Christopher D Ward
During my training as a neurologist I spent three years at NIH, Bethesda, participating in research on the clinical pharmacology and genetics of Parkinson's disease. My clinical and research focus has always been on chronic, disabling conditions, and I had a lead role in services for people diagnosed with chronic fatigue syndrome (or ME). This work constantly brought me into contact with couples and families, which led to my training in Systemic Family Therapy at the University of Birmingham. I am now Emeritus Professor of Rehabilitation Medicine University of Nottingham, and a family therapist, now working independently following several.years with the Derbyshire Child and Mental Health Service. An interest in the concepts of illness and diagnosis is reflected in two recent books. My CV and its selection of publications describes a trajectory that is (hopefully) incomplete.
BLOGS:
Between Sickness and Health https://thinkmore.typepad.com/chris_d_ward/
Inhabiting Medicine https://thinkmore.typepad.com/inhabiting_medicine/RECENT BOOKS:
RECENT BOOKS:
Between Sickness & Health. The Landscape of Illness & Wellness. Routledge, 2019. https://bit.ly/2QVTZ7A
Meanings of ME: Interpersonal and Social Dimensions of Chronic Fatigue. Palgrave Macmillan, 2015 https://bit.ly/2XA7ZGv
Phone: +447954302765
BLOGS:
Between Sickness and Health https://thinkmore.typepad.com/chris_d_ward/
Inhabiting Medicine https://thinkmore.typepad.com/inhabiting_medicine/RECENT BOOKS:
RECENT BOOKS:
Between Sickness & Health. The Landscape of Illness & Wellness. Routledge, 2019. https://bit.ly/2QVTZ7A
Meanings of ME: Interpersonal and Social Dimensions of Chronic Fatigue. Palgrave Macmillan, 2015 https://bit.ly/2XA7ZGv
Phone: +447954302765
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• Claiming to be unwell is a plea for subjective experience to be recognised. The performance of symptoms is just as necessary in authentic illness as in malingering
• Feelings of illness are never ‘unreal’ or ‘fake’, whatever their biological basis
• Illness, as a subjective reality, cannot be categorised as ‘physical’, ‘psychosomatic’ or ‘psychiatric’.
• Illness cannot be described solely in the language of disease. The meanings of symptoms require interpretation, as distinct from causal explanation
The book’s second part describes the conditions for recovery. These include:
• A concept of wellness that takes account of personal needs, desires and motivations
• Freedom from personal and environmental hindrances to recovery, including systemic factors such as medicalisation
• Resources, including medical and other intervention along with human relationships. Healing is viewed as an innate process that technologies can support but never replace
• Personal abilities, viewed as skills rather than as inborn resilience traits
Systemic ideas provide a perspective within which issues such as power, relational positioning, culturally-derived meaning and personal motivations can be integrated with biological aspects of illness.
The book’s many clinical examples are drawn from the author’s broad experience as a neurologist, rehabilitation physician and systemic family therapist. Between Sickness and Health demonstrates that clearer thinking about illness, disease and disability is both literally and philosophically therapeutic. The book will be useful for students, practitioners and academics but will also be of interest to a wider readership.
The skills perspective suggests that ordinary magic is made possible by reflecting about oneself and one’s situation. Clinical and literary evidence suggests that this kind of reflection has affinities with formal meditation and with the spiritual exercises of Stoic philosophers and others. Reflection may be a non-verbal process, producing alternative images of reality, so that one is not ‘held captive’ by specific pictures of illness and wellness. An overarching skill, finally, is the ability to hope.
Once a situation comes to be regarded as an illness, medical theories must follow. The history of neurasthenia turned less on scientific theories than on different cultural responses to the ambiguities of illness. A traditional response was to think of illness as a disturbance of the whole organism but the ‘ontological ’ idea of a discrete ‘disease ’ fitted better with the progress of scientific medicine. The advance of medical specialisation has favoured the view that either the brain or the mind is the locus of disease in neurasthenia. Explanations of illness that are oriented towards whole systems and whole persons lack the authority and legitimacy of organ-based specialities. Medicalisation, medical theorising, and medical specialisation have jointly created an environment in which patients who lack a discrete biological cause for their symptoms seem more mysterious and extraordinary than perhaps they are.
Keywords
Irritable Bowel Syndrome Chronic Fatigue Syndrome Medical Professionalisation Medical Theorise Nervous System Disorder
Existing ways of writing about CFS/ME are generally unable to accommodate the idea that symptoms and illnesses can have personal or interpersonal meanings. Greater openness to meanings is possible if we assume (1) that any given account of CFS/ME is a particular ‘punctuation ’ of complex realities and (2) that the meanings people associated with CFS/ME do not form a fixed code but are developed discursively. For these reasons a multi-perspectival, systemic approach is needed in order to replace preconceptions with curiosity about the many meanings of CFS/ME.
The chapter ends with an overview of the rest of the book.
All three responses — somatic monitoring, experiential regulation, and pre-emptive defensiveness — become aspects of the person and may be amplified over time. They may then pose problems for people with CFS/ME in their relations with others. They could, for example, ‘make up ’ an identity which encourages disparaging attitudes among professionals. They could also contribute to public controversy about CFS/ME. People ’s somatic monitoring, experiential regulation, and pre-emptive defensiveness may be rational responses to their publicly derived knowledge of CFS/ME but may make them appear anxious or low in mood. These responses, interpreted by professionals in clinical terms, may then ‘loop back ’ to alter the public profile of CFS/ME so that the condition appears to be a producer of ‘anxious depression ’.
My own experience suggests that professionals tend to disavow any ambivalence they feel. ‘Safe uncertainty’, as Barry Mason calls it, is a better goal than unwarranted dogmatism in the context of CFS/ME. More good than harm will be done if doctors and patients make their ambivalence manifest to one another, whatever theory of illness they may favour.