Behind the Biological Veneer: A Closer Look at the BMJ, SIRPA and Garner’s Framing of Chronic Illness
The Weaponisation of Cognitive Therapies in Mind-Body Medicine
Cognitive Therapies Part Two
So far in Part One, we have explored mindfulness and meditation and the sociological, philosophic and pragmatic issues that arise with their unquestioning acceptance.
This article explores how cognitive therapies contribute to a dangerous medical paradigm for chronic illness. We shall focus on Paul, ‘he’s not the messiah, he’s a very naughty boy’, Garner’s opinion piece for the BMJ and his appearance at the SIRPA conference.
We examine the historical, rhetorical, and systemic forces behind mind-body medicine and how they obscure harm through compassion-washing, concept laundering, and misplaced optimism.
When chronically ill, one is presented, with a whole smorgasbord of cognitive therapies that promise to help and offer hope. This can include traditional CBT and mindfulness-based stress reduction; “third wave” therapies like ACT (Acceptance and Commitment Therapy) and MBCT (Mindfulness-Based Cognitive Therapy); brain retraining programmes; six-week digital recovery courses; yoga-for-trauma classes; “Your COVID Recovery” platforms; self-help books; and the ever-expanding catalogue of mind-body medicine. It’s a psycho-industrial complex.
Buckle your seat belts, this should be quite the ride…
In Hopium We Trust: The BMJ’s Glossy Rebrand of Psychosomatic Medicine
During ME Awareness week, the BMJ, a supposed bastion of medicine, but which also has a terrible reputation in supporting quack behavioural and BPS models, published ‘Patients with severe ME/CFS need hope and expert multidisciplinary care.’ by Dr. Alastair Miller, Prof. Paul Garner, Fiona Symington and Dr. Maria Pederson.
It was a blast to the past of the historic harms of ME, where maladaptive beliefs are blamed for symptoms. This epitomises how CBT has been misused in treating ME. Also included was the dysregulation theory still perpetuated by BACME and the BPS Leeds model, where experts in CBT are ready and waiting to cause medical harm.
There are many issues with the piece, but the key errors are:
It ignores PEM and confuses it with fatigue.
The gradual exposure to activity and sensitisation theory has been around for decades and has not been proven in research or worked in patient experience.
Implying that patients need to only reframe their beliefs through cognitive therapies is victim blaming and utterly ick.
Rhetorical Trick 1 - Hopium
What the article does is centre hope, but uses it as a rhetorical device to deflect from criticism. Framing cognitive therapies as ‘hopeful’ means that those who are sceptical are painted as negative or anti-recovery. In essence, it weaponises hope, misusing it as a strategic shield which shuts down valid critique.
Garner transfers the commodification of hope - so prevalent in brain retraining and recovery stories - into a mainstream medical journal. It’s unlikely they even noticed. Hope in this industry is a powerful, marketable product and the root of the mind-body medicine’s hydra-like qualities.
Rhetorical Trick 2 - Biomedical Jargon
There is another rhetorical device: they frame their approach ostensibly in wooly biomedical terms while ultimately promoting psychosocial solutions. This is tactical vagueness and language obscuration. This strategic ambiguity makes it harder for them to be accountable.
This masks the behavioural roots of the interventions and serves as a pre-emptive shield against being accused of psychologisation. It’s so over-baked, it’s painful to watch. It is important to note that this is a key tactic and red flag to avoid stigmatisation.
By embracing biomedical language, and using performative compassion in order to disarm critics, the article acts as a Trojan horse, and we call for its retraction due to its lack of groundedness in validated diagnostic criteria.
Rhetorical Consequence - Epistemic Violence
That the authors and, by publication, the BMJ co-opted the death of very severe ME patient Maeve Boothby O’Neill, caused by medical neglect, is an ethical failure. It is an act of epistemic and testimonial violence to use the example of Maeve to promote the very framework that harmed her.
It’s appalling that the BMJ published this gross medical negligence reframed as a justification for the psychosocial narrative the authors cannot abandon at any cost - including life.
The Church of Mind-Body: SIRPA’s Cult of Rewiring and Garner’s Gospel
When this summary slide from Garner at the SIRPA conference surfaced, it would be easy to think that this is quack fringe stuff. The reality is somewhat more complex.
Let’s start with who are SIRPA? They are the Stress Illness Recovery Practitioners’ Association. It was founded by Georgie Oldfield and based on the mind-body medicine of John Sarno, from whom “she now had an answer to all her questions.”
Anyone acquainted with mind-body medicine knows Sarno is the godfather of the field. His work stems from the premise that psychological and emotional trauma contribute to and cause physical illness and especially pain. He pioneered mind-body techniques, some misappropriated from Eastern cultures, such as mindfulness, CBT, journaling, yoga, etc., to treat these psychological abnormalities and trauma. Sound horribly familiar?
The conference and SIRPA itself are great examples of the tenets of mind-body medicine.
Let’s go through them:
Healing begins when you trust the mind-body connection.
Symptoms are caused by being stuck in flight or fight mode. (Note: we are often told this in ME and Long Covid - it is not based on scientific evidence but sourced in mind-body medicine)
Focusing on symptoms can perpetuate them.
Believing you are in a state of danger and fear creates symptoms.
Suppressing emotions means you cannot heal.
Neuroplastic pain and somatic symptoms are the brain’s way of believing it is protecting the body.
Language and words shape chronic pain.
The brain manifests what the body expects.
Chronic pain and neuroplastic symptoms are a complex interplay between mind and body.
Creating a feeling of safety means you can move, overcome pain and recover.
Pain is the brain’s perception and not based in tissue damage.
Using neuroplasticity and mind-body tools, one can rewire the brain and be pain free.
Garner’s mantra of reframing beliefs and perception in Long Covid is actually rooted in a long, complex history that has power and influence. He is not acting within a vacuum. To him, he is the wronged man, the pioneer and the one who will save the day.
Now let’s go through some specific issues in Garner’s presentation that can be extrapolated to the conference and mind-body medicine in general:
n=1 and Thou Shalt Believe: Garner’s Evangelism
So, again, we have Garner relating his recovery story. We seriously wonder if he thinks if he repeats it enough times, he can replicate himself into a phase 3 trial of thousands?!
His recovery, though, is framed as generalisable. It implies that others can recover too if only they change their mindset, do their trauma processing and become mindful of and shift their maladaptive beliefs. And of course if it doesn’t work - we have victim blaming and the redirection of the problem onto the individual - all over again.
Garner fails brilliantly at turning his survivorship bias into saviourship. But all he does is reinforce the stigma for those who still have Long Covid. He in fact weaponises his lived experience.
Yet, the reliance on the anecdotal success story is what the conference and the ‘CFS Recovery’ industry rely on. The mind-body techniques they zealously advocate do not go through ethics boards, formal trial designs or longitudinal follow up. It’s hopium.
One Theory to Rule Them All: Mind-Body Imperialism in Chronic Illness
Garner and SIRPA promote the idea that chronic illness can be treated through psychological methods. But this is essentially flattening medical pluralism into one very handy ‘unifying’ psychological lens.
This means that they can indiscriminately capture and claim to treat any illness that isn’t well understood, usually because of bias in medicine. Lucrative - as everyone pretty much has something to sell.
This is a form of disciplinary imperialism - where one world view (mind-body trauma theory) is applied across all conditions without the humility of complexity or the tedious requirement of evidence.
Nor do they listen, or adapt if a vast swath of people with lived experience state that this psychological approach doesn’t work, and is actively harmful. In fact, denial, feigned hurt, DARVO, aggression and another smorgasbord of responses arise.
Not So Fringe: The Institutional Legacy Behind Garner’s Belief System
Now this is where it gets interesting. Although it is Garner who has caught the attention, he is likely not the biggest concern. Yes, Garner has soft influence through his contacts, but the inclusion of Dr. Deepak Ravindran and Prof. Jon Stone is important because they work in the NHS and are actively working to change the healthcare ecosystem to their agenda.
Ravindran leads the Long Covid Clinic in Reading and is committed to mindset medicine. He is connected and well-loved by a variety of different mind-body organisations and brain re-training outfits. It is his talk that looks at shifting viewing long-term conditions as “mind body/neural circuit disorder” and treating patients through the biopsychosocial model in the NHS, that is a major issue.
We have spoken before about our concern that he advises Long Covid orgs, but we get into a lot of trouble for doing so - so no more said. The point is, he is a crossover in the tenets of mind-body medicine/brain re-training and the NHS, most specifically the idea of nociplastic pain and the idea that symptoms arise from altered perception or nociception.
Rewiring the Narrative: How Neuroplastic and Nociplastic Pain Collide
You might have noticed the mention of neuroplastic pain - SIRPA and the mind-body industry are big on this. We need to understand why this is an important connection and link to medical culture through nociplastic pain. But we have to do some unpacking.
Now, technically, nociplastic and neuroplastic pain are different. Neuroplastic is a term used in brain re-training/mind-body outfits. Nociplastic pain is officially recognised in the IASP and made popular by Prof Lorimer Mortimer (which is a whole other kettle of fish or beasts).
The key point is that nociplastic pain is big in the NHS, one can see this in Dr Amir Khan’s video about pain. It has been unquestionably accepted without due scepticism, for many of the same reasons mindfulness and CBT have. There is significant underlying conceptual overlap and slippage. Both carry the core ideas that there are:
pain without tissue damage or disease pathology
pain is because of altered brain and nervous system processing and interoception
central mechanisms explain multiple symptoms in ‘medically unexplained symptoms’ such as ME, Fibromyalgia, IBS, chronic pain, etc.
danger, avoidance, and fear are factors in pain and symptoms
But both also carry a vagueness and centrality of brain-based pain with links to trauma, especially ACE (adverse childhood experiences) that invites psychosocial interpretations and interventions - like our old friend mindfulness.
Most importantly, neuroplastic and nociplastic pain both lack evidence. They are presented as a blanket explanatory mechanism without limits - committing the fallacy of a reductionist metaphor.
This acts as catch-all explanations that incorporate our mental and emotional lives in illness. It is diagnostic and concept capture that stops further investigation and research. Just as the catch-all concept of hysteria did and FND does now.
The SIRPA conference exemplifies this worrying convergence as we see Ravindran, Garner and Stone all contributing. This matters for people with chronic illness because it’s a present area where there is stealth psychologisation under the guise of neuroscience.
Institutional Drift: Mind-Body Medicine and Advocacy
But Ravindran isn’t the only one promoting psychological framing connected to organisations that presented at the conference. Most of us know the pernicious influence of Prof Jon Stone and his championing of FND and trying to capture many non-connected illnesses under its functional (psychiatric) umbrella, including Long Covid.
We’re increasingly concerned about the quiet alignment of charities, advocates and organisations with mind-body frameworks through platforming those involved with: FND; previous harm in CBT, mind-body medicine, brain re-training or the therapeutic use of meditation/mindfulness.
This isn’t just a matter of differing opinions; it reflects a deeper problem of influence, where certain narratives gain institutional traction and exposure to a large vulnerable audience, despite their harms to patients.
We would love to see an end to this through increased awareness of the issues at hand and co-operation. We are always happy to talk.
Advocacy is a learning curve, and it’s okay to not be fully aware of all the connotations. It’s how we move on and learn that matters. We know that having this pointed out in public is difficult. Which is why we try to reach out privately first. Unfortunately, that rarely works.
As an advocacy organisation committed to holding power to account in whatever form it takes it - it is necessary for us to address this. That way, everyone has all the evidence possible to make informed decisions.
Mind-Body Myths: When Empathy Becomes Misinformation
Adherents of mind-body medicine use several tricks to assert their validity. It is important to recognise what these are. They will tell you they aren’t gaslighting you because they believe:
Your symptoms are physical
It’s not all in your head
Your illness is biological
It’s real
We seem to endlessly repeat this point, but will do so again. There is a flawed premise that the definition of psychosomatic/psychologising means that someone is malingering (making it up, hypochondria).
FOR THOSE AT THE BACK - THIS IS NOT THE CASE. If we look back through the differing models of hysteria, they all had a basis in the physical body. If we look at the term psychosomatic, it means mind-body. If we look at biopsychosocial, it includes the biological.
If we examine what Parker, Gupta, Howard, Wessely, Chalder etc, all the brain retraining, psychs and mind-body folk say - they all claim it’s physical, real, not in your head.
This is biological window dressing and psychosomatic denialism. It’s a deflection tactic to avoid stigma and criticism and the actual argument (or motte and bailey fallacy if we want to get fancy). It’s also incredibly successful as a tactic, as one rarely gets beyond this point.
They are exploiting the binary between the physical and psychological whilst simultaneously denying it - creating a false dichotomy.
For example, they will say “it’s not all in your head,” yet their solutions almost entirely rely on the psychological. This is a false integration: claiming mind-body unity, whilst treating the mind as the strings and the body as the puppet.
They will likely tell you this with extra compassion, as Suzanne O’Sullivan does. This is emotional coercion. By wrapping claims in empathy, like “I believe you” and “it’s real”, they demand compliance with their model under the threat of being labelled negative or toxic if you disagree.
The nub is that if a medical practitioner, org (or anyone really) is platforming someone claiming that:
Unresolved trauma is involved in your illness
There is a mind-body connection
That fear is stopping you from moving or healing
You’re stuck in fight or flight etc, etc
Using the dysregulation hypotheses
You need to create safety to heal
It is deeply irresponsible, harmful and essentially framing your illness as psychosomatic. In other words, it’s all very Miranda and what we see in her book.
It is still gaslighting and misinformation, even if they don’t claim or believe it is. This is the difference between misinformation and disinformation - personal belief in its validity.
When Rest Isn’t Restful: The Dangers of Mindfulness and CBT
We need to address the specific harm that comes with applying these mind-body techniques and mindfulness to those with energy-limited illnesses and PEM.
A good touchstone to considering whether these approaches are suitable for severe and very severe patients. Garner and co will tell you they are and are safe. This is not the case, and it is monstrous that they claim they are.
CBT, mindfulness, breathwork, and journaling all take exertion and can stimulate PEM. They require energy that we often do not have to give. This is why brain retraining and CBT can be some of the most harmful therapeutic interventions. As they can stimulate a crash we never recover from.
At the extreme end, this is brainwashing people that ‘they are not in danger.’ Yet, there is danger for those who are ‘mild’ as PEM is difficult to recognise or even know you have it.
The caveat that people can engage in them in a paced way is irresponsible, as again, PEM is unpredictable, and it should not be the individual’s responsibility to manage harm.
These techniques, especially meditation, are seen as restful and restorative. They are often recommended to stop or prevent PEM. This is an ableist assumption, as it comes from a ‘normal’ perspective and is not always appropriate.
We saw in Part One how meditation and mindfulness cannot be assumed to be calming or restorative. That concentration, which mindfulness and meditation requires takes effort.
In fact, right effort (samma vayamo) is central to the practice of mindfulness in Buddhism.
Misappropriating meditation without its fuller context and no understanding of the complex web of factors involved, including its dangers, has the potential to harm. Especially as anyone thinks they can teach it to others, including children.
Mind-Body Medicine and Mindfulness as Capital and a Means of Production
“absent a sharp social critique, Buddhist practices could easily be used to justify and stabilise the status quo, becoming a reinforcement of consumer capitalism.” Bhikku Bodhi
In Part One, we looked at mindfulness and cognitive therapies and how they are pervasive in: education, prisons, medicine, the military, and is the go-to wellness tool.
We can conclude that this psycho-industry complex has capitalised psychological interventions. This is turbo-charged in the mind-body industry - be it therapy, webinar, a book or a course. Hope sells.
Now, the Buddha wasn’t into turning his teachings into capital, being more on the decentralised rebel side. In fact, he made it clear that people shouldn’t be charged for his teachings.
We are back to our old friend, the Amazon Zen booth (or AmaZen, cringe), where rather than dealing with the oppressive nature of exploiting labour, one can go and be mindful in a plastic box. It weaponises mindfulness to make people more malleable to harmful systems.
The point is that the emphasis and reliance on cognitive therapies depoliticises suffering because it places the responsibility on to the individual instead of the system. This is what Purser describes in 'McMindfulness'.
In chronic illness, it becomes part of systemic medical neglect by eating up funding and clinical practice. It ignores so many things, especially social determinants of health and inequalities.
There is a simple reason for this - cognitive therapies are cheaper. Its institutional co-option is predicated on the fact that it’s easy and ‘cost-effective’. Much easier than addressing the root causes, such as a medical research gap that is so vast, it’s far simpler to look away.
We can see this in chronic illness and Long Covid research and practice. How many times do we have to go through the dreaded six sessions of CBT? How much research funding has to be squandered on quick fix, sticking plaster medicine?
From Cruel Optimism to Clinical Harm: A Reckoning
If you’ve got to the end, thank you for reading. This has been a complex and leggy subject - you seriously deserve a medal whilst those involved deserve the naughty step.
It is vital that these outdated psychogenic frameworks in chronic illness are brought to light and stopped. We hope that this article can help you recognise the things we’ve covered, especially biological window dressing, psychosomatic denialism, concept laundering and using hopium as a shield to criticism.
It is worth leaving the last word to the very real distress these models and beliefs cause. The psychologisation of illness is, in fact, systemic failure. That institutional negligence opens the way for the continued abuse of vulnerable people. This exemplifies the ‘cruel optimism’ of Lauren Berlant, which is the paradox of when a system that promises hope turns to oppression.
I do mindfulness and meditation to cope with the gaslighting associated with ME. But dispare with the way some people say they have been cured by it. It gives the average person ( some family!!) the ammunition to say you need therapy to get up and DO something, don't just ly there and veg!! People in power with money again🙄
Thank you again for covering this. This is an invaluable resource.