Chronicity rhetoric in health and welfare systems inhibits patient recovery: a qualitative, ethnographic study of fibromyalgia care

Fibromyalgia is a leading cause of disability in the UK and worldwide, but is difficult to diagnose and treat due to unclear pathogenesis and diverse and fluctuating symptoms. Although various treatment modalities are recommended, no treatments have been proven to effect sustainable improvement or recovery, and patients are typically dissatisfied with their care. Increasingly, biopsychosocial services are being developed, that aim to take a multifaceted, holistic approach. In this paper, we draw on a qualitative, ethnographic study of biopsychosocial services in the UK (including 59 interviews, 200 h observation, document review, and stakeholder workshops), that are providing new and promising forms of support. Drawing on Smith's Sociology for People as our analytic framework, we explore the work that is undertaken in these services. We discover chronicity rhetoric that interrupts practitioners' and patients' efforts to promote healing and recovery. We show that chronicity rhetoric is produced and reinforced through Biomedical Research and Welfare Benefits systems. Our findings are likely to have wider applicability to services for other difficult-to-treat conditions that are having increasingly problematic impacts on health, wellbeing and economic productivity worldwide (e.g., chronic pain, Chronic Fatigue Syndrome (CFS), Myalgic Encephalomyelitis (ME)).