‘Medically unexplained symptoms’, through the lens of the biopsychosocial model, are understood in mainstream psy disciplines and related literature as a primarily psychosocial phenomenon perpetuated by ‘dysfunctional’ psychology on the part of people labelled with such. Biopsychosocial discourse and practice in this field, underpinned by little empirical foundation and lacking theoretical coherency, are associated with harms sustained by people labelled with MUS. Yet, little attention is paid to the psychology of social actors and institutions whose practice and policy derives from (...) biopsychosocial theorising, or whose vested interests produce such theorising. This article contends that lack of reflexivity among psy practitioners and other social actors on individual, institutional and structural levels furthers biopsychosocial hegemony and contributes to harms. Non-reflexive behaviour on the part of practitioners within clinical and ‘therapeutic’ encounters and on the part of social actors within institutions and broader power structures is examined, and possible psychological underpinnings of non-reflexivity are explored. Notably, the concept of gain, drawn from dominant discourse around MUS, is applied broadly to explore what might be gained from eschewing reflexivity and from adhering to biopsychosocial narratives. Implications for practice, supervision, training and research are discussed, notably highlighting a need for critical reflexivity in all domains. (shrink)

People with disabilities are subject to multiple forms of health-related and wider social disparities; carefully focused research is required to inform more inclusive, safe and effective healthcare practice and policy. Through lived experience, disabled people are well positioned to identify and persistently pursue problems and opportunities within existing health provisions that may be overlooked by a largely non-disabled research community. Thus, the academy can play an important role in shining a light on the perspectives and insights from within the disability (...) community, and combined with policy decisions, these perspectives and insights have a better opportunity to become integrated into the fabric of public life, within healthcare and beyond. However, despite the potential benefits that could be yielded by greater inclusivity, in this paper we describe barriers within the UK academy confronting disabled people who wish to embark on health research. We do this by drawing on published findings, and via the lived experience of the first author, who has struggled for over 3 years to find an accessible PhD programme as a person with energy limiting conditions who is largely confined to the home in the UK. First, we situate the discussion in the wider perspective of epistemic injustice in health research. Second, we consider evidence of epistemic injustice among disabled researchers, focusing primarily on what philosophers Kidd and Carel (2017, p 184) describe as ‘strategies of exclusion’. Third, we offer recommendations for overcoming these barriers to improve the pipeline of researchers with disabilities in the academy. (shrink)

Following years of debate over the effectiveness of cognitive behavioural therapy for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), public health bodies in the UK and beyond have determined that no psychotherapy is clinically proven for this patient group. In the field of ME/CFS and the wider arena of ‘medically unexplained symptoms’ (MUS), patient survey data and qualitative research capturing patient experiences and psychotherapist attitudes suggest that therapeutic practice may sometimes fall short of required ethical standards. This raises questions about how psychotherapists (...) can safely support, as opposed to treat, people with these debilitating conditions. We consider four ethical principles that feature throughout psychotherapists’ codes of practice, those of respect, competence, responsibility and integrity, and discuss examples of good and poor practice in this arena as evinced by recent empirical literature. Following this, we offer a variety of suggestions to help strengthen ethical psychotherapy practice with patients with ME/CFS and other MUS. In terms of practitioner education, we recommend greater emphasis on humility, reflexivity and disability-affirming practices, exploration of personal as well professional ethics, and integration of patient expertise-by-experience, accompanied with the latest evidence, into foundational and ongoing training. In terms of ongoing practice, we suggest consideration of formalised patient-focused feedback systems and greater transparency vis-à-vis patient access to clinical notes. Finally, we underline the importance of elevating patients from mere subjects to co-producers of psychotherapy research. (shrink)