/cfs/health/
)"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 times 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 support 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 required enormous
courage and persistence. Each move back into (her words) 'real 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 many
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 working with anxiety must acquaint themselves
with a far slower pace of change, much less spectacular progress. They
must acquire patience, and lower their 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 patients with "CFS" who are confined to
wheelchairs are there because of medically verifiable physical
limitations, the scenario described on the King's College 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 mistreated in the name of a false science; as long
as insurance companies and government institutions rely on such advice - how
can a thinking person take the chance of dignifying such practices by
promoting the phrase "cognitive behaviour 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
chance?Psychiatry as a profession should be so embarrassed by
this performance to assign the phrase "Cognitive Behaviour Therapy" to the
dustbin of history, along 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 scholarship is, frankly, beyond me. Perhaps
it has to do with the patient in the 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, warfare. 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.
In 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 extensive efforts to treat her, the good
doctor decided that her claim was too grotesque 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.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 pushers and proponents of
"biopsychosocial" medicine have been unusually prolific - 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 index as highly
regarded, too. Highly regarded by themselves alone, perhaps, but the
citation index does not make these distinctions. It simplies counts 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 the
cruel version. Children and young people have been taken from their
families 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 Reeves' "empiric [sic]" questionnaires, the U.S. has
finally arrived at a purely psychiatric view of CFS.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 professional
should run, not walk, from their terminology. The dangers are too great: the
risk lies in legitimizing an inherently illegitimate
activity.Has CBT as a concept been sufficiently polluted in
CFS research and clinical use that it will have to be
retired? My answer is an
unqualified "Yes."
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