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Alegria says: CFS is a "Neurasthenia Spectrum Disorder" (2012)!

justinreilly

Senior Member
Messages
2,498
Location
NYC (& RI)
…And that Neurasthenia is a Psychiatric disorder, specifically a Somatoform disorder.

The following journal article by Alegria et al. was cited in Jennie Spotila's blogpost today, "Balance = Experts + Information - Bias." This paper on Neurasthenia, below, contains this important quote:

"Likewise, further research is needed to examine the concordance of neurasthenia spectrum disorders (e.g., ICD-10 neurasthenia, CFS, CCMD-2 and CCMD-3 [these last two are the two Chinese Criteria] for neurasthenia) across non-clinical, population-based samples across cultural contexts [cf. 21, 23]." [Emphasis added]

"Prevalence of Neurasthenia, Comorbidity, and Association with Impairment Among a Nationally Representative Sample of US Adults" (2012)

http://forums.phoenixrising.me/inde...impairment-among-a-nationally-represen.27105/

For this proposition, the authors cite the Pune, India study of neurasthenia spectrum disorders. I don't have access to the full article, but the abstract is damning enough:

"Clinically significant fatigue or weakness is a common but understudied clinical problem in India...Alternative criteria sets used in different clinical contexts suggest a range of conditions constituting neurasthenia spectrum disorders (NSDs)...CFS, ICD-10 neurasthenia, DSM-IV draft criteria for neurasthenia, and CCMD-2 [ie Chinese Criteria] neurasthenia."

This study was an attempt to see if the four "neurasthenia categories" mentioned, including CFS, were able to define idiopathic chronic fatigue well!

Paralikar V, Sarmukaddam S, Agashe M, Weiss MG (2007) Diagnostic concordance of neurasthenia spectrum disorders in Pune, India. Soc Psychiatry Psychiatr Epidemiol 42:561–572

http://link.springer.com/article/10.1007/s00127-007-0196-x#page-1


I do not have access to the other study cited:
Starcevic V, Kelin K, Munjiza M (1996) Characteristics of neurasthenia: examination and cross-cultural applicability of ICD-10 diagnostic criteria for research. Eur J Psychiatry 11:289– 297

Alegria repeatedly characterizes Neurasthenia as a Psychiatric disorder. In the final line of her Neurasthenia paper, Alegria calls Neurasthenia a Somatoform disorder:
"Significantly, our study is timely given the attention being paid to the classification of somatoform disorders and comorbidity, as well as on the role of culture and social factors on the epidemiology of such disorders."
 
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Messages
47
For this proposition, the authors cite the Pune, India study of neurasthenia spectrum disorders. I don't have access to the full article, but the abstract is damning enough:

"Clinically significant fatigue or weakness is a common but understudied clinical problem in India...Alternative criteria sets used in different clinical contexts suggest a range of conditions constituting neurasthenia spectrum disorders (NSDs)...CFS, ICD-10 neurasthenia, DSM-IV draft criteria for neurasthenia, and CCMD-2 [ie Chinese Criteria] neurasthenia."

CFS is characterised by exhaustion - weakness is a separate condition, and in India there are millions of people on a poor diet
 

SilverbladeTE

Senior Member
Messages
3,043
Location
Somewhere near Glasgow, Scotland
And neurasthenia has ALWAYS been a load of bullshit dreamed up by bigoted, misogynistic arseholes.

Like I said, muy mum had serious spinal injury, then X ray dye that was known to be toxic but covered up, ended up causing scarring on spinal cord, incredibly painful;
Psychiatrist told her it was "neurasthenia"
neurasthenia doesn't show up on xrays!


Most psychiatrists are as much use as genital warts in a knocking shop!
evil-smiley.gif
 

alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
Historically my understanding is that neurasthenia was male hysteria. Men couldn't have hysteria, that was a worman's disease. It was also thought to be from not enough sex. Since then it fell out of favour, and then resurfaced in recent decades with new twists. Along the way men were allowed to be hysterical, and women to have neurasthenia.

Like probably all these types of disease categories, neurasthenia is a made-up disease category. There may or may not be any such thing, but they have never been able to show any real evidence for it.

As I said in my new blog:

Medically Unexplained Symptoms are Psychosomatic? Psychosomatic illnesses are medically unexplained.

Its very hard to see that anyone can claim to be into evidence based medicine and believe in psychosomatic illnesses. "Evidence based psychosomatic illness" is an oxymoron.
 

Ren

.
Messages
385
It's unethical that we've been denied access to the contract, and it's unethical that we don't have access to proposed-panel members' writings.

Thank you for this find, Justin!

Does anyone know who nominated Alegria? Or is such info "top-secret" as well?
 

Nielk

Senior Member
Messages
6,970
Jennie Spotila of ocupyCFS discusses Dr. Alegria at length here:

Dr. Alegria

As we mentioned in our profile of Dr. Alegria, she has co-authored three publications potentially relevant to her views on ME/CFS. The first two (here and here) address the relationship between somatic symptoms and psychiatric disorders like depression. Only 14 symptoms were assessed in these papers, and fatigue was not one of them. The papers found that having 3 or more of the 14 symptoms was associated with depression/anxiety and mental health service use. However, one of the papers correctly noted that the data are ill suited to infer causality between the physical symptoms and mental health issues.

After examining the third paper in its entirety, we came to mixed conclusions about whether it represents unreasonable bias on Dr. Alegria’s part. The paper builds on previous research showing that neurasthenia has the highest rate of comorbidity among ICD-10 disorders, and examines whether prevalence and comorbidity rates hold up across racial/ethnic groups. Comorbidity was examined only in depressive, anxiety and substance abuse disorders. Space does not permit a full parsing of the data here, including significant methodological limitations. Although the paper itself does not directly examine the relationship between neurasthenia and CFS, statements about CFS included in the paper have caused serious concerns among advocates. We carefully considered the statements and whether these are indications of unreasonable bias.

Likewise, as Lee [51] argued, the ‘‘disappearance’’ of culture-bound syndromes is related to changing sociocultural conditions, including economic and political factors and changes in managed care and pharmaceutical forces, to name a few. Indeed, chronic fatigue syndrome (CFS), also a controversial illness which has been argued to be a variant of neurasthenia [4, 21] has become increasingly diagnosed in the US [52, 53], whereas neurasthenia is virtually no longer diagnosed in the US context [51].

Many advocates are correctly concerned about the statement above that CFS is “a controversial illness which has been argued to be a variant of neurasthenia.” The first reference is to a thoroughly offensive article from 1991 that argued that CFS is a culturally sanctioned form of illness behavior. The second reference is from 2007, but examined the concordance of CFS and three neurasthenia criteria in four medical practices in Pune, India. Neither reference can legitimately be used to support the statement that CFS should be seen as a variant of neurasthenia today.

After noting again that neurasthenia has almost disappeared from US clinical practice, the paper states:

This has implications for diagnosis and treatment of individuals who may present with symptoms of neurasthenia, but may otherwise be misdiagnosed as having depression, anxiety, or CFS.

This sentence can be read two ways. In one interpretation, neurasthenia patients are misdiagnosed with depression, anxiety or CFS because “neurasthenia” is not used in the US, and this does not imply that CFS as an entity is actually neurasthenia. In the second interpretation, people are diagnosed with CFS incorrectly because CFS is actually neurasthenia. Depending on which interpretation you choose, Dr. Alegria’s presence on the panel can be quite alarming, as she may have a simplistic, outdated view of ME/CFS or worse. But other team members see these few sentences in the paper within the context of Dr. Alegria’s research focus, which does not appear to reflect a tendency to classify patients with diagnosable physical conditions as having mental disorders.

Regardless of our personal interpretations of the meaning of these three papers, we all share a strong concern about her presence on the panel. She seems to have little experience relevant to an ME/CFS case definition at best, and potentially disastrous views if she does in fact believe that the physical symptoms of ME/CFS are equivalent to neurasthenia. Given the damaging legacy of psychogenic approaches to ME/CFS, we believe that her potential bias must be thoroughly investigated before the panel is finalized.​
 
Messages
47
And neurasthenia has ALWAYS been a load of bullshit dreamed up by bigoted, misogynistic arseholes.

Like I said, muy mum had serious spinal injury, then X ray dye that was known to be toxic but covered up, ended up causing scarring on spinal cord, incredibly painful;
Psychiatrist told her it was "neurasthenia"
neurasthenia doesn't show up on xrays!


Most psychiatrists are as much use as genital warts in a knocking shop! View attachment 6107
doctors usually refer CFS/FMS patients to psychiatrists because they are clueless -- they are required to take action, as the patient is clearly ill and VOILA, enter the psychiatrist! problem offloaded!
 

Ecoclimber

Senior Member
Messages
1,011
And the esteem psychriatrists and clinical psychologists treat patients diagnose with a mental health condition at a Nevada State run Mental Health Hospital with "Greyhound Therapy" . Didn't know that 'Greyhoud Therapy was a therapuetic technique in the the DSM-5 manual but then practioners have a habit of making things up on the go.

http://www.thedailybeast.com/articl...yhound-therapy-for-mentally-ill-patients.html

LAS VEGAS (AP) — The San Francisco city attorney filed a lawsuit on Tuesday against the state of Nevada, claiming it has wrongfully and intentionally bused psychiatric patients to the city and declined to pay the costs connected with their care. City Attorney Dennis Herrera filed the case in San Francisco Superior Court a day after a deadline he had set for Nevada to strike an agreement with the city.

Named as defendants were the state and several Nevada agencies, the Rawson-Neal Psychiatric Hospital in Las Vegas, and state health chief Mike Willden.

http://www.usatoday.com/story/news/nation/2013/09/10/san-francisco-patient-dumping/2795909/

http://www.theguardian.com/society/2013/may/12/psychiatrists-under-fire-mental-health

Which is why including social behaviorists, psychiatrists etc. on a panel to diagnose medical illnesses is an inherent danger....an alchemy of science with non-science.

Just remember that according to the American Psychiatric Association, until 1974 homosexuality was a mental illness DSM-2 but was instantly cured by a vote.
http://www.behaviorismandmentalheal...osexuality-the-mental-illness-that-went-away/

"An interesting aspect of this is that homosexuality actually does meet the APA’s present criterion for a mental illness! The criterion is: “… a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress…or disability…or with a significantly increased risk of suffering death, pain, disability or an important loss of freedom.” (DSM-IV-TR, p xxxi) "

Of couse the 'gay disease' was instantly cured by a vote of the APA.

With the DSM-5 manual, psychiatry encroaches more into the field of medicine with 'fads' and unproven andunscientific theories and treatments. This is why any individual in the field of behaviorial science who has shown a current or past prejudice toward a scientific medical explanation of unexplained symptoms should be excluded from the IOM panel.

It is not mental illness because scientific technology does not have the capability to detect nor assess unexplained symptoms within the human body.

Recently, scientists have discovered a second code hiding within DNA. This second code contains information that changes how scientists read the instructions contained in DNA and interpret mutations to make sense of health and disease. http://www.washington.edu/news/2013/12/12/scientists-discover-double-meaning-in-genetic-code/.

We are not living in the dark ages of 1918 with Sigmund Freud, where the framwork of psychiatry and behavioral science is built on the models of outdated and unscientific theories from a drug-addled psychologist whose use of cocaine as his drug of choice — which he rationalized as a therapeutic anti-depressant.

We live in age where scientific research, exploration and technology are opening the doors for a medical explanation for many of the unexplained symptoms within patients.
 
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Messages
5,238
Location
Sofa, UK
:mad:

The panel has to aim for 100% consensus on case definition. That is surely impossible with Alegria who believes ME/CFS is not a physical disease. That fact alone seems to guarantee that a 'majority' verdict, or one with dissenting voices noted, is inevitable - which will weaken the impact of the report considerably.

In order to get her replaced, perhaps an alternative is needed who can tick whatever boxes she is ticking for the panel. Some of those boxes may include diversity though, which might make it tricky...perhaps another psych or from similar discipline but with more of an open mind? Really the case for Jason and Peterson is incredibly strong - what kind of panel decides on a question like this and does not include those two? :eek:
 

Izola

Senior Member
Messages
495
And neurasthenia has ALWAYS been a load of bullshit dreamed up by bigoted, misogynistic arseholes.

Like I said, muy mum had serious spinal injury, then X ray dye that was known to be toxic but covered up, ended up causing scarring on spinal cord, incredibly painful;
Psychiatrist told her it was "neurasthenia"
neurasthenia doesn't show up on xrays!


Most psychiatrists are as much use as genital warts in a knocking shop! View attachment 6107

Uh er-- What's a knocking shop or dare I ask?
 

justinreilly

Senior Member
Messages
2,498
Location
NYC (& RI)
This was Jennie's response to this post:

"We didn’t miss those quotes. We discuss them in this post. And the group was mixed in their interpretation of whether Alegria equates CFS and neurasthenia, as we explain in the post."
 

justinreilly

Senior Member
Messages
2,498
Location
NYC (& RI)
My response:

Jennie,
Pls look carefully at your section on Dr. Alegria; you do NOT discuss the quote I said you missed: “Likewise, further research is needed to examine the concordance of neurasthenia spectrum disorders (e.g., ICD-10 neurasthenia, CFS, CCMD-2 and CCMD-3 [these last two are the two Chinese Criteria] for neurasthenia) across non-clinical, population-based samples across cultural contexts [cf. 21, 23].”

(1) It was not quoted,
(2) It was not discussed or considered

If it had been discussed your group would not be “mixed in their interpretation of whether Alegria equates CFS and neurasthenia, as we explain in the post.”

If the group considered her quote that CFS is a “Neurasthenia Spectrum Disorder” along with the cite to support, which was a study to determine if any of four “Neurasthenia Categories” including CFS could define Idiopathic Chronic Fatigue in India, there would be no doubt in your minds that Alegria does equate CFS and Neurasthenia.
 

justinreilly

Senior Member
Messages
2,498
Location
NYC (& RI)
Her more recent "Feedback to IoM":

"Dr. Margarita Alegria co-authored a paper on the prevalence and comorbidity of neurasthenia. While this paper did not directly examine the potential overlap between ME/CFS and neurasthenia, I am troubled by the statements on page 1742 that CFS is “a controversial illness which has been argued to be a variant of neurasthenia,” and that individuals “may present with symptoms of neurasthenia, but may otherwise be misdiagnosed as having depression, anxiety, or CFS.” If Dr. Alegria believes that ME/CFS is actually a psychological condition such as neurasthenia, then her presence on the panel is unacceptable. I urge IOM to establish whether Dr. Alegria has such a bias, and remove her from the panel if she does."

http://www.occupycfs.com/2013/12/19/my-feedback-to-the-institute-of-medicine/#comment-51957
 
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