Reply to Angela Kennedy
Sorry to be picking your brains- but any chance of a specific reference for [Chalder etc on factors of increased psychiatric comorbidity in ME/CFS such as response to illness and psychogenic dismissal]? It would be interesting to see Chalder or anyone even address this possibility regarding direction of causation.
I must have pulled the Chalder quote from
this 2007 presentation:
Slide 22: "Depression could be response to a physical illness controlled studies show lower rates of psychiatric disorder in medical controls."
Slide 24: "CFS patients have more psychological distress than medical controls making it unlikely that the distress is secondary to the experience of having a chronic illness."
Also see
this 2008 presentation by Hotopf: Page 17 of the PDF "Current psychiatric disorder in CFS compared with medical controls" lists the results, notice how CFS is generally much higher.
This 1991 paper lists some earlier comparisons: "
Postviral fatigue syndrome and psychiatry"
There is a lot of other literature on psychiatric pre/co/post-morbidity and CFS, too much to wade through at the moment to give a referenced summary on the speculation regarding the direction of causation (I did find
the Discussion section of a study which indicates that while rates of depression in CFS is higher than some other medical diseases, the predictors of depression are similar).
From memory, biopsychosocialists like Chalder, proud of their transcendence from the mind-body problem, do acknowledge that psychogenic dismissal is unhelpful to patients, that CFS is not imaginary and not "all in the mind" but is "real" and also physical/bodily (in a "functional" sense), yet they seem fixated on "abnormal" illness beliefs or "maladaptive" cognitions and behaviours as the primary issue in CFS. Increased psychiatric comorbidity would probably be largely attributed to supposed overlap and maladaptive cognitions more than a "normal" response to illness and lack of support etc.
The claimed (yet disputed) association between prior psychiatric disorder and later CFS onset could be an artifact of poor methodology, or a probable contributory factor (like with heart disease), or an early manifestation of CFS pathology which is mistaken for a psychiatric diagnosis (a similar relationship has been observed for depression and Parkinson's disease).
I think this is an important problem, and I feel more and more that how ME/CFS has been treated has highlighted some terrible problems in how psychiatrists construct people as psychiatrically ill based on ideological interpretations of human responses per se. ME/CFS has become almost exemplary of psychiatry's problems in this respect. Kirk and Kutchin's 'making us crazy' and Paula Caplan's 'They say you're crazy' are both useful in looking critically at DSM constructions in particular- you may already be aware of them.
I agree. There is an obvious disagreement between what patients experience/discover as an appropriate response to CFS and what these psychiatrists speculate should be a "normal" response to CFS. There are insulations that we are behaving "abnormally" to ordinary infections and stressors. Doesn't the DSM generally stay neutral on etiology (except where psychogenic judgements on physical sympoms are part of the diagnosis)? I will have to check out those names and literature later.
ME/CFS involves a massive symptom burden on par with severe medical diseases. As I'm sure you only know too well, ME/CFS has a profound effect on patients' lives, ranging from struggling to remain employed, to lifestyle falling apart, to being effectively paralysed with suffering and unable to look after oneself. On top of that, one must face frequent dismissal and derision, while patients' criticism of how they are treated is intepreted as further evidence for their (alleged) neuroticism, intransigence, lack of insight, disgust for mental patients, etc. Medical care is not only lacking but often purposely withheld because of a CFS diagnosis. If researchers have trouble understanding or believing the nature and severity of such patient experience, then it is no surprise that they fail to properly consider the influence such experience can have on the mental health of patients.
Papers by Acheson and Dowestt suggest to me that non-causal emotional symptoms including irritability and depression (of suspected organic origin) were a commonly reported part of ME as well, at least in the early stages, but were obviously not the same as a primary psychiatric diagnosis of major depression. I still suspect that disturbed homeostasis and the neuroimmune-like pathology of ME/CFS could amplify the psychological impact of the above mentioned pressures. I like the influenza, sleep deprivation, and hangover comparisons because these can make otherwise healthy people appear irritable and depressed, while ME/CFS can feel like all 3 at once for decades. Biopsychosocial-naut psychiatrists are welcome to emulate all the above for themselves and see how normally they cope.
All research claiming to be about 'CFS' since 2003 should be including a discussion about different criteria and at least acknowledging Carruthers et al and now Jason et al's revision, in a 'limitations of study' section. I've already started responding to articles on 'CFS' stating words to this effect. Whether they'll take any notice, who knows (shrugs and rolls eyes!)
At least we got that from Switzer et al. Flawed as that paper was, their acknowledgement, though confused and problematic, has allowed the issue to be discussed I think.
I agree. It was a very smart move by the WPI/NCI/CC, both scientifically and politically, to use the Canadian criteria in their 2009 Science paper on XMRV, it has pushed the issue into the spotlight.
