Brief Report: Writing about Chronic Fatigue Increases Somatic Complaints
Marko Jelicic, Mincke Frederix, Harald Merckelbach
Department of Clinical Psychological Science,
Faculty of Psychology and Neuroscience,
Maastricht University, The Netherlands
Participants were instructed to imagine that either they or a friend were suffering from chronic fatigue syndrome (CFS) and were asked to fabricate a story about how CFS affected their own or their friend's daily functioning. Control participants were not given an imagination exercise but were asked to write about their study choice. After the writing exercise, all participants completed the Symptom Checklist-90 (SCL-90). Participants who had written a story about how CFS symptoms affected daily life (either their own life or that of a friend) had higher scores on the Somatization subscale of the SCL-90 than controls. This finding resembles the misinformation effect documented by memory research, and suggests that elaborative writing about illness, through its symptom-escalating power, has iatrogenic potential.
Evidence suggests that psychological mechanisms play a crucial role in the development of MUS (see Rief & Broadbent, 2007, for an overview). Rief and Barsky (2005) argued that misinterpreting benign somatic sensations as signs of illness lies behind the creation of MUS.
The suggestive nature of the evidence is very weak, yet its played as if it were strong. It is likely that most MUS (medically unexplained symptoms/syndromes) in history have been failed diagnosis, whether through medical failure or insufficient medical research at the point in history, or simply not having the tests available or affordable. Take almost any so-called MUS of the current age, from IBS to Fibromyalgia or even ME. Lots of things can be shown to be wrong using tests, the problem is not that we don't know that things are wrong, the problem is that we don't understand the causal pathways.
The practice of limiting or denying tests, and writing this up as though its normal, leads to misdiagnoses and failed diagnoses. Its a justifiable cost saving measure, not a justifiable medical measure, but I suspect in time it becomes the medical norm.
Participants were instructed to fabricate stories about some of the events they previously had evaluated as unlikely. During a follow-up session, they were again asked to evaluate the likelihood of the childhood events. Polage found that a significant minority (i.e., 10 to 16%) eventually came to believe the autobiographical stories they had fabricated.
This is an own goal for psychosomatic medicine here. People imagine things, then some can't tell the difference in memory from imagined things and the real event. This is not new. It however makes questionnaires to evaluate outcomes on psychologically indoctrinated patients a highly dubious instrument.
Our results suggest that writing about CFS may lead to elevated self-reported somatic symptoms.
By asking individuals to write about an illness, their mental schema of that illness becomes activated, making them overly attentive to vague and ambiguous sensations that could be part of the illness. This focus on everyday sensations may then lead to an increase in somatic symptoms. Thus, it can be argued that having individuals to elaborate on the characteristics and consequences of an illness may play a role in the development of MUS. This iatrogenic route has been recognized by many authors.
Don't think of an elephant. Now what did you think of? This doesn't always work on us because our brains read blah blah blah blah blah, but most people think of an elephant, or at least its often claimed.
If you ask people to think of something, then of course they are more sensitive to issues on this, temporarily. The argument they get around to is this can become permanent. Now extreme traumas might do this, but casual thoughts? Even thoughts with emotional overtones?
Thirdly, the current experiment does not provide a clear demonstration of the causal chain that is involved in symptom escalation and writing about illness.
At least we agree on that point.
Summing up, our finding resembles the misinformation effects documented by memory research, and suggests that elaborative writing about illness, through its symptom-escalating effect, has iatrogenic potential.
Their finding suggests things based upon other suggested findings, based upon yet other suggested findings.
Once they start thinking about MUS and don't realise many if not most patients with MUSes have measurable physiological abnormalities, it becomes difficult to consider the conclusion credible.
It doesn't matter if you are talking about current MUSes like fibromyalgia or ME, or obsolete ones like epilepsy (formerly hysteria), MS or diabetes, or even rheumatoid arthritis.
Medically Unexplained Symptoms = psychosomatic
Unidentified Flying Objects = flying saucers
Like with flying saucers there is a basis for believing that flying saucers might exist, but not that its proven they exist. Its the same with psychosomatic medicine. Such things might exist, but they remain medically unexplained ... oops.
Its much better for doctors and researchers to say they don't know than to rely on dubious and unproven hypotheses and hope the patient doesn't see through them.
Maybe one day a saucer will land and communicate with us, and maybe one day a psychosomatic illness will be proven, but that day has not verifiably happened yet.
If you look at this its all maybes, based on other maybes, based on yet more maybes. Its a chain of unlikely reason. We have heard of the Emperor's new clothes, some are familiar with vaporware, but what do you call a logical chain made of nothing but metaphorical tissue?
I will leave you with a final thought:
Medically Unexplained Symptoms are Psychosomatic? Psychosomatic illnesses are medically unexplained.