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Small Wins Matter in Advocacy Movements: Giving Voice to Patients

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American Journal of Community Psychology

Abstract

In this article, the various players are delineated in a story of a contested illness and patient advocacy, played out within the corridors of federal power. It is suggested that the mistreatment and negative attitudes that health care providers and others have towards those with chronic fatigue syndrome (CFS) is possibly due to the social construction of this illness as being a “Yuppie flu” disease. Institutional factors are identified that created these norms and attributions, as well as the multiple stakeholders and constituent groups invested in exerting pressure on policy makers to effect systemic change. This article also provides examples of how the field of Community Psychology, which is fundamentally committed to/based on listening to and giving voice to patients, is broadly relevant to patient activism communities. This approach focused, over time, on epidemiological studies, the name, the case definition, and ultimately the change in CFS leadership at the Centers for Disease Control and Prevention. Keys to this “small wins” approach were coalition building, use of “oppositional experts” (professionals in the scientific community who support patient advocacy goals) to challenge federal research, and taking advantage of developing events/shifts in power. Ultimately, this approach can result in significant scientific and policy gains, and changes in medical and public perception of an illness.

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Notes

  1. In a response to this, Reeves et al. (2009) brought up a number of methodological concerns regarding this article including our rationale for using a comparison group with Major Depressive Disorder and the fact that we only used eight symptoms to compute our CDC Symptom Inventory. We responded to these critiques in a subsequent article (Jason et al. 2010).

References

  • Abbey, S. E., & Garfinkel, E. E. (1991). Chronic fatigue syndrome and depression: Cause, effect, or covariate. Reviews of Infectious Diseases, 13, S73–S83.

    Article  PubMed  Google Scholar 

  • Anderson, J. S., & Ferrans, C. E. (1997). The quality of life of persons with chronic fatigue syndrome. Journal of Nervous and Mental Disease, 185, 359–367.

    Article  PubMed  Google Scholar 

  • Aronowitz, R. A. (1992). From myalgic encephalitis to yuppie flu: A history of chronic fatigue syndromes. In C. E. Rosenberg & J. Golden (Eds.), Framing disease: Studies in cultural history. Piscataway, New Jersey: Rutgers University Press.

    Google Scholar 

  • Barsky, A. J., & Borus, J. F. (1999). Functional somatic syndromes. Annals of Internal Medicine, 130, 910–921.

    PubMed  Google Scholar 

  • Brown, P. (2000). Popular epidemiology and toxic waste contamination: Lay and professional ways of knowing. In S. Kroll-Smith & V. J. Gunter (Eds.), Illness and the environment: A reader in contested medicine. New York: New York University Press.

    Google Scholar 

  • Buchwald, D., Pearlman, T., Umali, J., Schmaling, K., & Katon, W. (1996). Functional status in patients with chronic fatigue syndrome, other fatiguing illnesses, and healthy individuals. American Journal of Medicine, 101, 364–370.

    Article  PubMed  Google Scholar 

  • CFSAC (2007). Minutes of the May 1617, 2007 chronic fatigue syndrome advisory committee (pp. 68). Retrieved at: http://www.hhs.gov/advcomcfs/meetings/minutes/cfsac070516min_pdf.pdf.

  • CFSAC (2008). Minutes of May 56, 2008 chronic fatigue syndrome advisory committee (pp. 23, 25). Retrieved at: http://www.hhs.gov/advcomcfs/meetings/minutes/cfsac080505min_pdf.pdf.

  • CFSAC (2009). Minutes of October 2930, 2009 chronic fatigue syndrome advisory committee. Retrieved at: http://www.hhs.gov/advcomcfs/meetings/minutes/cfsac102909min_pdf.pdf (videos of these meetings for Day 1: http://videocast.nih.gov/Summary.asp?File=15408 and for Day 2: http://videocast.nih.gov/Summary.asp?File=15409).

  • Couch, S. R., & Kroll-Smith, S. (2000). Environmental movements and expert knowledge: Evidence for a new populism. In S. Kroll-Smith, P. Brown, & V. J. Gunter (Eds.), Illness and the environment: A reader in contested medicine. New York: New York University Press.

    Google Scholar 

  • Freire, P. (1970). Pedagogy of the oppressed. New York: Herder and Herder.

    Google Scholar 

  • Friedberg, J. R., & Jason, L. A. (1998). Assessment and treatment of chronic fatigue syndrome. Washington, DC: American Psychological Association.

    Book  Google Scholar 

  • Gould, D. B. (2009). Moving politics: Emotion and ACT UP’s fight against AIDS. Chicago: University of Chicago Press.

    Google Scholar 

  • Green, J., Romei, J., & Natelson, B. J. (1999). Stigma and chronic fatigue syndrome. Journal of Chronic Fatigue Syndrome, 5, 63–75.

    Article  Google Scholar 

  • Heim, C., Wagner, D., Maloney, E., Papanicolauo, D. A., Solomon, L., Jones, J. F., et al. (2006). Early adverse experience and risk for chronic fatigue syndrome: Results from a population-based study. The Archives of General Psychiatry, 63, 1258–1266.

    Article  Google Scholar 

  • Jason, L. A. (2007, January). Epidemiology session summary: State-of-the-art with a CFS-perspective. Paper presented at the International Association of Chronic Fatigue Syndrome, Ft. Lauderdale, Fl.

  • Jason, L. A., Benton, M., Johnson, A., & Valentine, L. (2008).The economic impact of ME/CFS: Individual and societal level costs. Dynamic Medicine, 7:6 PMCID: PMC2324078.

    Google Scholar 

  • Jason, L. A., Corradi, K., Gress, S., Williams, S., & Torres-Harding, S. (2006). Causes of death among patients with chronic fatigue syndrome. Health Care for Women International, 27, 615–626.

    Article  PubMed  Google Scholar 

  • Jason, L. A., Najar, N., Porter, N., & Reh, C. (2009). Evaluating the centers for disease control’s empirical chronic fatigue syndrome case definition. Journal of Disability Policy Studies, 20, 93–100.

    Article  Google Scholar 

  • Jason, L. A., Porter, N., Brown, M., Brown, A., & Evans, M. (2010). A constructive debate with the CDC on the CFS empirical case definition. Journal of Disability Policy Studies, 20, 251–256. doi:10.1177/1044207309359515.

    Article  Google Scholar 

  • Jason, L. A., Richman, J. A., Friedberg, F., Wagner, L., Taylor, R. R., & Jordan, K. M. (1997). Politics, science, and the emergence of a new disease: The case of chronic fatigue syndrome. American Psychologist, 52, 973–983.

    Article  PubMed  Google Scholar 

  • Jason, L. A., Richman, J. A., Rademaker, A. W., Jordan, K. M., Plioplys, A. V., Taylor, R. R., et al. (1999). A community-based study of chronic fatigue syndrome. Archives of Internal Medicine, 159, 2129–2137.

    Article  PubMed  Google Scholar 

  • Jason, L.A., Sorenson, M., Porter, N., & Belkairous, N. (2011). An etiological model for myalgic encephalomyelitis/chronic fatigue syndrome. Neuroscience & Medicine, 2: 14–27. doi:10.4236/nm.2011.21003. Retrieved from http://www.scirp.org/journal/nm/.

  • Jason, L. A., Taylor, R. R., Stepanek, Z., & Plioplys, S. (2001). Attitudes regarding chronic fatigue syndrome: The importance of a name. Journal of Health Psychology, 6, 61–71.

    Article  PubMed  Google Scholar 

  • Jason, L. A., Taylor, R. R., Wagner, L., Holden, J., Ferrari, J. R., Plioplys, A. V., et al. (1995). Estimating rates of chronic fatigue syndrome from a community based sample: A pilot study. American Journal of Community Psychology, 23, 557–568.

    Article  PubMed  Google Scholar 

  • Johnson, H. (1996). Osler’s web: Inside the labyrinth of the chronic fatigue syndrome epidemic. NY: Crown Publishers.

    Google Scholar 

  • Johnson, S. K. (2008). Medically unexplained illness: Gender and biopsychosocial implications. Washington, DC: American Psychological Association.

    Book  Google Scholar 

  • Kelly, J. G. (1990). Changing contexts and the field of community psychology. American Journal of Community Psychology, 18, 769–792.

    Article  Google Scholar 

  • Kingry-Westergaard, C., & Kelly, J. G. (1990). A contextualist epistemiology for ecological research. In P. Tolan, C. Keys, F. Chertok, & L. A. Jason (Eds.), Researching community psychology: Issues of theory and methods (pp. 23–31). Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  • Kroll-Smith, S., & Gunter, V. J. (Eds.). (2000). Illness and the environment: A reader in contested medicine. New York: New York University Press.

    Google Scholar 

  • Lewis, G., & Wessely, S. (1992). The epidemiology of fatigue: More questions than answers. Journal of Epidemiology and Community Health, 46, 92–97.

    Article  PubMed  Google Scholar 

  • Lindblom, C. E. (1979). Still muddling, not yet through. Public Administrative Review, 39, 517–526.

    Article  Google Scholar 

  • Lost Voices. (2008). Invest in ME. Great Britain: Wild Conversations Press.

    Google Scholar 

  • Moritsugu, J., Wong, F. W., & Duffy, K. G. (2009). Community psychology (4th ed.). Upper Saddle River, New Jersey: Pearson.

    Google Scholar 

  • Reeves, W. C., Gurbaxani, B. M., Lin, J. S., & Unger, E. R. (2009). A response to Jason et al. (2009). Evaluating the Centers for disease control’s empirical chronic fatigue syndrome case definition. Journal of Disability Policy Studies. OnlineFirst, published on September 25, 2009 as doi:10.1177/1044207309346310.

  • Reeves, W.C., Jones, J.J., Maloney, E., Heim, C., Hoaglin, D. C., Boneva, R., Morrissey, M., & Devlin, R. (2007). New study on the prevalence of CFS in metro, urban and rural Georgia populations. Population Health Metrics 2007, 5:5. doi:10.1186/1478-7954-5-5. Available at: http://www.pophealthmetrics.com/content/5/1/5.

  • Reeves, W. C., Lloyd, A., Vernon, S. D., Klimas, N., Jason, L. A., Bleijenberg, G., Evengard, B., White, P. D., Nisenbaum, R., Unger, E. R. (2003). Identification of ambiguities in the 1994 chronic fatigue syndrome research case definition and recommendations for resolution. BMC Health Services Research, 3, 25. Available at: http://www.biomedcentral.com/content/pdf/1472-6963-3-25.pdf.

  • Reeves, W. C., Wagner, D., Nisenbaum, R., Jones, J. F., Gurbaxani, B., Solomon, L., Papanicolaou, D., Unger, E. R., Vernon, S. D., & Heim, C. (2005). Chronic fatigue syndrome—A clinical empirical approach to its definition and study. BMC Medicine, 3:19; doi:10.1186/1741-7015-3-19. (available at: http://www.biomedcentral.com/content/pdf/1741-7015-3-19.pdf).

  • Regier, D. A., Boyd, J. H., Burke, J. D., Jr., Rae, D. S., Myers, J. K., Kramer, M., et al. (1988). One-month prevalence of mental disorders in the United States: Based on five Epidemiological Catchment area sites. Archives of General Psychiatry, 45, 977–986.

    Article  PubMed  Google Scholar 

  • Reyes, M., Gary, H. E., Jr., Dobbins, J. G., Randall, B., Steele, L., Fukuda, K., et al. (1997). Descriptive epidemiology of chronic fatigue syndrome: CDC surveillance in four cities. Morbidity and Mortality Weekly Report Surveillance Summaries, 46(SS-2), 1–13.

    Google Scholar 

  • Reyes, M., Nisenbaum, R., Hoaglin, D. C., Unger, E. R., Emmons, C., Randall, B., et al. (2003). Prevalence and incidence of chronic fatigue syndrome in Wichita, Kansas. Archives of Internal Medicine, 163, 1530–1536.

    Article  PubMed  Google Scholar 

  • Richman, J. A., & Jason, L. A. (2001). Gender biases underlying the social construction of illness states: The case of chronic fatigue syndrome. Current Sociology, 49, 15–29.

    Article  Google Scholar 

  • Ryan Baldwin Returned home (2010). Prohealth. Retrieved on April 18, 2010 at http://www.prohealth.com/me-cfs/blog/boardDetail.cfm?id=1384763.

  • Sandler, I. N., Gensheimer, L., & Braver, S. (2000). Stress: Theory, research, and action. In J. Rappaport & E. Seidman (Eds.), Handbook of community psychology (pp. 187–214). New York: Kluwer/Plenum.

    Chapter  Google Scholar 

  • Sarason, S. B. (1972). The creation of settings and the future societies. San Francisco: Jossey-Bass.

    Google Scholar 

  • Sarason, S. B. (1976). Community psychology and the anarchist insight. American Journal of Community Psychology, 4, 243–261.

    Article  Google Scholar 

  • Seidman, E. (1988). Back to the future, community psychology: Unfolding a theory of social intervention. American Journal of Community Psychology, 16, 3–24.

    Article  PubMed  Google Scholar 

  • Shinn, M., & Toohey, S. (2003). Community contexts of human welfare. Annual Review of Psychology, 54, 427–459.

    Article  PubMed  Google Scholar 

  • Showalter, E. (1997). Hystories: Hysterical epidemics and modern media. NY: Columbia University Press.

    Google Scholar 

  • Trickett, E. J., & Mitchell, R. E. (1993). An ecological metaphor for research and intervention in community psychology. In M. S. Gibbs, J. R. Lachenmeyer, & J. Sigal (Eds.), Community psychology: Theoretical and empirical approaches (2nd ed.). New York: Wiley.

    Google Scholar 

  • Vercoulen, J. H., Swanink, C. M., Galama, J. M., Fennis, J. F., Jongen, P. J., Hommes, O. R., et al. (1998). The persistence of fatigue in chronic fatigue syndrome and multiple sclerosis: Development of a model. Journal of Psychosomatic Research, 45, 507–517.

    Article  PubMed  Google Scholar 

  • Wandersman, A., & Florin, P. (1990). Citizen participation, voluntary organizations and community development: Insights for empowerment and research [special issue]. American Journal of Community Psychology, 18, 41–177.

    Article  Google Scholar 

  • Watzlawick, P., Weakland, J. H., & Fisch, R. (1974). Change: Principles of problem formation and problem resolution. New York: W. W. Norton.

    Google Scholar 

  • Weick, K. E. (1984). Small wins: Redefining the scale of social problems. American Psychologist, 39, 40–49.

    Article  Google Scholar 

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Acknowledgments

I appreciate the suggestions and editorial help of Molly Brown, David Glenwick, Meredyth Evans, Abby Brown, John Moritsugu, Nicole Porter, Jessica Hunnell, Valerie Anderson, Athena Lerch, Jocelyn Droege, Laura Hlavaty, Chris Keys, G. Anne Bogat, Judith Richman, Brad Olson, Jacob Tebes, Jo Ellyn Walker, Steve Everett, and Daryl Isenberg. A particular note of thanks to Dorothy Wall who helped me link this work to the larger patient advocacy movement.

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Correspondence to Leonard A. Jason.

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Jason, L.A. Small Wins Matter in Advocacy Movements: Giving Voice to Patients. Am J Community Psychol 49, 307–316 (2012). https://doi.org/10.1007/s10464-011-9457-7

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