On Insanity: Ladies Nervously Affected

While participating in the Feministe thread on fibromyalgia, I’ve been re-reading a few UK-based journal papers on how chronic fatigue syndrome is all in our heads and shit.

I just re-stumbled across this little nugget from the British Medical Journal, in “ABC of psychological medicine: Fatigue”[1]. The Journal’s hugely popular “ABC” series has been widely reprinted into a series of textbooks used in medical schools, including in Australia.




Patients should be told that they are suffering from a common and treatable condition that the doctor takes seriously and for which behavioural treatment can be helpful. While patients may be concerned about possible disease and the need for medical investigation and treatment, it can be explained that no disease has been found, and hence there is no disease based treatment, but that with help there is a great deal that the patients can do themselves.

Identifying unhelpful beliefs—Potentially unhelpful beliefs should be discussed. If a patient has a simple aetiological model (such as “It is all due to a virus”) an alternative approach based on a biopsychosocial formulation can be outlined. This has the advantage of highlighting potential perpetuating factors, as these may be regarded as obstacles to recovery. Doctor and patient can then work together to overcome these. It is rarely productive to argue over the best name for the illness; instead, the emphasis should be on agreeing a positive and open minded approach to rehabilitation.

[Box]: [image – 1836 artwork depicting women walking in a garden-like setting] Image caption: Patients should be encouraged to gradually increase their activity. (“Mrs Bradbury’s establishment for the recovery of ladies nervously affected,” from On Insanity by William B Neville London 1836)

[1] BMJ 2002;325:480-483

Categories: medicine

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12 replies

  1. OMG. I just looked up the pdf myself because I thought I was misunderstanding you. I thought you were understandably pissed about what they were saying and had put in the illustration and caption to further highlight how asinine the instructions were. Surely to god the BMJ didn’t really include that?
    And yet they did! Oh my fucking god, they really published an article on fatigue that had that as an illustration. I probably should include some pithy observation or commentary here, but I’m still stuck at OMFG.

  2. Now I really DO feel sick…

  3. Well, nobody knows more about women’s health than the Victorians. 😀

  4. And these people apparently have no concept of what they’re saying. Surely they would laugh at those silly doctors who thought a woman’s “hysteria” could be cured by removal of her female-parts, or that clitoridectomy is required when a woman masturbates. And yet here they are, complaining of “unhelpful beliefs” and “negative beliefs” (or whatever phrase the doctor used) — that women are just worrying themselves into illness, and that illness (which is far more than just “worries too much”) can be cured — or even just partly alleviated! — by convincing these women to stop thinking about the pain and fatigue, so they don’t thereby create it.

  5. The only word I can think to type in response to that is, shit!

    Where would we write to the BMJ or whoever is responsible for peddling this trash?

  6. I can’t believe the timing of this. It’s been on my mind all night waking up in a bad mood thinking about it.
    Yesterday I went to the DR and even though i booked a long appt. to discuss a heap of intensification of pain issues i’ve been having the past 3 months, Centrelink stuff etc. it was clear from the start that he was running seriously late and that he wouldn’t even let me finish the initial update I was giving him over what had been happening the past 3 weeks. First off i had to say that the last sick certificate had 2008 rather than 2009, on it and it needed to be corrected. Maybe he didn’t take that too well, as he’d done the same thing on the previous Centrelink certificate in Jan or Feb.?
    He interrupted my update saying your last tests we can’t find anything – your problem is diabetes – I don’t want to hear about the pain – this is about your out of control glucose levels- are you taking the medication? See this, and he pointed me to the screen which i couldn’t see clearly enough to read but saw a short sentence and remember he said something about my ideas about this. He said eat smaller portions and I don’t care about Centrelink – I care about you being a grandmother – then he said i’m increasing the medication see me monthly and then gave me a script and stood up. Don’t need the coding here I definitely felt bounced right out and charged $76 up front just so i could feel some financial pain as well. (to his credit he often bulk bills me but yesterday did not)
    Maybe he was having a bad day, but there were a few things that may have triggered this – but I had an appt with my physio who works at my Drs clinic and it was a similar thing raised – I pick up that you’ve had many serious experiences with accidents when you were young and you catastrophise – making the brain send inappropriate pain signals to that foot and hip.
    I’m flabbergasted by this as I’ve been seeing the physio regularly the past 3 months because C1 and others in neck and shoulder are out and ive been getting terrible headaches and some kind of spinal inflammatory systemic pain thing.
    Then as that was getting better, spurred on by taking my medicine from work rehab services to be ‘productive’ from about 6 weeks ago, I went outside and started rushing around in the garden and promptly injured my foot, twisting not to fall and effecting my previously problematic painful hip and now giving me a bad leg.
    But here it is plain as you like I’ve got diabetes, unhelpful beliefs and a mere sprained ankle that i’m sabotaging the recovery of. As well, I had to stop myself from raising with the physio about her last treatment. Last time i went to the physio she taped my injured foot but in the shoddiest way with bunched up tape and wrongly placed. So much so that the following day when I finally got active again after not being able to weight bare for very long (I’m 77kg) the tape was interfering with achilles tendon movement and I was developing a pressure sore from it and Mum had to remove the tape and dress it so i could continue to wear shoes. (Mum is a sports trainer and has done a lot of specialised first aid training)
    I’ve come home from those appointments thinking that they went nearly as well as when I tried to raise swine flu quarantine with my neighbour whose kids had just come home from the basketball carnival in Melbourne…hahaohhh
    Thanks for tolerating the rant and for raising these issues as they are very much still on the agenda for reform. Any tips about sites with suggestions for communicating better with health professionals?

  7. At this point I’m thinking of suggesting to the next psych-theorist I come across that my “wandering uterus” may be what’s keeping me bedridden.

  8. The depressing part for me was that
    Patients should be told that they are suffering from a common and treatable condition that the doctor takes seriously is more than a lot of people get.

  9. I’d like to comment, but have the Ague and the Greensickness (not to mention my wandering uterus, which is playing Runescape on the other computer) and must retire to my fainting couch.

  10. (not to mention my wandering uterus, which is playing Runescape on the other computer)

    I really, really want a cartoon of this.

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