Food, Diets and Dieting

Inequities

The world is full of contradictions, inconsistencies and inequities. On the one hand, it has been reported by the Food and Agriculture Organization of the United Nations (FAO, 2015) that 805million people are estimated to be chronically undernourished. Yet, it has been estimated that the volume of food produced is more than one and a half times what is needed to provide everybody on the planet with a nutritious diet (Weis, 2007). It is not about lack, it is about inequity. While 805 million starve, we also know that 1460 million are overweight or obese, and that number is increasing.

There is also water scarcity with 1.2 billion people lacking access to clean drinking water and 2.5 billion people having no access to a toilet, less than the number of people with a mobile phone (United Nations, 2015). As the world population increases from 7.3 billion today to around 9.6 billion in 2050 (+31.5%), the supply of fresh drinking water available will remain about the same. Yet, around 70 per cent of the world’s water is used in agriculture. Annual grain crops are planted on about 70 per cent of the world’s cropland and provide 80per cent of the world’s food (Pimentel et al., 2012), 70 per cent of which is stock feed for farm animals, which in turn produce dairy and meat.

Over the next 25 years, a lot more food will be needed for the extra 31.5 per cent and the only way it can be produced is through agriculture, creating a vicious circle. The FAO (2015) predicts that the global demand for livestock products will increase by 70 per cent by 2050 with an estimated 1 billion poor depending on livestock for food and income. The livestock sector contributes to human-induced Greenhouse Gas emissions for 14.5 per cent and is a large user of natural resources, especially water.

As Father Time waves his sickle over the remaining decades of this century, there will be a worsening water scarcity. Thanks in part to a ready supply of beef burgers, fried chicken, milk, eggs and cola. Many recent editorials in medical and scientific journals have addressed issues relating to food, diets and dieting (e.g. Drewnowski, 2014; Edmonds and Templeton, 2013; Fitzgerald, 2014; Gold and Graham, 2011; Ndisang et al., 2014; Pagadala and McCullough, 2012; Potenza, 2014; Sniehotta et al., 2014; Stuckler and Basu, 2013; The PLoS Medicine Editors, 2012; Yanovski, 2011).

Special Issue

The Special Issue on ‘Food, Diets and Dieting’ provides a state-of-the-art overview of psychological studies by international researchers on this topic area. The Call for Papers for a Special Issue on ‘Food, Diets and Dieting’ was timely; we received unprecedented interest with many high-quality submissions. Following peer review, the number of accepted papers finally reached the total of 42. The contributions have been divided into two sets for publication in the May and June 2015 issues of Special Issue: Food, diets and dieting. These publications in Journal of Health Psychology are complemented in our companion, open access journal, Health Psychology Open, by a theoretical review paper and a series of commentary papers (Marks, 2015).

According to the McKinsey Global Institute (2014) obesity is responsible for around 5 per cent of global deaths and the global economic impact is US$2.0trillion, or 2.8per cent of global gross domestic product (GDP), roughly equivalent to the impact from smoking or armed violence, war and terrorism. In the United States, in 2004, direct and indirect health costs associated with obesity were US$98 billion. That figure probably has doubled by now.

Depending on the source, it is reported that the direct medical cost of overweight and obesity combined has been estimated to be 5–10per cent of the US health care spend. 42million children under the age of 5 were overweight or obese in 2013. Prevalence of overweight or obesity in adults doubled from 6 per cent in 1980 to 12 per cent in 2008. By 2050, it is predicted that obesity will affect 60 per cent of adult men, 50 per cent of adult women and 25per cent of children making the United States, Britain and much of Europe a mainly obese society.

Globalization is Driver

The main driver of the obesity epidemic and increased prevalence of other non-communicable diseases is unregulated corporate globalization (Swinburn et al., 2011). From the point of view of human health, globalization flies a banner of progress and freedom yet brings illness and an early death to millions of people with non-communicable ‘diseases of affluence’. Transnational corporations are scaling up their promotion of tobacco, alcohol, cola and other sugary beverages, ultra-processed food and unhealthy commodities generally throughout low- and middle-income countries. Moodie et al. (2013) have observed that sales of unhealthy commodities across 80 low- and middle-income countries are strongly interrelated. They argue that wherever there are high rates of tobacco and alcohol consumption, there are also a high intake of snacks, soft drinks, processed foods and other unhealthy food commodities. Moodie et al. (2013) argued that the alcohol and ultra-processed food and drink industries are using similar strategies to the tobacco industry to undermine effective public health policies and programmes. Furthermore, it is suggested that unhealthy commodity industries should have no role in the formation of national or international policy for non-communicable disease policy. Therefore, it follows that the only evidence-based mechanisms that can prevent harm caused by unhealthy commodity industries are public regulation and market intervention.

Food Affordability

The work of Drewnowski and others has demonstrated a strong relationship between affordability of food and beverages and their energy density measured in terms of fat and sugar (Drewnowski, 2014; Drewnowski and Specter, 2004). A systematic review of 27 studies across 10 countries showed that a healthful diet costs around US$550 per year more than an unhealthy one (Rao et al., 2013). In England, another study suggested that the healthiest dietary pattern costs double the price of the least healthy, costing £6.63/day and £3.29/day, respectively (Morris et al., 2014). That is a difference of £1219 per annum.

The inverse relationship between income and prevalence of overweight and obesity follows from two related facts: (a) cheaper foods and drinks are energy-dense and (b) a healthful diet is unaffordable for the majority of people. In 2008, an estimated 1.46 billion adults worldwide had a body mass index (BMI) of 25kg/m2 or greater, and of these, 205million men and 297million women were obese. Taking into account, the rate of increase in obesity, this half-billion figure is projected to increase at least 30 per cent by 2050. The World Health Organization (WHO) (2014) estimates that around 3.4million adults die each year as a result of overweight or obesity. The WHO (2013) published a plan to halt the rise in diabetes and obesity as a part of a vision: ‘A world free of the avoidable burden of noncommunicable diseases’. WHO interventions revolve around ‘mobilizing sustained resources Marks 471 … in coordination with the relevant organizations and ministries’ which consists of high-level meetings between governmental representatives and publishing position statements.

Evidence and logic suggest that economic prosperity is the enabler for obesity and, furthermore, leading authorities have concluded that Obesity is the result of people responding normally to the obesogenic environments they find themselves in. Support for individuals to counteract obesogenic environments will continue to be important, but the priority should be for policies to reverse the obesogenic nature of these environments. (Swinburn et al., 2011) Policy reversals to reduce obesogenicity by regulation face robust resistance from the food and drinks industry. Yet without regulation to change the price imbalance between unhealthful and healthful foods, the obesity epidemic is unlikely to go away. In the meantime, hundreds of millions of individuals continue inexorably along the path of overweight and obesity, with the associated unpleasant illnesses and an early death. It follows that health care systems must be competent to offer effective interventions to prevent, treat and ameliorate the impact of overweight or obesity. Authorities decree that a ‘balanced diet’ with regular physical activity is of crucial importance to a healthy body. Yet, in spite of thousands of studies, hundreds of campaigns and scores of dedicated institutes and journals based on this creed, there are currently no validated public health interventions able to achieve sustained long-term weight loss. Today, the muchtouted idea of the ‘balanced diet’ seems little more than worn out myth. Some basic questions require answers: What is causing the obesity epidemic? What can be done about it? and What is the role of health psychologists (if any)? (Marks et al., 2015; Marks, in press). The obesity epidemic is comparable in importance to the smoking epidemic. Arguably, it will prove to be even more significant in human history than smoking. It took 50 years of consolidated pressure to reduce the prevalence of smoking related diseases. Progress has been frustratingly slow. Still, in 2015, only one industrialized country in the world has plain or standard packaging of cigarettes (Australia) with a second one planning to follow next year (England). With no significant interventions on the horizon for obesity prevention, for example, unhealthful food taxation, the obesity epidemic can continue unabated to run its course, until food and water shortages have their ultimate impact on human society.

Enough Knowledge Now to Tackle Obesity

There is enough knowledge now to tackle the obesity epidemic. Unfortunately our political leaders lack the spine to do what is necessary. Our market-led governance is in the pocket of the paymasters who influence the election of our presidents and prime ministers. If the food chain could be rationally developed, the food and water crises could be curbed within two decades from now. This Special Issue contains a collection of in-depth psychological studies on food, diets and dieting. These studies are relevant to the issue of why certain foods are eaten or avoided by individual consumers and how the choices of consumers are influenced by family, social and economic conditions. Diets and dietary changes involve complex systems of variables which operate on a mass scale. Improved understanding of psychological functioning around food, diets and dieting holds one key to improving nutritional health. A better understanding of behaviour alone is not enough; changes to the food environment are also necessary. Our governmental leaders need to wake up, loosen their ties to their industrial paymasters and take effective action.

References

Drewnowski A (2014) Healthy diets for a healthy planet. The American Journal of Clinical Nutrition 99(6): 1284–1285.

Drewnowski A and Specter SE (2004) Poverty and obesity: The role of energy density and energy costs. The American Journal of Clinical Nutrition 79(1): 6–16.

Edmonds EW and Templeton KJ (2013) Childhood obesity and musculoskeletal problems: Editorial Clinical Orthopaedics and Related Research 471(4): 1191–1192.

Fitzgerald DA (2014) Mini-symposium: Childhood obesity and its impact on respiratory wellbeing: Editorial title: Childhood obesity is the global warming of healthcare. Paediatric Respiratory Reviews 15(3): 209–284.

Food and Agriculture Organization of the United Nations (FAO) (2014) The State of Food Insecurity in the World: Strengthening the Enabling Environment for Food Security and Nutrition. Rome: FAO. Available at: http:// www.fao.org/3/a-i4030e.pdf

Food and Agriculture Organization of the United Nations (FAO) (2015) Livestock and the environment. Available at: http://www.fao.org/ livestock-environment/en/

Gold MS and Graham NA (2011) Editorial: Hot topic: Food Addiction & Obesity Treatment Development (Executive Guest Editors: Mark S Gold and Noni A Graham). Current Pharmaceutical Design 17(12): 1126–1127.

McKinsey Global Institute (2014) Overcoming obesity: An initial economic analysis. Discussion paper. London. Available at: http://www. munideporte.com/imagenes/documentacion/ ficheros/025183D9.pdf

Marks DF (2015) Homeostatic theory of obesity. Health Psychology Open. Marks DF, Murray M, Evans B, et al. (2015) Health Psychology: Theory, Research and Application (4th edn). London: SAGE.

Moodie R, Stuckler D, Monteiro C, et al. (2013) Profits and pandemics: Prevention of harmful effects of tobacco, alcohol, and ultraprocessed food and drink industries. The Lancet 381(9867): 670–679.

Morris MA, Hulme C, Clarke GP, et al. (2014) What is the cost of a healthy diet? Using diet data from the UK Women’s Cohort Study. Journal of Epidemiology and Community Health 68(11): 1043–1049.

Ndisang JF, Vannacci A and Rastogi S (2014) Oxidative stress and inflammation in obesity, diabetes, hypertension, and related cardiometabolic complications. Oxidative Medicine and Cellular Longevity 2014: 506948.

Pagadala MR and McCullough AJ (2012) Editorial: Non-alcoholic fatty liver disease and obesity: Not all about BMI. The American Journal of Gastroenterology 107: 1859–1861.

Pimentel D, Cerasale D, Stanley RC, et al. (2012) Annual vs. perennial grain production. Agriculture, Ecosystems & Environment 161: 1–9.

Potenza MN (2014) Obesity, food, and addiction: Emerging neuroscience and clinical and public health implications. Neuropsychopharmacology 39(1): 249–250.

Rao M, Afshin A, Singh G, et al. (2013) Do healthier foods and diet patterns cost more than less healthy options? A systematic review and metaanalysis. BMJ Open 3: e004277.

Sniehotta FF, Simpson SA and Greaves CJ (2014) Weight loss maintenance: An agenda for health psychology. British Journal of Health Psychology 19: 459–464.

Stuckler D and Basu S (2013) Getting serious about obesity. BMJ: British Medical Journal 346: f1300.

Swinburn BA, Sacks G, Hall KD, et al. (2011) The global obesity pandemic: Shaped by global drivers and local environments. The Lancet 378(9793): 804–814.

The PLoS Medicine Editors (2012) PLoS Medicine series on Big Food: The food industry is ripe for scrutiny. PLoS Medicine 9(6): e1001246.

United Nations (2015) Water Scarcity. Available at: http://www.un.org/waterforlifedecade/scarcity. shtml

Weis T (2007) The Global Food Economy. London: Zed Books. World Health Organisation (WHO) (2014) Obesity and overweight. Fact Sheet No 311. Available at: http://www.who.int/mediacentre/factsheets/ fs311/en/http://www.who.int/mediacentre/ factsheets/fs311/en/

World Health Organization (WHO) (2013) Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020. Geneva: WHO.

Yanovski SZ (2011) Obesity treatment in primary care – Are we there yet. New England Journal of Medicine 365(21): 2030–2031.

First published in the Journal of Health Psychology 2015

“Truly original…foundational”

A General Theory of Behavior is an innovative and promising new theory that integrates the long tradition of investigations on homeostasis with contemporary research in such diverse areas as emotion, addiction and sleep. A truly original and wide-ranging study of human nature, this book will be foundational for anyone who considers the importance of theory for modern psychology.

Henderikus J. Stam
Professor of Psychology at the University of Calgary

Cochrane Catastrophe

Peter Gøtzsche’s Expulsion Triggers Mass Resignation

The Board of a prestigious scientific organisation, The Cochrane Collaboration,  recently suffered a mass resignation.  This post documents the reasons why, using the words of the organisation itself. The board has been reduced from 13 to 6 members, following a vote to expel a founding member  for the first time in its 25-year existence.

On 14 September, Peter Gøtzsche, director of the Cochrane’s Nordic Centre and a member of its governing board, posted a statement on the centre’s website. This announced that he had been expelled as a member of the Cochrane Collaboration, after a vote by 6 of 13 of the board’s members.

A further four elected members of the board — which also has appointed members — stepped down in protest. To maintain a balance between appointed and elected members, the board also asked two appointed members to resign.

Gøtzsche claims no justification was given for his expulsion except that he was accused by the board of bringing the organization into “disrepute”. The organization — which carries out systematic reviews of health-care interventions — told Nature it had received “numerous complaints” about Gøtzsche after the publication earlier this year of a critique he co-authored, entitled ‘The Cochrane HPV vaccine review was incomplete and ignored important evidence of bias’ and published in the BMJ Evidence-Based Medicine.

Who or What is Cochrane?

I quote from the Cochrane website:

“Cochrane is for anyone interested in using high-quality information to make health decisions. Whether you are a doctor or nurse, patient or carer, researcher or funder, Cochrane evidence provides a powerful tool to enhance your healthcare knowledge and decision making.

Cochrane’s 11,000 members and over 35,000 supporters come from more than 130 countries, worldwide. Our volunteers and contributors are researchers, health professionals, patients, carers, and people passionate about improving health outcomes for everyone, everywhere. Our global independent network gathers and summarizes the best evidence from research to help you make informed choices about treatment and we have been doing this for 25 years.

We do not accept commercial or conflicted funding. This is vital for us to generate authoritative and reliable information, working freely, unconstrained by commercial and financial interests.

Our Strategy to 2020 aims to put Cochrane evidence at the heart of health decision-making all over the world.”

The Strategy to 2020 has hit a stumbling block. GOAL 4 is or was: “Building an effective sustainable organization.”

“To be a diverse, inclusive, and transparent international organization that effectively harnesses the enthusiasm and skills of our contributors, is guided by our principles, governed accountably, managed efficiently, and makes optimal use of its resources.”

In light of the torpedo the shambolic Governing Board has fired at its own organisation, the expulsion of Peter Gøtzsche, Goal 4 of the Strategy now reads like an ill-timed joke. The statement that spells the end of Cochrane is quoted below.

Bizarre Situation

The Cochrane website is currently as bizarre as can be. A Screen Shot taken this morning 2018-09-27 at 07.05.55 shows an announcement of Peter Gøtzsche’s expulsion immediately followed by the announcement of the 25th Anniversary event to celebrate Peter’s Nordic Cochrane Centre and the foundation of the Cochrane Collaboration:

Screen Shot 2018-09-27 at 07.05.55

Statement from Cochrane’s Governing Board

Statement made by the Governing Board at Cochrane’s 2018 Annual General Meeting, 17th September, at the Edinburgh Cochrane Colloquium

“Dear Cochrane members,

These are extraordinary times and we find ourselves in an extraordinary situation. Your Board is always happy to answer questions about our decisions, and today is no different. We want to explain how we got here today. This wasn’t our original plan because we wanted to behave fairly and with integrity, in a process that respected the privacy of an individual, whilst taking place over a number of days. Days, which unfortunately span this special Colloquium.

This is about the behaviour of one individual. There has been a lengthy investigation into repeated bad behaviour over many years. It is exceptionally unusual for a Board to have to do such an investigation.

Last Thursday, the Board took a decision which divided the Board. Subsequently, four Board members chose to resign. At the same time, others contributed to a public and media campaign of misinformation.

We recognize that the last 24 hours have been exceptionally difficult and as a result, we as a Board have decided to share with you information about the decision that was made, the process by which it was made, and where we are now, in order to act in the best interests of Cochrane.

We now want to put before you as much evidence as we can, so you know what is going on. We cannot tell you everything. All of you will understand why individuals have a right to privacy and confidentiality. We ask that you all respect this, because we may not be able to tell you everything, for legal reasons and reasons of privacy.

By way of background, we are a global organization which operates under British law because we were founded as a UK charity. Our mission is to benefit the public. We are governed by our Articles of Association.

As the Board, we are in fact the employers of the Cochrane staff. All our staff, and our members, have the right to do their work without harassment and personal attacks. We are living in a world where behaviours that cause pain and misery to people, are being ‘called out’. This Board wants to be clear that while we are Trustees of this organization, we will have a “zero tolerance” policy for repeated, seriously bad behaviour. There is a critical need for ALL organizations to look after their staff and members; once repeated, seriously bad behaviour had been recognized, doing nothing was NOT an option.

So, here are the facts as we are able to report them. We may be able to tell you more later, we may not. Time will tell.

This Board decision is not about freedom of speech.
It is not about scientific debate.
It is not about tolerance of dissent.
It is not about someone being unable to criticize a Cochrane Review.

It is about a long-term pattern of behaviour that we say is totally, and utterly, at variance with the principles and governance of the Cochrane Collaboration. This is about integrity, accountability and leadership.

In March this year, we received three complaints about an individual. These were not the first complaints that had ever been received. In fact, the earliest recorded goes back to 2003. Many have been dealt with over the years. Many disputes have arisen. Formal letters have been exchanged. Promises have been made. And broken. Some disputes have been resolved, some have not.

It was clear to the Co-Chairs that the Board had to reach a decision about these most recent complaints. The individual then made serious allegations against one of the Senior Management Team and shared those with the Board. We seemed to be in an impossible situation. How could the Board now reach a decision about the complaints in a fair way? How could we fulfil our responsibilities as employers of the Senior Management Team? Or alternatively, act to admonish that member of the Senior Management Team if they had done wrong?

With guidance from a Trustee with extensive experience of complaints, we proposed asking a totally independent person to undertake a review. The report was to be confidential to the Board.

After failing to get agreement from the individual to an independent review, we then sought legal advice on behalf of Cochrane. We asked the lawyers, what should a Charity such as Cochrane do in this situation? We were advised that various legal consequences flowed from the events – the complaints and the accusations – and that Cochrane should take them seriously.

We asked the lawyers to take particular note of Cochrane’s commitment to transparency. They noted that, but also stressed the importance of confidentiality.

They advised that an independent review was both a sensible and proportionate response.

At the Governing Board Teleconference on 13th June 2018, all Board members read the letter from our lawyers. The lawyers stated that given the serious legal concerns about this matter they strongly recommended an independent review by a very senior lawyer. The Board approved a motion to accept the lawyer’s advice and establish the independent review.

Our lawyers identified a senior independent lawyer (QC) and he was instructed on 2nd July 2018. As part of the process, he invited written submissions from both individuals concerned. He invited both to be interviewed. The lawyer was asked to work to a deadline of the Board Meeting on Thursday last week, 13th September. And, we did in fact receive his preliminary report in time for that meeting. The report completely exonerated the member of the Senior Management Team but did not exonerate the other individual.

Whilst the review was underway, and as a completely separate matter, a paper was published in the journal BMJ-EBM co-authored by the individual concerned on July 27th 2018. The publication of this paper has proved controversial. As a result, the Board received a number of letters of complaint. Each was sent to the individual to allow a written response. In order to avoid any misunderstanding, the Board want you to be clear that this was a matter that arrived very late in this whole process.

So, at the Board Meeting on Thursday September 13th, the trustees reviewed the lawyer’s report of his independent review, and all the material related to the recently published paper. After they had reviewed and discussed this at length, the Trustees exercised their judgement, and looking across a broad range of behaviours, the Board came to a decision to invoke Article 5.2.1. relating to termination of membership. This was not unanimous.

As a result, Article 5.3 was triggered, and the member has been invited to make a written response within seven days.

At this point in time, this person remains a member of the Cochrane Collaboration. We are waiting for the process to be completed. We will report back to you about the outcome as soon as we are able to.

Let us repeat, this is an extremely rare and unusual thing to do. We hope never to have to do this again.

Cochrane Governing Board
Edited (without prejudice): 19th September 2018

Wednesday, September 19, 2018″

 

 

 

Special issue on the PACE Trial

We are proud that this issue marks a special contribution by the Journal of Health Psychology to the literature concerning interventions to manage adaptation to chronic health problems. The PACE Trial debate reveals deeply embedded differences between critics and investigators. It reveals an unwillingness of the co-principal investigators of the PACE trial to engage in authentic discussion and debate. It leads one to question the wisdom of such a large investment from the public purse (£5million) on what is a textbook example of a poorly done trial.

The Journal of Health Psychology received a submission in the form of a critical review of one of the largest psychotherapy trials ever done, the PACE Trial. PACE was a trial of therapies for patients with myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS), a trial that has been associated with a great deal of controversy (Geraghty, 2016). Following publication of the critical paper by Keith Geraghty (2016), the PACE Trial investigators responded with an Open Peer Commentary paper (White et al., 2017). The review and response were sent to more than 40 experts on both sides of the debate for commentaries.

The resulting collection is rich and varied in the perspectives it offers from a neglected point of view. Many of the commentators should be applauded for their courage, resilience and ‘insider’ understanding of experience with ME/CFS.

The Editorial Board wants to go on record that the PACE Trial investigators and their supporters were given numerous opportunities to participate, even extending the possibility of appeals and re-reviews when they would not normally be offered. That they failed to respond appropriately is disappointing.

Commentaries were invited from an equal number of individuals on both sides of the debate (about 20 from each side of the debate). Many more submissions arrived from the PACE Trial critics than from the pro-PACE side of the debate. All submissions were peer reviewed and judged on merit.

The PACE Trial investigators’ defence of the trial was in a template format that failed to engage with critics. Before submitting their reply, Professors Peter White, Trudie Chalder and Michael Sharpe wrote to me as co-principal investigators of the PACE trial to seek a retraction of sections of Geraghty’s paper, a declaration of conflicts of interest (COI) by Keith Geraghty on the grounds that he suffers from ME/CFS, and publication of their response without peer review (White et al., 4 November 2016, email to David F Marks). All three requests were refused.

On the question of COI, the PACE authors themselves appear to hold strong allegiances to cognitive behavioural therapy (CBT) and graded exercise therapy (GET) – treatments they developed for ME/CFS. Stark COI have been exposed by the commentaries including the PACE authors themselves who hold a double role as advisers to the UK Government Department of Work and Pensions (DWP), a sponsor of PACE, while at the same time working as advisers to large insurance companies who have gone on record about the potential financial losses from ME/CFS being deemed a long-term physical illness. In a further twist to the debate, undeclared COI of Petrie and Weinman (2017) were alleged (Lubet, 2017). Professors Weinman and Petrie adamantly deny that their work as advisers to Atlantis Healthcare represents a COI.

After the online publication of several critical Commentaries, Professors White, Sharpe, Chalder and 16 co-authors were offered a further opportunity to respond to their critics in the round but they chose not to do so.

After peer review, authors were invited to revise their manuscripts in response to reviewer feedback and many made multiple drafts. The outcome is a set of robust papers that should stand the test of time and offer significant new light on what went wrong with the PACE Trial that has been of such high significance for the nature of treatment protocols. It is disappointing that what has been the more dominant other side refused to participate.

Unfortunately, across the pro-PACE group of authors there was a consistent pattern of resistance to the debate. After receiving critical reviews, the pro-PACE authors chose to make only cosmetic changes or not to revise their manuscripts in any way whatsoever. They appeared unwilling to enter into the spirit of scientific debate. They acted with a sense of entitlement not to have to respond to criticism. Two pro-PACE authors even showed disdain for ME/CFS patients, stating: We have no wish to get into debates with patients. In another instance, three pro-PACE authors attempted to subvert the journal’s policy on COI by recommending reviewers who were strongly conflicted, forcing rejection of their paper.

The dearth of pro-PACE manuscripts to start off with (five submissions), the poor quality, the intransigence of authors to revise and the unavoidable rejection of three pro-PACE manuscripts led to an imbalance in papers between the two sides. However, this editor was loathe to compromise standards by publishing unsound pieces in spite of the pressure to go ahead and publish from people who should know better.

We are proud that this issue marks a special contribution by the Journal of Health Psychology to the literature concerning interventions to manage adaptation to chronic health problems. The PACE Trial debate reveals deeply embedded differences between critics and investigators. It also reveals an unwillingness of the co-principal investigators of the PACE trial to engage in discussion and debate. It leads one to question the wisdom of such a large investment from the public purse (£5 million) on what is a textbook example of a poorly done trial.

ME/CFS research has been poorly served by the PACE Trial and a fresh new approach to treatment is clearly warranted. On the basis of this Special Issue, readers can make up their own minds about the scientific merits and demerits of the PACE Trial. It is to be hoped that the debate will provide a more rational basis for evidence-based improvements to the care pathway for hundreds of thousands of patients.

References

Geraghty, KJ (2016‘PACE-Gate’: When clinical trial evidence meets open data access. Journal of Health Psychology 22(9): 11061112Google ScholarSAGE JournalsISI
Lubet, S (2017Defense of the PACE trial is based on argumentation fallacies. Journal of Health Psychology 22(9): 12011205Google ScholarSAGE JournalsISI
Petrie, K, Weinman, J (2017The PACE trial: It’s time to broaden perceptions and move on. Journal of Health Psychology 22(9): 11981200Google ScholarSAGE JournalsISI
White, PD, Chalder, T, Sharpe, M. (2017Response to the editorial by Dr Geraghty. Journal of Health Psychology 22(9): 11131117Google ScholarSAGE JournalsISI

The Editorial has been abridged and the photograph of Dr. Keith Geraghty added.

Personality, Heart Disease and Cancer: A Chequered History

Type A and B Personality

We discuss here the chequered history of the claims by Psychologists and others about the links between personality and illness, particularly heart disease and cancer. The research has been marred by dirty money and allegations of fraud.

Speculation about ‘Type A’ and ‘Type B’ personalities and coronary heart disease (CHD) has existed for at least 70 years. The distinction between the two personalities was introduced in the mid-1950s by the cardiologists Meyer Friedman and Ray Rosenman (1974) Type A behavior and your heart.  Their ideas can be traced to Franz Alexander one of the ‘fathers’ of psychosomatic medicine.

The Type A personality is described this: highly competitive and achievement oriented, not prepared to suffer fools gladly, always in a hurry and unable to bear delays and queues, hostile and aggressive, inclined to read, eat and drive very fast, and constantly thinking what to do next, even when supposedly listening to someone else. Type A was thought to be at greater risk of CHD,

The Type B personality is: relaxed, laid back, lethargic, even- tempered, amiable and philosophical about life, relatively slow in speech and action, and generally has enough time for everyone and everything.

The Type A personality is similar to Galen’s choleric temperament, and Type B with the phlegmatic.  It is well known that men are at greater risk of CHD than women.

‘Classic’ Studies

The key pioneering study of Type A personality and CHD was the Western Collaborative Group Study (WCGS).  Over 3,000 Californian men, aged from 39 to 59, were followed up initially over a period of eight-and-a-half years, and later extending to 22 years plus. At the eight-and-a-half-year follow-up, Type As were twice as likely compared with Type Bs to suffer from subsequent CHD. 7% developed some signs of CHD and two-thirds of these were Type As. This increased risk was there even when other risk factors, such as blood pressure and cigarette smoking, were statistically controlled.

Similar results were obtained in another large-scale study in Framingham, Massachusetts.  This time the sample contained both men and women.  By the early 1980s, it was confidently asserted that Type A characteristics were as much a risk factor for heart disease as high blood pressure, high cholesterol levels and even smoking.

Failure to Replicate

Later research failed to support these early findings. When Ragland and Brand (1988) conducted a 22-year follow-up of the WCGS, using CHD mortality as the crucially important measure, they failed to find any consistent evidence of an association.

Further research continued up to the late 1980s, yielding few positive findings. Reviewing this evidence, Myrtek (2001) suggests that the modest number of positive findings that did exist were the result of over-reliance on angina as the measure of CHD. Considering studies that adopted hard criteria, including mortality, Myrtek concludes that Type A personality is not a risk factor for CHD.

Enter the Tobacco Industry

With such disappointing results, why did Type A obtain so much publicity over more than 40 years? The reason is in part connected with the involvement of the US tobacco industry.

Mark Petticrew et al. (2012) analysed material lodged at the Legacy Tobacco Documents Library. This is a vast collection of documents that the companies were obliged to make public following litigation in 1998. These documents show that, for over 40 years from the 1950s, the industry heavily funded research into links between personality, CHD and cancer. The industry was hoping to demonstrate that personality variables were associated with cigarette smoking.

Any such links would undermine the alleged causal links between smoking and disease. Thus, for example, if it could be shown that Type A personalities were both more likely to smoke than Type Bs, and more likely to develop CHD, then it could be argued that smoking might be just an innocent background variable.

The Philip Morris company funded Meyer Friedman, the originator of Type A research, for the Meyer Friedman Institute. The research aimed to show that Type A personalities could be changed by interventions, thereby presumably reducing proneness to CHD even if they continued to smoke.

Petticrew et al. show that, while most Type A–CHD studies were not funded by the tobacco industry, most of the positive results were tobacco-funded. As has been pointed out in many areas of science, positive findings invariably get a great deal more publicity than negative findings and rebuttals.

Hans J Eysenck

The late H J Eysenck was one of the most controversial psychologists who ever lived. Generations of UK psychology students had to study his books as gospel.

The German-born, British psychologist worked at the Institute of Psychiatry, University of London.  He did a PhD under Sir Cyril Burt  who was proved to have fabricated researchers and data to support his eugenic theory of intelligence.  (Kamin, 1974, The science and politics of IQ).

Eysenck used the tobacco industry as a source of funding for his research on psychological theories of personality. According to Pringle (1996), Eysenck received nearly £800,000 to support his research on personality and cancer.  Eysenck’s results were a spectacular exception to the general run of negative findings in this field.  Eysenck (1988) claimed that personality variables are much more strongly related to death from cancer than even cigarette smoking.

One of my lecturers while I was an undergraduate had worked for Eysenck as a research assistant for a year. It had seemed clear to him that data massaging was required before placing Eysenck’s studies into publication. Data manipulation or even worse, outright fraud, has surfaced in a major re-analysis of Eysenck’s work on tobacco and personality.

Ronald Grossarth-Maticek

Two of Eysenck’s papers, with Ronald Grossarth-Maticek (pictured above), based  in Crvenka, Serbia, claimed to have identified personality types that increase the risk of cancer by about 120 times and heart disease by about 25 times (Grossarth-Maticek and Eysenck, 1991; Eysenck and Grossarth-Maticek, 1991). They also claimed to have tested a new method of psychological treatment that could reduce the death rate for disease prone personalities over the next 13 years from 80% to 32%. These claims are too good to be true.

These extraordinary claims were not received favourably by others in this field. Fox (1988) dismissed earlier reports by Eysenck and Grossarth-Maticek as ‘simply unbelievable’ and the 1991 papers were subjected to devastating critiques by Pelosi and Appleby (1992, 1993) and Amelang, Schmidt-Rathjens and Matthews (1996).  The ‘cancer prone personality’ was not clearly described and seems to have been an odd amalgam of emotional distance and excessive dependence.

A Case of Fraud?

After pointing out a large number of errors, omissions, obscurities and implausible data, in a manner reminiscent of Leon Kamin’s  analysis of Burt’s twin IQ data, Pelosi and Appleby comment:

It is unfortunate that Eysenck and Grossarth-Maticek omit the most basic information that might explain why their findings are so different from all the others in this field. The methods are either not given or are described so generally that they remain obscure on even the most important points . . . Also essential details are missing from the results, and the analyses used are often inappropriate.

(Pelosi and Appleby, 1992: 1297).

They never used the word “fraud”. They didn’t need to. For an update of this story,  see this post

and this post

Update

I wrote to Ronald Grossarth-Maticek on 3rd December 2018 and again on 5th March 2019 inviting him to respond to the allegations.
Dr. Grossarth-Maticek has responded saying that he will give me an answer within the next month.
He also says that he will send me the results of his actual research.
To be continued…

Post-Traumatic Growth

Post-Traumatic Growth 

Experiences of life disruption, threat, distress, or adversity can lead to positively evaluated “growth” (Tedeschi and Calhoun, 1995). It has been observed for centuries that benefit finding and posttraumatic growth (PTG) can follow the occurrence of traumatic events including accidents, warfare, death of a loved one, and cancer diagnosis and treatment (Stanton, 2010).

Benefit finding and growth represent a fundamental restorative principle of homeostasis that is continually active towards the achievement of stability, equilibrium and well-being. Adaptation to any life-threatening illness, such as cancer, is facilitated by homeostasis systems that include the drive to find meaning, exert mastery or control over the experience, and bolster self-esteem. Growth and benefit-finding are frequently reported by cancer survivors as they gain awareness of their illness, its treatment and prognosis.

Measurement of PTG

The theoretical model of PTG proposed by Tedeschi and Calhoun suggests growth occurs in different ways.  Developing new relationships, finding new appreciation for life, new meanings in life, discovering personal strength, experiencing spiritual change, and realizing new opportunities are all possibilities. The experiences of benefit finding and growth are undeniable. The methods and measurements used for their study, however, raise more questions than answers.

Among cancer populations, reported prevalence rates of perceived PTG range from 53 to 90% and vary according to the type of cancer, time since diagnosis, heterogeneity and ethnicity of the sample, choice of measurement, and many personal factors (Coroiu et al., 2016). Posttraumatic growth is measured using scales such as “The Posttraumatic Growth Inventory” (PTGI), a 21-item measure of positive change following a traumatic or stressful event (Tedeschi and Calhoun, 1996). Respondents rate the degree to which positive change had occurred in their life “as a result of having cancer.” A total PTGI score and five subscale scores (New Possibilities, Relating to Others, Personal Strength, Spiritual Change, and Appreciation of Life) are calculated.

What the Critics Say

Critics have been less than enthusiastic about measuring PGI in this manner. James Coyne and Howard Tennen (2010) argue that: “Every PTG scale asks participants to rate how much they have changed on each scale item as the result of the crisis they faced. Thus, a respondent must: (a) evaluate her/his current standing on the dimension described in the item, e.g., a sense of closeness to others; (b) recall her/his previous standing on the same dimension; (c) compare the current and previous standings; (d) assess the degree of change; and (e) determine how much of that change can be attributed to the stressful encounter. Psychological science, which purportedly guides positive psychology, tells us that people cannot accurately generate or manipulate the information required to faithfully report trauma- or stress-related growth (or to report benefits) that results from threatening encounters…The psychological literature demonstrates consistently that people are unable to recollect personal change accurately” (Coyne and Tennen, 2010, p. 23).

The five steps a-e certainly are a tall order, and it seems highly doubtful that anybody could achieve them with any accuracy. It seems naïve to analyse numbers that research participants place on scales from the PTGI as though they are valid indices of ‘post-traumatic growth’ when no attempt is made to validate these measures.  In spite of these criticisms, many studies have been conducted using the PTGI scale.

Quack Science 

Quite rightly, Coyne and Tennen (2010) have damned the flawed methods and measures concerning PTG: “We are at a loss to explain why positive psychology investigators continue to endorse the flawed conceptualization and measurement of personal growth following adversity. Despite Peterson’s …warning that the credibility of positive psychology’s claim to science demands close attention to the evidence, post-traumatic growth—a construct that has now generated hundreds of articles—continues to be studied with flawed methods and a disregard for the evidence generated by psychological science. It is this same pattern of disregard that has encouraged extravagant claims regarding the health benefits of positive psychological states among individuals living with cancer” (p. 24).

As long as psychologists use shoddy methods, invalid measures and draw quack conclusions, they will not be taken seriously by outsiders.

Based on a section of: David F Marks et al. (2018) Health Psychology. Theory, Research & Practice (5th ed.) SAGE Publications Ltd.

The PACE Trial: A Catalogue of Errors

What was the PACE Trial?

Rarely in the history of clinical medicine have doctors and patients been placed so bitterly at loggerheads. The dispute had been a long time coming. Thirty years ago, a few psychiatrists and psychologists offered a hypothesis based on a Psychological Theory in which ME/CFS is constructed as a psychosocial illness. According to their theory, ME/CFS patients have “dysfunctional beliefs” that their symptoms are caused by an organic disease. The ‘Dysfunctional Belief Theory’ (DBT) assumes that no underlying pathology is causing the symptoms; patients are being ‘hypervigilant to normal bodily sensations‘ (Wessely et al., 1989; Wessely et al., 1991).

The Psychological Theory assumes that the physical symptoms of ME/CFS are the result of ‘deconditioning’ or ‘dysregulation’ caused by sedentary behaviour, accompanied by disrupted sleep cycles and stress. Counteracting deconditioning involves normalising sleep cycles, reducing anxiety levels and increasing physical exertion. To put it bluntly, the DBT asserts that ME/CFS is ‘all in the mind’.  Small wonder that patient groups have been expressing anger and resentment in their droves.

Top-Down Research

‘Top-down research’ uses a hierarchy of personnel, duties and skill-sets. The person at the top sets the agenda and the underlings do the work. The structure is a bit like the social hierarchy of ancient Egypt. Unless carefully managed, this top-down approach risks creating a self-fulfilling prophecy from confirmation biases at multiple levels. At the top of the research pyramid sits the ‘Pharaoh’, Regius Professor Sir Simon Wessely KB, MA, BM BCh, MSc, MD, FRCP, FRCPsych, F Med Sci, FKC, Knight of the Realm, President of the Royal College of Medicine, and originator of the DBT.  The principal investigators (PIs) for the PACE Trial, Professors White, Chalder and Sharpe, are themselves advocates of the DBT.  The PIs all have or had connections both to the Department of Work and Pensions and to insurance companies. The objective of the PACE Trial was to demonstrate that two treatments based on the DBT, cognitive behavioural therapy (CBT) and graded exercise therapy (GET), help ME/CFS patients to recover. There was zero chance the PACE researchers would fail to obtain the results they wanted. 

Groupthink, Conflicts and Manipulation

The PACE Trial team were operating within a closed system or groupthink in which they ‘know’ their theory is correct. With every twist and turn, no matter what the actual data show, the investigators are able to confirm their theory. The process is well-known in Psychology. It is a self-indulgent processes of subjective validation and confirmation bias.  Groupthink occurs when a group makes faulty decisions because group pressures lead to a deterioration of “mental efficiency, reality testing, and moral judgment” (Janis, 1972). Given this context, we can see reasons to question the investigators’ impartiality with many potential conflicts of interest (Lubet, 2017). Furthermore, critical analysis suggests that the PACE investigators involved themselves in manipulating protocols midway through the trial, selecting confirming data and omitting disconfirming data, and publishing biased reports of findings which created a catalogue of errors.

‘Travesty of Science’

The PACE Trial has been termed a ‘travesty of science’ while sufferers of ME/CFS continue to be offered unhelpful or harmful treatments and are basically being told to ‘pull themselves together’. One commentator has asserted that the situation for ME patients in the UK is: The 3 Ts – Travesty of Science; Tragedy for Patients and Tantamount to Fraud” (Professor Malcolm Hooper, quoted by Williams, 2017). Serious errors in the design, the protocol and procedures of the PACE Trial are evident. The catalogue of errors is summarised below. The PACE Trial was loaded towards finding significant treatment effects.

A Catalogue of Errors

The claimed benefits of GET and CBT for patient recovery are entirely spurious. The explanation lies in a sequence of serious errors in the design, the changed protocol and procedures of the PACE Trial. The investigators neglected or bypassed accepted scientific procedures for a RCT, as follows:

Error Category of error Description of error
1Ethical issue: Applying for ethical approval and funding for a long-term trial when the PIs knew already knew CBT effects on ME/CFS were short-lived. On 3rd November 2000, Sharpe confirmed: “There is a tendency for the difference between those receiving CBT and those receiving the comparison treatment to diminish with time due to a tendency to relapse in the former” (www.cfs.inform/dk). Wessely stated in 2001 that CBT is “not remotely curative” and that: “These interventions are not the answer to CFS” (Editorial: JAMA 19th September 2001:286:11) (Williams, 2016).
2Ethical issue: Failure to declare conflicts of interest to Joint Trial Steering Committee.Undeclared conflicts of interest by the three PIs in the Minutes of the Joint Trial Steering Committee and Data Monitoring Committee held on 27th September 2004.
3Ethical issue: Failure to obtain fully informed consent after non-disclosure of conflicts of interest.Failing to declare their vested financial interests to PACE participants, in particular, that they worked for the PHI industry, advising claims handlers that no payments should be made until applicants had undergone CBT and GET.
4Use of their own discredited “Oxford” criteria for entry to the trial.Patients with ME would have been screened out of the PACE Trial even though ME/CFS has been classified by the WHO as a neurological disease since 1969 (ICD-10 G93.3).
5Inadequate outcome measures.Using only subjective outcome measures.The original protocol included the collection of actigraphy data as an objective outcome measure. However, after the Trial started, the decision was taken that no post-intervention actigraphy data should be obtained.
6Changing the primary outcomes of the trial after receiving the raw data. Altering outcome measures mid-trial in a manner which gave improved outcomes.
7Changing entry criteria midway through the trial. Altering the inclusion criteria for trial entry after the main outcome measures were lowered so that some participants (13%) met recovery criteria at the trial entry point.
8The statistical analysis plan was published two years after selective results had been published. The Re-definition of “recovery” was not specified in the statistical analysis plan.
9Inadequate control Sending participants newsletters promoting one treatment arm over another, thus contaminating the trial.
10Inadequate controlLack of comparable placebo/control groups with inexperienced occupational therapists providing a control treatment and experienced therapists provided CBT.
11Inadequate controlRepeatedly informing participants in the GET and CBT groups that the therapies could help them get better.
12Inadequate control Giving patients in the CBT and GET arms having more sessions than in the control group.
13Inadequate controlAllowing therapists from different arms to communicate with each other about how patients were doing.

14

Lack of transparency

Blocking release of the raw data for five years preventing independent analysis by external experts.

Cover-Up

Blocking release of the raw data for five years and preventing independent analysis by external experts was tantamount to a cover-up of the true findings. An editorial by Keith Geraghty (2016) was entitled ‘PACE-Gate’. ME/CFS patient associations were rightly suspicious of the recovery claims concerning the GET arm of the trial because of their own experiences of intense fatigue after ordinary levels of activity which were inconsistent with the recovery claims of the PACE Trial reports. For many sufferers, even moderate exercise results in long ‘wipe-outs’ in which they are almost immobilized by muscle weakness and joint pain. In the US, post-exertional relapse has been recognized as the defining criterion of the illness by the Centers for Disease Control, the National Institutes of Health and the Institute of Medicine. For the PACE investigators, however, the announced recovery results validated their conviction that psychotherapy and exercise provided the key to reversing ME/CFS.

Alem Matthees Obtains Data Release

When Alem Matthees, a ME/CFS patient, sought the original data under the Freedom of Information Act and a British Freedom of Information tribunal ordered the PACE team to disclose their raw data, some of the data were re-analysed according to the original protocols. The legal costs of the tribunal at which QMUL were forced to release the data, against their strenuous objections, was over £245,000. The re-analysis of the PACE Trial data revealed that the so-called “recovery” under CBT and GET all but disappeared (Carolyn Wilshire, Tom Kindlon, Alem Matthees and Simon McGrath, 2016). The recovery rate for CBT fell to seven percent and the rate for GET fell to four percent, which were statistically indistinguishable from the three percent rate for the untreated controls. Graded exercise and CBT are still being routinely prescribed for ME/CFS in the UK despite patient reports that the treatments can cause intolerable pain and relapse. The analysis of the PACE Trial by independent critics has revealed a catalogue of errors and provides an object lesson in how not to conduct a scientific trial. The trial can be useful to instructors in research design and methodology for that purpose.

Following the re-analyses of the PACE Trial, the DBT is dead in the water. There is an urgent need for new theoretical approaches and scientifically-based treatments for ME/CFS patients. Meanwhile, there is repair work to be done to rebuild patient trust in the medical profession after this misplaced attempt to apply the Psychological Theory to the unexplained syndrome of ME/CFS. The envelope theory of Jason et al. (2009) proposes that people with ME/CFS need to balance their perceived and expended energy levels and provides one way forward, pending further research.

Ultimately, patients, doctors and psychologists are waiting for an organic account of ME/CFS competent to explain the symptoms and to open the door to effective treatments. Patients have a right to nothing less.

An extract from: David F Marks et al. (2018) Health Psychology. Theory, Research & Practice (5th ed.) SAGE Publications Ltd.

Psychology – Science or Delusion?

‘Mass Delusion’

Psychology is full of theories, not ‘General Theories’, but ‘Mini-Theories’ or ‘Models’.  Most Mini-Theories/Models are wrong.  Unfortunately these incorrect theories and models often persist in everyday practice. This happens because Psychologists are reluctant to give up their theories. These incorrect theories then act like ‘mass delusions’, which can have consequences for others, especially students and patients.

Academic Psychology suffers from ‘delusions of grandeur’. It is as if an entire academic discipline is manifesting a chronic disorder – a kind of  ‘Scientific Psychosis’.   Psychologists claim that Psychology is a Science but there is no objective evidence to support it.  In fact, the evidence suggests the exact opposite.

Aping Science

The ability to ape proper science is not in doubt. Laboratories, experiments and grants, thousands of journals, books, institutes and universities all espouse Psychology as a Science.  Many psychologists even wear white lab coats and poke around in animals’ brains. The ability to mimic genuine scientists like Physicists or Biologists, however, does not make Psychology a science. It actually makes a mockery of science.

There are many reasons why this is the case. I mention here two:

1) Psychology does not meet even the most essential criterion for an authentic science – quantitative  measurement along ratio scales.

2) Unlike all the true natural sciences, Psychology lacks a general theory. A general theory is held by the majority of scientists working in the field.

The shared belief of the vast majority of psychologists that they are scientists, when all of the evidence suggests that this can’t be true,  is a form of professional ‘mass hysteria’.  Psychologists share a belief system of scientific delusion, thought disorder and conceptual confusion. They then impose their beliefs, not only on one another, but on their students and their patients.

Students and Patients

Many students and patients are having none of it.  They refuse to be suckered in by the claim.  But they have to be courageous enough to come out of the closet and say it. If they dare to say it in an essay or exam, then they’d better be prepared for a grade C, D, E or F.

Researchers have found that  “medical students think their psychology lectures are “soft and fluffy”students think psychology is less important than the other natural scienceschildren rate psychological questions as easier than chemistry or biology questions; and expert testimony supporting an insanity defence is seen as less convincing when delivered by a psychologist than a psychiatrist.”

On a few rare occasions, established psychologists have expressed their doubts about the scientific credentials of Psychology. For example, Jan Smedslund wrote about: “Why Psychology Cannot be an Empirical Science.” There is increasing evidence that many patients are skeptical about Psychology also.

woman-outnumbered-by-male-scientists

Folie Imposée

Folie à deux (“madness of two”) occurs when delusional beliefs are transmitted from one individual to another.  When one dominant person imposes their delusional beliefs on another, it is folie imposée. In this case, the second person probably would never have become deluded if left to themselves. The second person is expected ultimately to reject the delusion of the first person, due to disproof of the delusional assumptions, and protest. This protest, however, will fall upon deaf ears.

The situation I describe is far from hypothetical.  It exists day in, day out, for millions of patients. One particular patient group are those labeled with ‘Medically Unexplained Symptoms’ (MUS).  Within this group is a particular group of patients with Myalgic Encephalomyelitis (“ME”) and/or Chronic Fatigue Syndrome (“CFS”).

Delusional thinking certainly can hurt and embarrass the individuals having the delusion (Psychologists and Psychiatrists). It can also be imposed upon others, for example, people in their care (Patients). To the help-seeking Patient, the Psychologist (or Psychiatrist) is an expert who follows the rules of Science. The Science informs the aetiology, diagnosis, and treatment of the Patient.

Treating Patients with ME/CFS

I consider here how many psychologists in the UK treat people labeled with ME/CFS. This treatment comes with the full backing of NICE (currently under review).

Psychological treatment for patients labeled with ME/CFS is based on a Psychological Theory of the illness. This theory is highly contested and has caused major controversies that has divided Patients from Psychologists and Psychiatrists.

The main Psychological Theory of ME/CFS asserts that ‘maladaptive’ cognitions and behaviours perpetuate the fatigue and impairment of individuals with ME/CFS (Wessely, David, Butler and Chalder, 1989). These authors represent the two main professions concerned with psychological illness, Psychology and Psychiatry.  They state: “It is essential to agree jointly on an acceptable model, because people need to understand their illness. The cognitive – behavioural model …can explain the continuation of symptoms in many patients.” This is where the imposition of the therapist’s model snaps in. “The process is therefore a transfer of responsibility from the doctor, in terms of his duty to diagnose, to the patient, confirming his or her duty to participate in the process of rehabilitation in collaboration with the doctor, physiotherapist, family and others.” (p. 26).

Although the Psychological Theory is contested by many scientists, patients and patient organisations who assume that their symptoms have an organic basis, i.e. a Physical Theory.

Vercoulen et al. (1998) developed a model of ME/CFS based on the Psychological Theory. However, Song and Jason (2005) suggested that the Psychological Theory was inaccurate for individuals with ME/CFS. In spite of the evidence against it, the Psychological Theory continues as the basis for cognitive behavioural and graded exercise therapies (GET) offered to individuals with ME/CFS. One reason for the continued use of an unsupported Psychological Theory is the PACE Trial, a lesson in how not to do proper science. Like most research, this trial was organised by a team and, in this case, the majority of principle investigators were Psychiatrists. This trial has been described as “one of the biggest medical scandals of the 21st century.”

New Approach Needed

In spite of the lack of empirical support, the Psychological Theory of ME/CFS lives on. ME/CFS patients are subjected to CBT and GET.  Patients and patient organisations protest about the treatments and are opposed to the Psychological Theory.  Perhaps Psychologists need to turn the Psychological Theory of unhelpful beliefs upon themselves.  If  ME/CFS has a physical (e.g. immunological) cause, then once the cause has been established, patients will have the chance of an effective treatment and decent care and  support.

The problems that exist for Psychologists’ treatment of patients with MUS and ME/CFS exist more generally across the discipline. A totally new approach is necessary.  Instead of tinkering with the problems at a cosmetic level by papering over the cracks, there is a need for root-and-branch change of a radical kind. The measurement problem must be addressed and there is a need for a general theory.   A new General Theory of Behaviour takes a step in that direction.

Psychology in Crisis – Sail On

 

‘Psychology in Crisis’ by Brian M Hughes has much in its favour. Like a knife through soft butter, it cuts through the huge swathes of BS that permeate Academic Psychology.  Brian Hughes addresses many different crises in Academic Psychology:

the Replication Crisis

the Paradigmatic Crisis (aka as the Theory Crisis or Fragmentation)

the Measurement Crisis 

the Statistical Crisis

the Sampling Crisis

the Exaggeration Crisis

None of these crises is new. The problem is the different crises are all getting bigger and more insoluble over time.

In his delightful book,  Psychology in Crisis, Hughes explains that there is little momentum to change because the discipline has taken over a century to build the mould. “The fact that the majority of those who teach psychology see no problem with the status quo, and so say nothing about it, does not indicate that their discipline is healthy. If anything, it implies the presence of groupthink. One might even consider it an instance of a mass delusion.” (p. 148, my italics).

A ‘mass delusion’! Strong words, but fully justified. The biggest delusion of all is the claim that Academic Psychology is a Science. There is no justification for this claim if Hughes’ allegations are true. Which they are.

As an academic discipline, Psychology continues to grow. The American Psychological Association reports that in 2012 – 2013, 1.84 million bachelor’s degrees were awarded to students. Of those, 6.2 percent of the degrees (or 114,080) went to psychology majors. The psychology major is the fourth most popular college major after business, health-related majors, and social science and history. In the 2013 academic year, 6,496 psychology doctorates were awarded in the U.S., a 32 percent increase from 2004.

One of simplest measures of Academic Psychology’s growth is publications numbers. The figures are plotted below for each quarter century since 1900. I got these numbers from Google Scholar.  Bearing in mind that the current quarter century still has 6 years to run, the increases are huge. The dotted line is an estimate for 2000-24 based on current trends. The line goes way off the chart.

Number of Publications about Psychology

Screen Shot 2018-09-21 at 16.54.11

As the Psychology enterprise continues to grow, it becomes ever more difficult to turn it around. To use a nautical analogy, the radius of the Turning Circle widens. The momentum to ‘Sail On’ becomes ever greater.

Landscape photography, nature and well-being

Landscape photography is beneficial to self-development, self-discovery and eudaimonic wellbeing. To the photographer, that is, and hopefully to others as well. In particular, landscape photography and post-photography processing can connect the photographer with nature. Research on well-being has explored two general perspectives: a hedonic approach, in which happiness and well-being are about pleasure attainment and pain avoidance, and a eudaimonic approach, in which meaning, self-realization and the degree to which a person is fully functioning are important. This post explores the links between landscape photography, nature connectedness and well-being

The beneficial role of nature connectedness in well-being has been suggested in recent publications:

The relationship between nature relatedness and anxiety, Martyn, Patricia, Brymer, Eric., Journal of Health Psychology, 2016, 21: 1436-1445.

Are nature lovers happy? On various indicators of well-being and connectedness with nature. Cervinka, Renate, Roderer, Kathrin, Hefler, Elisabeth. Journal of Health Psychology, 2012, 17: 379-388.

Flourishing in nature: A review of the benefits of connecting with nature and its application as a wellbeing intervention. Capaldi, C. A., Passmore, H.-A., Nisbet, E. K., Zelenski, J. M., & Dopko, R. L.  International Journal of Wellbeing, 2015, 5(4), 1-16.

Natural environments have a stress-reducing or restorative influence, a form of homeostasis, while urban environments have the opposite effect.  Roger S Ulrich et al. (1991) showed 120 participants a stressful movie, and then videotapes of different natural and urban settings. Stress recovery measures were obtained from self-ratings of affective states and a battery of physiological measures: heart period, muscle tension, skin conductance and pulse transit time, a non-invasive measure that correlates with systolic blood pressure.

Recovery was “faster and more complete when people experienced natural rather than urban environments. The pattern of findings indicated that responses to nature had a salient parasympathetic nervous system component; however, there was no evidence of pronounced parasympathetic involvement with urban settings.”  Findings were consistent in showing the restorative influence of nature to produce a shift towards a positively-toned feelings and sustained attention.

Liz Brewster and Andrew Cox study the connection between involvement in digital communities and well-being by examining ‘digital daily practice’. Digital daily practices involves doing one thing – exercise, photography or writing – every day and sharing it online. They explored the digital daily practice, photo-a-day, to understand the ‘affordances’ it offers for well-being. They found that: “Photo-a-day is not a simple and uncomplicated practice; rather it is the complex affordances and variance within the practice that relate it to well-being. We conclude that this practice has multifaceted benefits for improving well-being.”

C Yuill and colleagues highlight that “human social agents are embedded in particular landscapes and it is in landscapes that environmental changes are experienced, which can have implications for wellbeing.”  They study  how environmental change impacts on health and well-being. They analysed the connections between landscape, environment and wellbeing in Xuan Thuy National Park in north Vietnam (see photograph below). This area is in a precarious coastal region where extreme weather events can impact on the wellbeing of both humans and other living things. They state: “Landscapes can be protective of wellbeing or can be affected by rises in temperature, changes in sea level or extreme weather events which exert serious negative implications for wellbeing.”

Screen Shot 2018-09-16 at 11.23.21 Reproduced from Yuill et al. 2018.

The harmony between humans and the environment is under significant threat.  The natural level of homeostasis is being disrupted. This disruption is causing increases in anxiety, depression and chronic stress. These processes in turn have a domino effect on many physical indicators of well-being including overweight and obesity. The current threats to homeostasis between human well-being and the physical landscape cannot be underestimated. The landscape photographer plays a key role in documenting landscape change.  Photographs are a significant tool in rebalancing disequilibrium between human beings and the natural environment. The ultimate goal of all living beings is the preservation of homeostasis. Environmental activists use photography in their struggle for conservation.

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