Revolting Cruelty : a Response to Michael Sharpe

Revolting Cruelty : a Response to Michael Sharpe
Greg Crowhurst 26th April 2011

Professor Michael Sharpe must be very fond of George Bernard Shaw; his infamous quote that people with ME are the "undeserving sick" , he claimed was from Pygmalion and here he is at it again,  in his latest article,(Sharpe 2011)  quoting Shaw   :" George Bernard Shaw teasingly referred to America and England as two countries separated by a common language, psychiatry and neurology increasingly appear as two specialities separated by different perspectives on what is in fact a common organ; the brain."

Indeed ! If only Sharpe  had expanded !! Is he, I wonder,  referring to how psychiatry has become far  too driven by ideology (and vested interests) ; rather than structural neuropathology ( Sabshin, M. (1990) ? What's  changed, I would like to know ,  since Ferenczi,'s  , although never having seen a patient with Tourette syndrome, suggestion in 1921  that the disease  was the symbolic expression of masturbation caused by sexual repression (Kushner 2000) and McEvedy and Beard's assertion in 1970 , without seeing a patient,   that ME is a case of "mass hysteria " ? As Compston (1978)  points out  : "McEvedy and Beard’s conclusions (of mass hysteria) ignore the objective findings of the staff of the hospital of fever, lymphadenopathy, cranial nerve palsies and abnormal signs in the limbs...Objective evidence of brain stem and spinal cord involvement was observed” 

Oh, Sharpe  could have gone on, couldn't he ? About how the typical psychiatric explanation for depression was narcissism, rather than Limbic-cortical dysregulation about how psychiatrists put    Obsessive Compulsive Disorder down to poor parenting rather than frontal-subcortical circuitry, right caudate activity, Schizophrenia to Narcissictic escapism rather than NMDA receptor activation in the human prefrontal cortex, Visual hallucination
to Narcissism rather than retinogeniculocalcarine tract, ascending brainstem modulatory structures, Auditory hallucination, again  to Narcissism, rather than frontotemporal functional connectivity, Eating Disorder - again- put down to Narcissism, rather than Atypical serotonin system, right frontal and temporal lobe damage and Bipolar Disorder - once gain, wouldn't you know it, put down  to ol' Narcissism, rather than Prefrontal cortex and hippocampus, anterior cingulate, amygdala. (Wikipedia) 

Mind you, Neurologists by all accounts struggle - here's a revealing  post by a young doctor -"tx", by the way ,  is a medical abbreviation,  for "no treatment " :

"the brain is a fascinating organ and many neurological disorders provide insight into some of its structure and function. i was interested in neurology for many years but that interest died during my third year rotation. people say there are things you can do in neurology to make their patients better. i say neurology probably does the least out of any specialty out there. out of the things that the poster above me listed:

dementia - no tx, just delay inevitable
headache - sometimes chronic headaches can't be treated, for the others, who cares, it's a headache
epilepsy - moderately successful
parkinson's - temporary tx only
stroke - no tx except for the 1-2% of patients who get tPa
huntington's - no tx
ms - no tx
chronic pain - no tx
brain tumor - send to neurosurgeons

these are the bread and butter cases, the core of most of your practice. other than epilepsy, the neurologist really doesn't have a huge impact on these main diseases. that to me is unsatisfactory. there are some rarer diseases that neurology can impact, but i can't rely on those to keep me going.

 Given  the   vast amount of biomedical literature (some 5000 papers) going back to 1934 ;  given  the fact that ME  was classified as a neurological illness by the WHO (ICD-10 G93.3) in  1969 ;   given  that ME was recognised as a specific disease entity by The Royal Society of Medicine in 1978 ; given  that ME  was recognised as an organic disease by the Department of Health in November 1987; given  that on  25th November 2008, the Northern Ireland Minister for Health, Social Services and Public Safety, admitted  that ME is "a very real and debilitating neurological  condition";  given that on 23rd February 2010, in an Adjournment debate on ME, Gillian Merron, Minister of State (Public Health), Department of Health, stated:“I want first to put on the record that we accept the World Health Organisation’s classification of ME as a neurological condition of unknown cause.";  given that on 28th May 2010, Kay Ellis confirmed on behalf of the UK Chief Medical Officer:“The Department’s view is that it is important to recognise that CFS/ME is a genuine and disabling neurological illness and health professionals must recognise it as such”;  given that on  11th October 2010, in a debate on ME in the House of Lords, the Countess of Mar asked the noble Earl ,  the Parliamentary Under Secretary of State for Health, (Earl Howe) whether the coalition accepts that CFS/ME is a neurological condition and he replied that the " Government accepts that it is a neurological condition”;  given that on  19th June 2008, Stephen Atkinson on behalf of the Department of Health confirmed:“I would like to assure you that the Department recognises CFS/ME as a neurological disease”; and given that on Feb 2nd 2011 Paul Burstow,  Minister of State, Department of Health, in response to Ian Swales MP,  confirmed that there is :"strong international consensus that CFS/ME is a chronic and disabling neurological illness. I want to stress that it is a neurological illness; it is not a mental health problem " ...... it is a "revolting cruelty" for Michael Sharpe to keep stirring up things in this way. 

My wife continues to suffer appallingly, without treatment, after 18 years,  as a result of these psychiatrist's influence.

FINE failed dismally, as did PACE. 

Sharpe failed to mention how unscientific the PACE trail was, how it used no objective measurements, how it took no biomedical measurements, how modest the "improvements " were  : 20 steps at a cost to the UK taxpayer of £5 million, how not one  participant got  even near to their previous levels of health.

He fails to mention the Association of British Neurologists response to the NICE Guideline : “(The Guideline Development Group) is tactically promoting Oxford criteria over the more widely used and recognised international CDC criteria – again, a clear evidence of psychiatrists’ influence on this group”.

Referring to a paragraph in the draft Guideline:  “This paragraph deals with a publication (Wessely et al, Lancet 1999) which was published as a HYPOTHESIS and which remains to be proven. However, the GDG seems to have taken it as a matter of fact. Please refer to the criticisms of this article in the Lancet.  Being only a hypothesis, (it) is totally irrelevant for the purpose of a dedicated guideline on CFS/ME”.

“The GDG should also be criticised for its total lack of reference to the neurological aspect of fatigue and its overemphasis and over-reliance on the psychiatric literature from a group of psychiatrists”.

“With the possible exception of some psychiatrists, most specialists prefer the international criteria to diagnose CFS/ME”.

“Clearly there is very little compelling evidence at present that these patients benefit from CBT and GET”.

“There is selective omission of research literature on reproducible neuroendocrine tests, with an overemphasis on research data from certain psychiatrists”.(Williams 2007) 

Myalgic Encephalomyelitis , is a serious biomedical disorder; only those in the final stages of terminal cancer or dying of AIDS can possibly know what it is like to experience the level of sickness that a severe ME patient has to endure for years, often decades on end .There is simply  nothing more devastating than  for a sufferer  to be shoddily dismissed by a Neurologist . 

I am so angry that Sharpe so lightly embraces the fact that most UK Neurologists do not accept ME. Patients do not have be told that !! My wife was dismissed 5 years of agony ago as just "requiring reassurance " .  I know the depths of despair that this rejection  engenders.

 Sharpe does not stress that  any Neurologist who dismisses ME as a psychiatric condition ,  is potentially in  breach of the GMC regulations, concerning  the legal requirement for doctors to keep up to date with developments in medicine and medical science (as clearly set out in “Good Medical Practice: Duties of a doctor. The duties of a doctor registered with the General Medical Council: 'Keep your professional knowledge and skills up to date' and 'Never abuse your patients' trust in you or the public's trust in the profession' ( Hooper 2010

Given the impact of Sharpe et al - and the hopeless Neurologists -  if  an ME patient or carer was going to quote George Bernard Shaw I fancy, like MJ Higgins, that  this is the quote they'd favor  -the one  from The Doctor's Dilemma  :

"I must reply that the medical profession has not a high character: it has an infamous character. I do not know a single thoughtful and well-informed person who does not feel that the tragedy of illness at present is that it delivers you helplessly into the hands of a profession which you deeply mistrust, because it not only advocates and practises the most revolting cruelties in the pursuit of knowledge, and justifies them on grounds which would equally justify practising the same cruelties on yourself or your children, or burning down London to test a patent fire extinguisher, but, when it has shocked the public, tries to reassure it with lies of breath- bereaving brazenness. "

Compston N. (1978 Postgraduate Medical Journal)

Kushner H (2000) A Cursing Brain, Harvard University Press.
Sabshin, M. (1990). Turning points in twentieth-century American psychiatry. American Journal of Psychiatry, 147(10),1267-1274.
Sharpe M (2011) Chronic fatigue syndrome: Neurological, mental or both.Journal of Psychosomatic Research 

Williams M (2007) Comments on the NICE Guideline on “CFS/ME”


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