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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.

Whilst myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) has recently attracted high-profile media coverage, dominant accounts do not tell the whole story of how this group of disabled people came to occupy – albeit unequally – society’s fringes. This article, platforming some of the sidelined work of disabled activist-scholars, offers an understanding of oppressions confronting people with ME/CFS that is more inclusive of the politics impacting wider marginalised communities, offering possibilities for coalition-building with other social movements. Moreover, overlooked literature reveals intersecting power systems that differentially shape how ME/CFS is experienced, promoting an understanding of disability/impairment more inclusive of diversity. Inspired by the exhortation of Mike Oliver to record our own histories – lest they be written for us – this contribution seeks to challenge hierarchies and exclusions confronting the author as an academically-sidelined person with ME/CFS.

People with myalgic encephalomyelitis/chronic fatigue syndrome have historically been conceptualised in health and social policy as “undeserving” of societal support, largely via a variant of biopsychosocial model charged with promoting multifaceted harms. Whilst scientific literature has been preoccupied by paradigm conflicts pertaining to (bio)psychosocial and biomedical models of disability, the socio-cultural and biopolitical context driving (bio)psychosocial hegemony has received little mainstream scholarly attention. Nevertheless, this context is addressed within subjugated knowledges, notably through the epistemic labours of disabled activists and marginally situated scholars. This article espouses a feminist standpoint, feminist disability studies, and Foucauldian thought in re-examining and synthesising some of this work, locating psychosocial truth claims within an intersectionally oppressive and ever-expanding government of disability. I argue that greater respect for subjugated knowledges could lead not only to a more strongly objective and nuanced understanding of (bio)psychosocial hegemony but also to greater possibilities in terms of resistance.

Introduction In countries with access to the electronic health record (EHR), both patients and healthcare professionals have reported finding errors in the EHR, so-called EHRrors. These can range from simple typos to more serious cases of missing or incorrect health information. Despite their potential detrimental effect, the evidence on EHRrors has not been systematically analysed. It is unknown how common EHRrors are or how they impact patients and healthcare professionals.Methods and analysis A mixed systematic review will be carried out to address the research gap. We will search PubMed, Web of Science and CINAHL for studies published since 2000, which report original research data on patient-identified and healthcare professional-identified EHRrors. We will analyse (1) the prevalence of EHRrors, (2) the types of EHRrors and (3) their impact on care. Quantitative and qualitative findings will be synthesised following the Joanna Briggs Institute Framework for Mixed Systematic Reviews. Identified studies will be critically appraised for meta-biases and risk of bias in individual studies. The confidence in the emerging evidence will be further assessed through the Grading of Recommendations Assessment, Development and Evaluation approach. Findings will be contextualised and interpreted involving an international team of patient representatives and practising healthcare professionals.Ethics and dissemination The study will not involve collection or analysis of individual patient data; thus, ethical approval is not required. Results will be published in a peer-reviewed publication and further disseminated through scientific events and educational materials.PROSPERO registration number CRD42024622849.

People living with 'medically unexplained' health conditions, together with people labelled with 'mental illness', are subject to converging yet differentiated facets of normalising power/knowledge regimes, wherein psy and biopolitics play a central role. Drawing on lived experience of such biopolitics and tensions between and within these social movements, I seek to re-invigorate dialogue vis-a-vis a politics of solidarity in difference. 

Indictment of hegemonic psy construction of the “ideal” subject, and its marginalisation of the Other, is common to both feminism and (critical, feminist) disability studies. However, feminist literature largely lacks both an appreciation of the gendered, intersectional nature of disability as constituted and propagated by psy, and an exploration of how integrating disability as a category of analysis can strengthen critical feminist endeavours to transform psy. This article seeks to address this gap, espousing a feminist disability studies lens and taking as its subject energy-limiting chronic illnesses that are socially and clinically othered, notably via a strategic positioning of these illnesses as medically unexplained and recoverable through compliance with psy knowledge regimes. After discussing how power-laden gendered, dis/abled, and more fully intersectional constructions of the idealised subject, bolstered by psy–corporate–state agendas relating to welfare reform, have oppressively shaped dominant representations and practices in this arena, I consider how psy (chiefly, psychotherapy) might benefit from integrating thinking from within feminist disability studies. I conclude that feminist disability studies can help transform psy in an emancipatory direction through reimagining disability in a socioculturally and biopolitically cognisant, embodied, and maximally inclusive manner. The case of “medically unexplained” and energy-limiting chronic illness exemplifies this assertion.

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.Data sharing not applicable as no datasets generated and/or analysed for this study.

Myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS) is a chronic, disabling yet clinically “contested” condition, previously theorised through a lens of epistemic injustice. Phenomena conceptually close to epistemic injustice, including stigma, are known to have deleterious consequences on a person’s health and life-world. Yet, no known primary studies have explored how people with ME/CFS experience healthcare through a lens of epistemic injustice, whilst a dearth of research explicitly exploring healthcare-related injustice from a patient perspective has been noted. This qualitative study seeks to address this gap. Semi-structured interviews and interpretative phenomenological analysis (IPA) were used to explore the experiences of five people with ME/CFS in the UK, vis-à-vis healthcare-related epistemic injustice. One superordinate theme is presented, “Being de-centred in patient-centred care,” alongside two sub-themes: “Struggling for epistemic-existential validation” and “Negotiating socio-epistemic hierarchies, politics and ‘power’.” Findings suggest that healthcare-related epistemic injustice may differentially impact according to the patient’s social positionality (here, notably gender), and that a potential pathway of existential harm operates through threats to identity and personhood. Findings also indicate that cultural and political factors may further epistemic injustice in healthcare. Finally, epistemic injustice impacting as a chronic stressor cannot be ruled out and is worthy of further research. The experience of healthcare-related epistemic injustice can carry far-reaching yet varied consequences for patients. Future research should consider drawing upon more socio-demographically diverse samples and an intersectional approach is recommended. Further exploration of structural drivers of epistemic injustice may highlight a need for politically and socio-culturally cognisant clinical approaches.

The UK government's recent announcement that the highly controversial Work Capability Assessment (WCA) will likely be abolished leaves questions of what precisely will emerge in its place. This commentary revisits a construct central to the attempted justification of the WCA, that of ‘common health problems’, which may well continue to leave a legacy in delineating purported ‘deserving’ and ‘undeserving’ impairment, ill-health and related disability. After outlining the politically strategic application of this construct in social policy, concerns are raised for long Covid. In particular, the risk of long Covid following the trajectory of another post-infection diagnosis, myalgic encephalomyelitis / chronic fatigue syndrome, is discussed.

The historically dominant clinical positioning of myalgic encephalomyelitis / chronic fatigue syndrome (ME / CFS), as an entity allegedly recoverable through cognitive-behavioural technologies of power, supports the Foucauldian assumption that power and truth are mutually constitutive. This article explores how biopower and a psy-corporate-state complex are implicated in producing persuasive yet precarious truth-claims vis-a-vis ME / CFS, embedded within a (bio)psychosocial regime of truth that has infiltrated the wider disability space.