2002 paper: Physical or mental? A perspective on chronic fatigue syndrome [physical]

[WillowJ]

Richard Sykes. Physical or mental? A perspective on chronic fatigue syndrome. Advances in Psychiatric Treatment (2002) 8: 351-358 doi: 10.1192/apt.8.5.351

http://apt.rcpsych.org/content/8/5/351.full

This paper examines the question of whether chronic fatigue syndrome (CFS), often known as myalgic encephalomyelitis (ME), should be classified as a physical or mental illness.

The distinction made between physical and mental illness has far-reaching effects. Within medicine there are lists of illnesses considered to be mental disorders which are distinguished from those known as physical disorders. These lists appear in official classifications such as the ICD and the DSM. They are reflected in textbooks which only deal with illnesses considered to be mental ones. Although there is much dispute over some illnesses, there is also a large measure of agreement within medicine about which are to be called mental illnesses and which are not.

This demarcation is reflected in many other ways within medicine. There is a medical speciality which deals with mental illnesses (psychiatry), there is a branch of the National Health Service which deals with mental illnesses (the Mental Health Services), there are specially trained personnel (such as psychiatrists) who deal with people who have mental illnesses and there are special medications (e.g. antidepressants) and other treatments which are considered appropriate for those with mental illnesses.

In the wider world, the distinction between mental and physical illness is also widely used, with similar far-reaching effects. Regrettably, many of these are negative for people whose illnesses are classed as mental. In employment, those with a mental illness label may find themselves at a disadvantage; in financial matters, penalties may be imposed by insurance companies, pensions agencies or the state Benefits Agency; in society generally, there may be stigma.

 

[WillowJ]

Sometimes it is said that the distinction [between mental and physical illnesses] implies Cartesian dualism, but this overstates the problem. The distinction does not imply Cartesian dualism, although it may suggest it to some people.

Talking of mental illness does not imply the existence of some independent entity, the mind, any more than to talk about psychological illness implies the existence of some independent entity, the psychology of the person involved.

In a similar way we can talk about the side view or the frontal view of a mountain or a person, without implying that the side view and the frontal view exist independently.

The fact that two things can be conceptually distinguished (conceptual dualism) does not imply that they have some kind of separate independent existence (ontological or Cartesian dualism).

(paragraph breaks added)

 

[WillowJ]

more quotes for those unable to read the entire paper:

The point is to show that, even if you take a sympathetic view of the concept of psychological causation, there are no sufficient grounds for saying that, in general, CFS is due to psychological factors. Consequently, there are no good grounds for saying that, in general, CFS should be classified as a mental illness.

Box 3
Guidelines for imputing psychological causation

There must be good grounds for imputing psychological problems

There must be good grounds for thinking that particular psychological factors have a causal influence

The absence of a known physical cause is not good grounds for imputing psychological causation

The presence of some psychological causal factors is not sufficient

Psychological factors should be the predominant causes

When a symptom or condition has no known physical cause, there is a strand of medical thinking which makes the assumption that it must have a psychological cause. This assumption has had a long and troublesome past in the history of medicine, but it is time that it is finally declared unacceptable.

Indeed.

Box 4
Reasons for thinking that CFS does not generally have psychological causation

There are often no significant psychological problems

Where psychological problems are present, they are often part of the illness or consequences of it

The absence of a known physical cause does not imply psychological causation

Where psychological factors are present, they are often not the predominant cause

Patients report a flu-like illness from which they have never fully recovered

There is evidence of biological abnormalities of the central nervous and immune systems

The Department of Social Services regards patients problems in walking as generally not of psychological origin

Where psychological causal factors are correctly identified, they are often insufficiently significant either to be considered predominant or to rule out the possibility of some important physical factor which has not yet been identified.

Many patients with CFS mention that they were under considerable stress at the time that they fell ill. But so are people who have heart attacks. The presence of stress leading up to a heart attack does not result in heart attacks being classified as mental illnesses.

Equally, the presence of stress leading up to CFS is not, on its own, a sufficient justification for considering it to be a mental illness.

 

[oceanblue]

What a great find, I'd not seen that before. Thank you WillowJ for that and the easy-to-digest quotes. I note there are accompanying commentaries from Peter White though I've not read them or the paper yet. A reply to the commentaries from Sykes is here.

 

[Esther12]

There are responses from a few people, and then a reply from Sykes too. Here's the White response: http://apt.rcpsych.org/content/8/5/363.short

I've not re-read it, but remember it as avoiding Sykes's key points, and Sykes picking him up on this in response.

 

[Esther12]

The article and responses are pooled here: http://apt.rcpsych.org/content/8/5/358.full.pdf

It doesn't seem to include Syke's response to the responses though, and I thought that there was one.

edit: Just seen OB's post above where he mentions all this. Whoops. Too slow!

 

[Enid]

Very interesting find - thanks Willow.

 

[WillowJ]

thanks for the links to the commentaries

 

[DaiWelsh]

Wow got to love the logic in White's response - mind/body duality is unhelpful and old-fashioned so treating ME/CFS as physical is unhelpful. No mention that this leaves us as de-facto psychiatric which is errr.... dualistic and unhelpful (as well as contrary to prevailing evidence)... Also got to love the repeated name-checks for himself and wessely, you would think they were the only researchers in this field <sigh>

 

[Esther12]

Abstract for a more recent Sykes paper here: Medically Unexplained Symptoms and the Siren 'Psychogenic Inference': https://muse.jhu.edu/login?auth=0&t...ychiatry_and_psychology/v017/17.4.sykes01.pdf

Not looked for the full paper yet, but it sounds like it mentions CFS.

This commentary on it is by Dr Michael Loughlin, a philosopher of Science, and available free at the link below. It doesn't say much on the issues likely to be of interest to people here that has not already been discussed, but I find it interesting to see how these matters are discussed in the academic literature.

He makes an obvious comment on page 307 which is too rarely mentioned in academic papers imo. It starts - "Obviously, the fact that someone..." (can't copy and paste and too lazy to type sorry).

http://mmu.academia.edu/MichaelLoughlin/Papers/1025687/Psychologism_Overpsychologism_and_Action

Looks like there's another reply, and a response from Sykes in the issue too:

https://muse.jhu.edu/journals/philosophy_psychiatry_and_psychology/toc/ppp.17.4.html

Sorry for not providing much of a summary of what I read (I'm terrible at this).

 

[Megan]

Thanks Willow and Esther, these are a great read.

 

[Esther12]

Abstract for a more recent Sykes paper here: Medically Unexplained Symptoms and the Siren 'Psychogenic Inference': https://muse.jhu.edu/login?auth=0&t...ychiatry_and_psychology/v017/17.4.sykes01.pdf

Not looked for the full paper yet, but it sounds like it mentions CFS.

This commentary on it is by Dr Michael Loughlin, a philosopher of Science, and available free at the link below. It doesn't say much on the issues likely to be of interest to people here that has not already been discussed, but I find it interesting to see how these matters are discussed in the academic literature.

He makes an obvious comment on page 307 which is too rarely mentioned in academic papers imo. It starts - "Obviously, the fact that someone..." (can't copy and paste and too lazy to type sorry).

http://mmu.academia.edu/MichaelLoughlin/Papers/1025687/Psychologism_Overpsychologism_and_Action

Looks like there's another reply, and a response from Sykes in the issue too:

https://muse.jhu.edu/journals/philosophy_psychiatry_and_psychology/toc/ppp.17.4.html

Sorry for not providing much of a summary of what I read (I'm terrible at this).

I've not been able to get the full papers for these. If anyone has them and can share via a link or PM, I'd like to give them a look (no worries if not, I could always try e-mailing the authors for copies). Ta.

 

[PhoenixDown]

...In employment, those with a mental illness label may find themselves at a disadvantage; in financial matters, penalties may be imposed by insurance companies, pensions agencies or the state Benefits Agency; in society generally, there may be stigma.

and in the doctor's office the patient will be refused necessary testing to rule out physical illnesses and provide vital objective proof of why they are experiencing symptoms.

 

[Don Quichotte]

You may find this interesting:

http://www.huffingtonpost.com/2012/01/27/erin-brockovich-mystery-illness-leroy-high-school_n_1237396.html

http://www.youtube.com/watch?v=gbQK8ucIcAw&feature=related

 

[Dx Revision Watch]

I don't have time to write a lengthy post nor to discuss the work and affiliations of Dr Richard Sykes, PhD, (this issue was covered at length on my ME agenda site in 2009).

But please be aware that Dr Sykes, who is now in his late 70s, was the instigator and coordinator of the "CISSD Project" (Conceptual Issues in Somatoform and Similar Disorders) which ran from 2003-2007.

The project was administered by Action for M.E. and funded by the Hugh and Ruby Sykes Charitable Trust (Dr Sykes' twin brother is Sir Hugh Sykes).

In 2008/9 Dr Sykes went on to work, on his own, on the "MUPSS Project", for which the administrator was the Institute of Psychiatry and the funder, once again, the Hugh and Ruby Sykes Charitable Trust. He has published at least one paper out of this later project.


I did a considerable amount of work in 2009 to uncover the details of the CISSD Project, about which virtually nothing was known at the time. Eventually, Dr Sykes published a report on the project via the MEA's website (the MEA provided a platform but never commented on its content) and Action for M.E. subsequently placed an (uncorrected) copy of Dr Sykes' Final Report in the public domain.

The Final Report to Action for M.E. can be read here:

Co-ordinators Final Report
THE CISSD PROJECT 2003-2007

(Conceptual Issues in Somatoform and Similar Disorders)

FINAL REPORT OF CO-ORDINATOR (Richard Sykes PhD, CQSW)

Open document here in Word format: CISSD PROJECT Coordinators Final Report

http://meagenda.files.wordpress.com/2009/06/cissd-project-coordinators-final-report.doc


The version of the report published by the MEA on its old website can be read in this post on my ME agenda site:

http://meagenda.wordpress.com/2009/06/03/cissd-project-report-from-dr-richard-sykes/


Seven of the CISSD Project work group participants went on to become members of DSM-5 Work Groups:

Michael Sharpe (UK), Francis Creed (UK), James Levenson (US) and Arthur Barsky (US) are members of the APAs DSM-5 Work Group for Somatic Symptom Disorders; Javier Escobar (US) is a member of the DSM-5 Task Force and liaison to the DSM-5 SSD Work Group.

The UK chair of the CISSD Project was Michael Sharpe, the US chair was Kurt Kroenke.


Dr Sykes' project had started off as a personal project. This is the work group as it ended up (the only patient rep was Frankie Campling).

Reading the membership of the Project work group, you can see why Action for M.E. elected to keep the lid on this project.

"I would like to express my most appreciative thanks to all those who gave support to the project: to the funding bodies and to AfME for their indispensable support: to Natalie Banner for her most helpful research assistance; to all the consultants who not only most generously donated their time and knowledge but did so in a most friendly and co-operative way.

Most of all, my warmest thanks go to the organising group for their consistent support; to Rachel Jenkins for her invaluable help as Principal Collaborator; to John Bradfield, the Project Advisor, whose patient and perceptive comments on numerous draft documents were invaluable; to Michael Sharpe for his encouragement and work as Co chair UK; and, above all, to Kurt Kroenke for giving us the benefit of his internationally acclaimed expertise and for chairing the project so vigorously and effectively. My heartfelt thanks to all.

Richard Sykes PhD, CQSW"

Appendix B List of consultants

Organising Group (5)
Chairman: Prof Kurt Kroenke, Professor of Medicine, Regenstrief Institute, Indianapolis, USA
Co-Chair (UK): Prof Michael Sharpe, Professor of Psychological Medicine, Edinburgh Univ
Principal Collaborator: Prof Rachel Jenkins, WHO Collaborating Centre, Institute of Psychiatry, London Univ
Project Advisor: Prof John Bradfield, former Professor of Histopathology, Bristol Univ
Co-ordinator: Dr Richard Sykes, Hon Visiting Research Associate, Institute of Psychiatry, London Univ

Active Consultants (28) who attended one or more of the three workshops or were significantly involved in discussions or publications.

UK (10)
Prof Derek Bolton, Professor of Philosophy and Psychopathology, Institute of Psychiatry, London University
Dr Richard J Brown, Lecturer in Clinical Psychology, University of Manchester
Frankie Campling, Patient Representative, Oxford
Dr Rachel Cooper, Lecturer in Philosophy, Lancaster University
Prof Francis Creed, Professor of Psychological Medicine, Manchester University
Dr Richard Kanaan, Clinical Lecturer, Institute of Psychiatry, London University
Prof Richard Mayou, Professor of Psychiatry, University of Oxford
Dr Ruth Taylor, Senior Lecturer in Liaison Psychiatry, London University
Professor Michael Trimble, Professor of Behavioural Neurology, Institute of Neurology, London
Research Assistant Natalie Banner

USA (7)
Prof Arthur Barsky, Prof of Psychiatry, Harvard Medical School, Boston, Mass.
Dr Charles Engel, Assoc Prof of Psychiatry, Uniformed Services University, Washington, DC
Prof Javier Escobar, Prof of Psychiatry, Robert Wood Johnson Medical School, New Jersey
Prof James Levenson, Prof of Psychiatry, Medicine and Surgery, Virginia Commonwealth University, Richmond, Virginia
Prof Kathryn Rost, Prof in Mental Health, College of Medicine, Florida State University
Dr Robert C. Smith, Prof of Medicine and Psychiatry, Michigan State University, East Lansing, Michigan
Prof Mark Sullivan, Prof of Psychiatry, Washington University, Seattle

Germany (4)
Prof Dr Peter Henningsen, Prof of Psychosomatic Medicine, University Hospital, Munich
Prof Dr Wolfgang Hiller, Psychological Institute, University of Mainz
Prof Dr Bernd Lwe, Director, Institute for Psychosomatic Medicine and Psychotherapy, Hamburg
Prof Dr Winfried Rief, Professor of Psychology and Psychotherapy, Marburg

The Netherlands (5)
Dr Ingrid Arnold, Department of Public Health and Primary Care, Leiden University Medical Center
Dr Veronique de Gucht, Department of Clinical and Health Psychology, Leiden University
Prof dr Stan Maes, Professor of Health Psychology, Leiden University
Prof Dr Philip Spinhoven, Faculty of Social Sciences, Leiden University
Dr Margot de Vaal, Department of Public Health and Primary Care, Leiden University Medical Center

Denmark (1)
Prof Per Fink, Professor of Psychiatry, Aarhus University Hospital

Norway (1)
Dr Kari Ann Leiknes, Research Fellow, Institute of Basic Medical Sciences, Oslo University

------------

In mid 2007, Sykes, Sharpe and Kroenke published this paper out of the CISSD Project (note there is virtually no mention of CFS, ME and WHO ICD classifications in this paper):

Paper published by the CISSD Project Chairs and Principal Collaborator, Rachel Jenkins, in July 2007:

Review Articles

Psychosomatics 48:4, July-August 2007

Revising the Classification of Somatoform Disorders: Key Questions and Preliminary Recommendations

Full paper in PDF format: http://psy.psychiatryonline.org/cgi/reprint/48/4/277.pdf

Full paper in html format: http://psy.psychiatryonline.org/cgi/content/full/48/4/277


Suzy Chapman

 

[Dx Revision Watch]

Links for all the posts on ME agenda site around the CISSD Project are collated on this page:

http://meagenda.wordpress.com/dx-revision-directory/

Under:

Elephant in the Room Series One
Elephant in the Room Series Two


The paper: Kroenke K: Somatoform disorders and recent diagnostic controversies. Psychiatr Clin North Am 2007 Dec;30(4):593-619. http://www.ncbi.nlm.nih.gov/pubmed/17938036

contains the caveat:

Although the CISSD is an ad hoc group that includes many international experts on somatoform disorders, it was neither appointed nor sanctioned by the APA or WHO, the organizations authorized to approve revisions of DSM and ICD, respectively. As such, the CISSD recommendations should be considered advisory rather than official. Also, there were some suggestions for which the CISSD achieved near consensus but other issues where opinions diverged considerably.

Recommendations and proposals resulting out of the work of the CISSD Project have fed into the DSM-5 revision process. Proposals have also been submitted to the WHO ICD Update and Revision Platform to the Topic Advisory Group Mental Health (TAGMH) section by Dr Sykes, specifically in respect of F45-F48 codes. No proposals appear to have been submitted by Dr Sykes to any other Topic Advisory Group (TAG) via the ICD Update and Revision Platform.

 

[Wildcat]

.
Richard Sykess PhD was in the Philosophy of Language. He has not had a paid/official position in any University for decades. For the last two decades he has made a career out of his hobby of linguistically deconstructing the words Chronic Fatigue and Syndrome.

Richard Sykes was offered a platform at Royal College of Medicine Conferences and International Medical Conferences to exponentially pontificate and discursively shuffle backwards and forwards about the linguistic meaning of the words Chronic, Fatigue, and Syndrome, without ever reaching a conclusion.

Richard Sykes was financed by his brother (Sir Hugh Sykes, who is a director of the Welfare to Work Company A4E).
.
For where Richard Sykes 'hobby' eventually lead (The CISSD Project) , please see MEAgends's posts above.
.

.

 

[Wildcat]

.
The Company of which Richard Sykes' brother Hugh Sykes is a Director: A4e's input into David Freud's "In Work Better Off' consultation making .....recommendations in the context of commissioning modern
welfare services"


http://www.a4e.co.uk/PathwaystoWork.aspx

"We believe that Pathways to Work can increase your chances of
returning to sustainable, progressive employment while providing you
with support for your condition through our Condition Management
Programme."


.

The possible conflict of interest relating to Richard Sykes' CISSD Project being funded by his brother who is a Director of the biggest commercial Welfare to Work company in Europe (A4E), was never addressed by Richard Sykes Mentor, the UK charity Action for ME (AFME).

.


Please note that A4E is now under the most intense scrutiny in Britain for widespread Fraud, and its head, Emma Harrison, has consequently resigned:


http://www.bbc.co.uk/news/uk-17476415

'Leaked document suggests 'systemic fraud' at A4e'

"Margaret Hodge MP, chair of the public accounts committee, said of the document:

"This appears to be devastating evidence of systemic fraud within A4e. Either A4e failed to act or to inform DWP, or they did inform DWP and the department failed to investigate properly.
Whichever, it is completely unacceptable. Once again, I am urging the department to suspend all its contracts with A4e immediately."

.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~





Dr Richard Sykes (the CISSD Project Co-ordinator) was founder and
former Director of the former Bristol-based small charity Westcare, that controversially 'merged'
with the charity Action for ME (AFME) in 2003 and spread counselling theories and counselling
theory consciousness amongst AFME employees. The belief in counselling, along with the fact that AFME had inherited a number of counsellors from the now defunct Westcare, was also incorporated into AFME policy in 2003.

Following the 'merger' of AFME with Westcare, AFME did a hard sell on marketing counselling
to severely ill people with ME who phoned AFME because they were in
need of homecare, Incapacity Benefit, DLA, or in need of legal representation for Sickness Benefits or Medical-Legal cases. Instead of being given practical and legal advice, due to Westcare's influence, the desperate callers to the AFME helpline were instead given advice by AFME on seeking counselling and learning relaxation.

The counselling that AFME heavily marketed to the AFME Helpline callers was offered in two forms: as face to face counselling sessions in Bristol, or in a package of 10 telephone distance counselling
sessions, both paid for by the NHS.

The NHS eventually stopped funding the counselling sessions; and then AFME moved on to advertising and promoting (through articles) personal growth 'ME cures' such as Lightning Process, EFT, Yoga, and the Chrysalis Effect.



~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

.

http://tinyurl.com/artoz8

2003:
InterAction Interview August 2003: The Westcare ME Counsellor (Psychotherapist
and counsellor Georgina Nye, with Westcare since 1990):

"...People with ME need to recover their self respect, their sense of
self value. That's deeply important because it's hard to keep a
management program in focus if you don't value yourself enough to
care what happens to you"




~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~



Action for ME and Westcare:

Action for M.E. Report and Accounts 31st March 2003 says:

`Action for M.E. has placed on record its appreciation of the work of
Westcare UK's trustees, its founder and director Dr Richard Sykes and
benefactors, including Sir Hugh Sykes, whose support made the merger
possible.'
.

 

[Wildcat]

Re the Action for ME Magazine 'Interaction' August 2003 interview with Richard Sykes' Westcare Counsellor Georgina Nye:


The AFME/Westcare counsellor would have had us examine our self
esteems, and then goes on to casually attribute People with ME with
supposed feelings of "being stuck", and "not valuing
ourselves enough to care what happens" to us; not to mention the Westcare Counsellor's concerns about the terrible, supposedly self-inflicted problem of "stifling the flow of energies
through our bodies".


Such unthinking and misinformed assumptions are staggering a
disgraceful hotch-potch of half-digested, irresponsible pseudo-
holism, pseudo-humanism and Pop-Paradigms a really bad
advertisement for counselling per se.

.

It could be that both CBT and counselling are attracting avoidably
bad reputations from the misuse and misapplication of those therapies
to people with a serious medical disease, ie ME. It could it be
that such misuse of psychotherapy and counselling is bringing both
the therapies themselves, and the therapy/counselling professions,
into disrepute.

.

 

[Enid]

Philosophy and linguistics (a hobby apparently) - any glimpse of medicine or science ? - Wittgenstein's personal problems for sure. S.... them. They do indeed bring the whole of medicine into disrepute.

Luckily there are some Docs who know better.