Letter in response to: Chronic fatigue syndrome: is the biopsychosocial model responsible for patient dissatisfaction and harm?, by John Peters, patient, 31 July 2016

Geraghty & Esmail are right to draw attention to the harm done to the doctor-patient relationship by the biopsychosocial model of ME. The doctor considers the patient an unreliable witness to their own illness and so does not trust the patient; the patient knows the doctor does not trust them and so does not trust the doctor.

There are many other harms:

1. Patients are pained simply from being seen as an unreliable witness to their own body and illness. Enduring devastating symptoms, mourning the loss of their life, patients are distressed to be told that the illness is a function of their belief; that the knowledge they are ill is a false belief; and, implicitly, that the power to recover lies simply within themselves.
2. Patients are disempowered. Not only does ‘doctor know best’, but anyone who feels the urge to express an opinion: family, friends, acquaintances, strangers, online commentators. Since the patient can not be considered reliable then everyone knows better.
3. Patients are harmed by the popular perception of the illness which follows from the biopsychosocial designation. While many who work in the field would never use the term, the illness is understood as ‘all in the mind’.
4. Patients’ relationships to the wider society are harmed. Governments are encouraged to question the payment of benefits to avoid encouraging patients in their illness beliefs.
5. The patient-family relationship is damaged: families are told to challenge the patient’s false beliefs. They look differently at their family member when told the patient has the power to recover within them. Families are not receiving the information, help and support they need.
6. Since patients do not respond to therapy, therapists are harmed. Therapists become frustrated with the patient or with themselves for this failure.
7. Other patients, with illnesses which may respond to therapy, are unable to get the help they need because therapists are wasted on ME patients.
8. Research priorities are distorted.
9. Persisting with a diagnosis with no scientific basis is harmful in itself: damaging to science and public confidence.

It is time the UK followed the USA and dumped the failed, unevidenced, harmful biopsychosocial model.

Read more letters in British Journal of General Practice