The Social Course of Fibromyalgia: Resisting Processes of Marginalisation

This sociological article reports an empirical study into the lived experience of fibromyalgia. It includes 28 participants (26 women, 2 men) with a formal diagnosis of fibromyalgia. Data collection consisted of the completion of an identity box project and subsequent interviews. Data analysis followed the principles of iterative, inductive, semantic thematic analysis, and led to the identification of four major themes: the role of the social in making sense of the experience, the process of redefining lifegoals, the refusal to accept fibromyalgia as a diagnosis, and the consideration of identifying as a patient. These themes in turn demonstrate four forms of resistance against processes of marginalisation amongst those who have been diagnosed with fibromyalgia: (1) the incorporation of societal expectations and norms into their life-stories; (2) the re-making the lifeworld at a cerebral level through redefining reality and creating a new, socially acceptable reality; (3) the active rejection of the fibromyalgia diagnosis; and (4) the employment of active and pro-active countermeasures to assuming the sick role.

From Engel to Enactivism

In this article we offer a two-part commentary on Bolton and Gillett’s reconceptualization of Engel’s biopsychosocial model. In the first section we present a conceptual and historical assessment of the biopsychosocial model that differs from the analysis by Bolton and Gillett. Specifically, we point out that Engel in his vision of the biopsychosocial model was less concerned with the ontological possibility and nature of psychosocial causes, and more concerned with psychosocial influences in the form of illness interpretation and presentation, sick role, seeking or rejection of care, the doctor-patient therapeutic relationship, and role of personality factors and family relationships in recovery from illness, etc. On the basis of this assessment, we then question Bolton and Gillett’s restricted focus on accounting for biopsychosocial causal interactions. The second section compares Bolton and Gillett’s account with a recent enactivist account of mental disorder that tackles similar conceptual problems of causal interactions. Bolton and Gillett’s utilize elements of the 4E cognition, but they combine these proto-ideas with an information-processing paradigm. Given their explicit endorsement of 4E approaches to mind and cognition, we illustrate some key ways in which a more fleshed out enactive account, particularly one that doesn’t rely on notions of information-processing, differs from the account proposed by Bolton and Gillett.

Factitious Disorder Masquerading as a Life-Threatening Anaphylaxis

Factitious disorder is a psychiatric disorder in which sufferers intentionally fabricate physical or psychological symptoms in order to assume the role of the patient, without any obvious gain. We present a case of a 23-year-old female with chronic urticaria who presented with dyspnea, dysphasia, mild generalized erythema, abdominal cramps, and headache. She was tachypneic and hypotensive. This was her third admission with similar symptoms within the last 7 months. Tryptase, complement, anti-SM/RNP, Sjogren, Scl-70, C3, and C4 were negative. Computed tomography–guided bone marrow biopsy showed no mast cells. Flow cytometry did not show any immunophenotypic reaction. Other possible differentials including pregnancy, autoimmune disorders, and infections including hepatitis, thyroid disorder, and age-related malignancies were ruled out. After a thorough review, malingering disorder was ruled out, but we noticed the patient’s intent of assuming a sick role. Later, the patient was diagnosed with major depressive disorder. Factitious anaphylaxis can present with multiple presentations including a life-threatening condition that mimics true anaphylaxis. A better approach would be thorough clinical evaluation and early multidisciplinary involvement. This case highlights the importance of further evidence-based studies in factitious disorder to decrease the disease burden and reduce the health care cost.

Sick of the Sick Role: Narratives of What “Recovery” Means to People With CFS/ME

Little is known about what recovery means to those with chronic fatigue syndrome/myalgic encephalomyelitis, a poorly understood, disabling chronic health condition. To explore this issue, semi-structured interviews were conducted with patients reporting improvement ( n = 9) and deterioration ( n = 10) after a guided self-help intervention, and analyzed via “constant comparison.” The meaning of recovery differed between participants—expectations for improvement and deployment of the sick role (and associated stigma) were key influences. While some saw recovery as complete freedom from symptoms, many defined it as freedom from the “sick role,” with functionality prioritized. Others redefined recovery, reluctant to return to the lifestyle that may have contributed to their illness, or rejected the concept as unhelpful. Recovery is not always about eliminating all symptoms. Rather, it is a nexus between the reality of limited opportunities for full recovery, yet a strong desire to leave the illness behind and regain a sense of “normality.”

Narratives of illness in a Chinese virtual hospital

This study explores 60 individual narratives of illness presented in the initiating messages of threads that are posted in a well-known virtual space, ‘Tianya Hospital’ (????), in China. ‘Tianya Hospital’ is a discussion board where website users discuss their own or their loved ones’ health problems with other participants, who may be either health experts or patients with similar illnesses. Adopting the approach of mediated discourse analysis, the study aims to find out what is narrated (i.e., narrative presentation categories), what stance is taken and what the patterns and functions of the narrative presentation and the stance taking are. Some narrative presentation categories identified in this study are to some degree associated with existing face-to-face medical consultation phases, while others are related to a ‘timescale’ frame and the ‘sick role’ concept. The findings also show that the online narratives present not only the description of health problems, but also epistemic and affective stances. Some features of the narrative presentation organization and the stance taking in narratives can perform particular functions, such as serving to legitimize patients’ or patients’ caregivers’ complaints about healthcare services

MINDFULNESS DENGAN PERILAKU PERAN SAKIT PADA PASIEN PASCA STROKE

Stroke is a common cause of disability and has a large impact on an individual's life. Stroke recovery is very individual and requires a long process. Family support is not enough to give effect to the recovery of post-stroke sufferers, the mindfulness of post-stroke sufferers themselves to recover is also needed. The purpose was determined the relationship between mindfulness with sick role behavior in post-stroke patients with. The subjects were 110 people with characteristics aged 30-65 years. The instruments of this study were the Applied Mindfulness Process Scale (AMPS) and Barcylas Sick Role Process Inventory (BSRPI). The technique of Mediated Multiple Regression was the data analysis. The results showed there was a correlation between mindfulness and sick role behavior (β = 0.51, p 0.05).