Philosophy of the Canadian Criteria: Carruthers's Cheshire Cat (Research paper)

Here's something a little different: the author of the Canadian Consensus Criteria explains some of the thinking behind them, in a way not usually seen in scientifc publications. Published in the J Clinical Pathology, 2007

Definitions and aetiology of myalgic encephalomyelitis: how the Canadian consensus clinical definition of myalgic encephalomyelitis works

Despite the title it's more of a philosophical work and I don't pretend to understand all of it, but he does make some interesting comments on the danger of the biopsychosocial model. I've picked out of few of my favourite quotes.

On the Canadian Consensus criteria:
With its flexible combination of necessary and optional features, the definition allows the diagnosis to fit the patient rather than the other way around (as with Procrustes, an innkeeper from Greek mythology who stretched the guests to fit his bed!).
On the biopsychosocial approach:
The move towards ignoring the distinctions between primary and secondary which designate sensed causal directions in a clinical entity, whether applied to depression, anxiety, infection or fibromyalgia, add to the confusion and impede the elucidation of a properly dynamic clinical entity.

The widespread use of the holistic biopsychosocial model of disease without any distinction between a clinical entity and its background encourages the “drowning” of clinical entitiesby risk factors, which can proliferate endlessly in a nominalist fury without orientation as to their state of relevance or lack thereof with respect to a real entity.
Ok, it's not an easy read...

In case you thought that people conjouring up a lopsided view of an illness is new, he quotes Thomas Sydenham, a 17th Century English Physician:
Writers, ... have saddled diseases with phenomena which existed in their own brains only; but which would have been clear and visible to the whole world had the assumed hypotheses been true.
He concludes by highlighting the dangers of not properly defining ME/CFS, using the example of the smile of the Cheshire Cat:
Choose the right kind of entity or you may end up only considering background factors with no clinical entity left that they are the background of—see the fate of the Cheshire cat in Alice in Wonderland, where the cat fades, leaving only the smile!
I thought people might enjoy something different. Apologies if it's been posted before.


Senior Member
Very interesting, and a direct challenge to the 'bio-psycho-social' model of ME/CFS.

The basic philosophy expressed by the CCC author is not new.

"Men think epilepsy divine, merely because they do not understand it. We will one day understand what causes it, and then cease to call it divine. And so it is with everything in the universe."

Hipocrates (460-377 BC)
Thanks oceanblue. This is wonderful! Amazing what can happen when a group of thinking caring people get together. Carruthers, Klimas.............. they not only have a deep understanding of the disease symptoms, but of the history and politics of it + of human frailty as well.

In 7 years, nothing has come close to the CCD and overivew.