I know. But if you look back at the history and case histories the presentation of hysteria is mentioned as 'florid' - the women are manic and attention seeking they have spasms and dance around etc. ME/CFS has never been spoken of in this way - writings on neurasthenia, on the other hand talk of prostration and malaise etc which is more like ME/CFS.
I do not in any way believe there is any proof for psychogenesis in relation to any of this. What I do wonder is if some of the people who were given these diagnosis in the 18th and 19th century did in fact have what we now call ME/CFS.
I also agree with you on the gender roles assigned in these cases - it was, in part, the topic of my MA dissertation.
As someone who studied this stuff for my degree and MA in philosophy I do understand the mind/body stuff and that it is all 'bodily/organic' etc - you misundertood what I was saying. Which is that there were always people with the illness now called ME/CFS or CFIDS or SEID or whatever who were put in the hysteria/neuresthenia bag. There is no reason to think it suddenly started in the documented outbreak of 1934.
No, we're in agreement. I just think your impression of hysteria is too influenced by reading accounts of 19th century freakshow clown wagon style parades of vulnerable patients (and actors) by "doctors" like Charcot and Freud. Any motor or sensory symptom that a neurologist is unable to explain will get you a diagnosis of conversion disorder, hence the mass hysteria label of the Royal Free outbreak of ME. It does not have to be florid in presentation, although you are of course far more likely to get this diagnosis if it is and you're female, low education/socioeconomic status, have a history of childhood trauma/sexual abuse, are deemed to be alexithymic and/or have a cluster B personality disorder, especially borderline or histrionic personality disorder.
More destructive Freudian ramblings at the expense of severely physically sick people:
Canadian academic Donald Carveth believes and teaches that ME sufferers are ‘hystero-paranoid’ Fugitives from Guilt.
Donald L. Carveth, Ph.D.
Emeritus Professor of Sociology and Social & Political Thought,
Senior Scholar, York University;
Training and Supervising Analyst, Canadian Institute of Psychoanalysis;
Director, Toronto Institute of Psychoanalysis.
by Donald L. Carveth, Ph.D. & Jean Hantman Carveth, Ph.D.
‘In our experience, most of us, to one degree or another, are fugitives from guilt—whether our guilt evasion takes an hysterical, a psychosomatic, or some other psychopathological form. We cling to the de-moralizing discourses that we fabricate for ourselves, sometimes with the help of de-moralizing therapists, and the de-moralizing discourses offered by our postmodern culture, in a desperate attempt to believe we are victims of mysterious afflictions rather than moral agents afflicting ourselves with suffering for our real or imagined crimes. And we do this because we refuse the burden of moral agency: the need either to consciously bear guilt or consciously confront and modify the accusing superego.
It matters little whether our hysteria takes the old-fashioned form of the paralyses, tics and fainting episodes, etc., that characterized the hysterias of the late nineteenth and early twentieth centuries, or such more contemporary forms as so-called “environmental illness,” “multiple chemical sensitivity,” “chronic fatigue syndrome,” “fibromyalgia syndrome,” etc. (readers of the New Yorker will be kept up to date regarding the newest hystero-paranoid manifestations), the dynamics remain essentially the same. However much what Edward Shorter calls “the legitimate symptom pool” may vary from time to time and place to place—for example, a legitimate symptom in one cultural situation is the Koro complaint that someone has stolen or reduced the size of one’s penis—the underlying dynamics remain constant: unconscious superego accusation for real or imagined crimes, leading to a need for punishment, that takes the form of hysterical, psychosomatic, paranoid and other forms of psychological and/or physical suffering.
What does characterize the new, as distinct from the old hysterias, is their more obvious reliance upon defensive externalization and, hence, the paranoid element in their structure. It is for this reason that we employ the term hystero-paranoid to describe states of feeling persecuted by supposed environmental agents (toxins, molds, parasites, etc.) or molestation by satanic cults or by aliens. The role of hostility, its projection, and its return in the form of delusions of external or internal persecution is emphasized in our paper precisely because these factors have been underemphasized in most previous discussions of hysteria.
* * *
In Hystories: Hysterical Epidemics and Modern Media, Elaine Showalter (1997) explores a range of conditions—chronic fatigue syndrome; multiple personality disorder; recovered memory; satanic ritual abuse; alien abduction; Gulf War syndrome—that she views as modern forms of hysteria as distinct from the old conversion and anxiety hysterias characteristic of the last fin-de-siecle and explored by Charcot, Janet, Breuer and Freud. Against the widespread claim that hysteria is a thing of the past, having disappeared due to the rise of feminism or a level of psychological sophistication incompatible with the formation of hysterical symptoms (except perhaps among culturally “backward” populations), Showalter argues that, on the contrary, far from having died, hysteria is alive and well in the form of the psychological plagues or epidemics of “imaginary illnesses” and “hypnotically induced pseudomemories” that characterize today’s cultural narratives of hysteria (pp.4-5).’……..
But the present lot go back and make the connection as well (and get it wrong) - that's where all the rest of it has come from including the new ICD codings and all the crap that went down with the APA about Bodily Distress Disorder etc..
"Mr. Masson is not just any man who became disenchanted with his profession or his religion (in this case, the same thing). He is the man who, through friendship with Anna Freud and her close associate Kurt Eissler, became in 1980 the projects director of the Sigmund Freud Archives, the sanctum sanctorum of the psychoanalytic establishment, the source of documents that had been sealed to the outside world until the next century. And he is the man who used many of these newly discovered materials to argue, in ''The Assault on Truth,'' that Freud was guilty of ''a failure of moral courage'' when he denied the reality of the childhood sexual abuse his patients reported, deciding instead that they were fantasizing. Psychoanalysts did not respond to this news by saying, ''Oh, thank you, Jeff, for explaining why the entire foundation of psychoanalysis is wrong!'' They unceremoniously kicked him out. He had become, and to many still remains, ''the arch traitor, the Antichrist in the church of psychoanalysis,'' as Mr. Masson describes himself."
And what did Freud do after his "peers" rejected his original observation that men of his day were sexually abusing their children, grandchildren, friend's children, nieces? He went back and changed his "research" conclusions to say these females were fantasizing this sexual abuse. Failure of moral courage INDEED!
Many psychologists probably are embarrassed by this sort of garbage, but Shorter isn't a psychologist, a psychiatrist or a medical doctor of any kind. He's a historian, at least in name, if not in fact. (I recall that during the process of coming up with the new DSM, about half of those in involved did not want the MUS -- medically unexplained symptoms -- definition in there as a mental illness.)
I should think even HISTORIANS would be embarrassed on his behalf since his "history" is not accurate and is so obviously biased and sexist. He apparently hasn't made himself aware of the history of this illness for the last 40 years.
PhD Shorter should be challenged to read Osler's Web by Hillary Johnson. Now that's history!
Why not include science fiction, too, since that's basically what Shorter writes. Re: Showalter, there have always been the "Uncle Toms" amongst oppressed people. They like to give the impression that, yes, they are aware their class of persons is inferior, but they themselves are somehow so much better than those peons, in this case "hysterical women" and should therefore be given special privileges not given to those inferiors.
@Wildcat@Iquitos I've been offline for a week, just clearing my backlog, so I'm starting on this page, not at the beginning of this thread I just wanted to register my feelings re your posts above re Freud and hysteroparanoia.
. @Bob - I posted the material about Elaine Showalter (which I hope you have read) because she and Shorter cross reference each other and reinforce each others theories and publications. They have both been highly influential in portraying ME as not only psychosomatic, but have put it into a supposed historical continuum of 'hysterical diseases', or 'hysterical plagues' as Showalter puts it.
And ridiculous as they sound, it is not the case that no one takes them seriously. Showalter got massive and sustained publicity for the preposterous theories from her book 'Hystories'.
Members of the British intelligentsia went public in the media and net to agree with Showalter and to disparage ME patients in terrible ways. They sounded beside themselves with contempt for ME sufferers.
The words "Elaine Showalter says ..... " were everywhere. Then she played the victim, portrayed the patients as nasty and threatening, herself as "brave", and played the media to her own advantage yet again, and got even more publicity, and more sympathy.
Does that sound familiar?
Do you detect a copycat recurrence of Showalter's tactics in 2011/12 .....
And let's not forget that we still live in a male-supremist/male-dominant world where the misogyny is culturally accepted, many times quite unconsciously. The men who own, run and profit by the media, the research cultures, the governments, the churches -- they all love it when a female assassinates her own kind.
Go for it! I don't twitter but if you've got the energy and the account, why not? And to nit pick just a little, the spelling is Osler. Who knows, maybe Shorter actually reads history.... nah, probably not.
So for DSM-5, what they did was deemphasize “medically unexplained” as the central defining feature of this disorder group.
What the SSD work group signed off on was to dismantle the DSM-IVSomatoform disorders categories; fold these disorders into a single, new disorder category (Somatic Symptom Disorder); eliminate the requirement for symptoms to be medically unexplained (which had previously been available to clinicians under the DSM-IV Undifferentiated somatoform disorder criteria which on which SSD draws); shift the focus away from multiple symptom counts and symptom clusters from body systems to positive psychobehavioural responses to unspecified symptoms, and thereby created a diagnosis that can be bolted on to patients with “established general medical conditions or disorders” like diabetes, heart disease and cancer or conditions presenting with “somatic symptoms of unclear etiology.”
DSM-5 retained the Conversion disorders with revised criteria, under new disorder term, "Conversion Disorder (Functional Neurological Symptom Disorder)".
Whereas, for ICD-11, the Conversion disorders are accommodated under Dissociative disorders.
But the ICD-11 Topic Advisory Group for Neurology has proposed that this group of disorders should be located under a new parent class, "Functional clinical forms of the nervous system," attached to the Neurology chapter, as neurologists may be asked to evaluate these conditions.
Under this new parent class, it is proposed by TAG Neurology to locate a list of “functional disorders” (Functional paralysis or weakness; Functional sensory disorder; Functional movement disorder; Functional gait disorder; Functional cognitive disorder, Functional visual loss et al.)
But the Mental Health Topic Advisory Group don't like this; TAG MH is opposing this proposal or offers as an alternative, retaining this disorder grouping but primary parenting the group under Dissociative disorders in the Mental and behavioural disorders chapter, with a secondary parent under Diseases of the nervous system. This is being referred to the Revision Steering Group for review.
(ICD-11 dispenses with the ICD-10 concept of discrete chapter location and permits multiple parent classes across two or more chapters, with one code, but listed under both a primary and a secondary location.)
A link for the full Stone, Shakir et al rationale paper for locating these categories under "Functional clinical forms of the nervous system" under Diseases of the nervous system can be found in this post on my site, and also TAG MH's comments in opposition to this proposal:
With the exception of the Sunday Times Michael Hanlon feature (May 2013), I don't think anything has made me more angry and exasperated than this reaction to the IOM's report from Edward Shorter.
I'd like to see the IOM panel chair issue him with a public statement correcting his misperceptions and misrepresentations and expressing their concern for an attack by a professional on a patient group.
I cannot dismiss this as "hissy fit" from someone with an agenda and a pile of books to shift.
This was an example of grossly unprofessional conduct.
I have copied the text here since the second part requires a registration:
What do physicians intend by the term “disease”? This may strike many clinicians as a philosophical question more suited to medieval scholastics than to practicing physicians. But the recent 235-page report on “systemic exertion intolerance disease” (SEID) from the Institute of Medicine1 (IOM) casts this question in a new light and has many practical implications for patients, physicians, and third-party payers.
The definition of “disease” has been a matter of contention since the dawn of clinical medicine. For example, the ancient Greek academies of Knidos and Kos had differing views of disease.2 Knidos, the school of Aesculapius, recognized the discrete morbid entity—such as an abscess or tumor—as the defining feature of disease, subservient to the general rules of pathology. The more empirical school of Kos, associated with Hippocrates, emphasized the sick individual with his particular kind of misery. In effect, these two schools saw disease either as a specific pathological processor as a particular human experience whose character was determined by the patient’s manner of presentation.
In the 19th century, medical science was revolutionized by the German pathologist Rudolf Virchow and his famous pronouncement: Es gibt keine Allgemein krankheiten, es gibt nur Local krankheiten—“There is no general, only local, disease.” But Ludwig Aschoff, Virchow’s colleague, argued that Virchow wished merely to localize lesions,not diseases.3 There are indeed reasons to believe that Virchow conceptualized disease as a generalized condition of the living organism, which, unlike lesions, disappears when the organism dies.
To this day, the definition of disease remains controversial. Recently, in its deliberations on obesity, the AMA requested an advisory opinion from its Council on Science and Public Health. The question before the Council was, “Is obesity a disease?” The Council’s considered response was a lesson in both the limits of language and the merits of humility: “Without a single, clear, authoritative, and widely accepted definition of disease, it is difficult to determine conclusively whether or not obesity is a medical disease state.”4
Unfortunately, in the past 50 years, narrow interpretations of Virchow, such as those of the late psychiatrist Thomas Szasz, have dominated discussions of what constitutes “disease.”5 This has led to the claim—mistaken, in my view—that only those conditions with specific and identifiable pathophysiology or anatomical abnormalities “count” as disease.
Yet these criteria fly in the face of medical diagnosis throughout the ages and are not consistent with several modern-day diagnoses in the fields of neurology, psychiatry, and pain medicine. Physicians in these fields recognize that many states of severe suffering and incapacity cannot yet be causally linked with specific biochemical or anatomical findings.5 For example, migraine headache, trigeminal neuralgia, and even epilepsy remain clinical diagnoses—made primarily on the basis of the patient’s history and subjective reports. (Physical examination and imaging studies, of course, are important in ruling out certain lesions, such as a brain tumor.)
This is also true for the vast majority of psychiatric disorders. It is the patient’s degree of suffering and incapacity—or distress and dysfunction—that defines a state of disease (etymologically, dis-ease). Of course, pathophysiologic correlates, imaging studies, and biomarkers can help us understand the underlying biological nature of the specific disease process and devise appropriate treatments. But such abnormalities are neither necessary nor sufficient for the recognition of “disease” as a profound and troubling human experience.5
Indeed, in the edition of Harrison’s Principles of Internal Medicine that I used when I was a resident, the following breathtakingly broad definition of disease was put forth:
The clinical method has as its object the collection of accurate data concerning all the diseases to which human beings are subject; namely, all conditions that limit life in its powers, enjoyment, and duration [italics added].6
The editors went on to say that the physician’s “. . . primary and traditional objectives are utilitarian—the prevention and cure of disease and the relief of suffering, whether of body or of mind . . . [italics added].”6
Now comes the IOM report, which has renamed so-called chronic fatigue syndrome (also called “myalgic encephalomyelitis”) as “systemic exertion intolerance disease” (SEID) and proposed essentially clinical criteria for its diagnosis. (Our word “clinical” is derived from the Greek klinikē “bedside”—so, diagnosis made at the bedside). In brief, the SEID criteria entail the following:
• Substantial reduction or impairment in the ability to engage in pre-illness levels of occupational, educational, social, or personal activities
• Postexertional malaise
• Unrefreshing sleep
• Either cognitive impairment or orthostatic intolerance (or both)
Note that the SEID criteria do not require the identification of any specific biological, biochemical, or neuroanatomical abnormality. Rather, they entail a substantial degree of distress and impairment. To be clear: the report did find evidence of a strong association of SEID with diminished natural killer cell function; Epstein-Barr virus infection; decreased cardiopulmonary function; and neuropsychiatric testing abnormalities—but these correlates are not required for diagnosis of SEID.1 Similar biomarkers and associated abnormalities have been found in several psychiatric disorders. For example, abnormal eye movements can distinguish persons with schizophrenia from normal persons with considerable accuracy.7 Nevertheless, current diagnostic criteria for schizophrenia remain clinical, as with SEID.
Already, the IOM report has attracted sharp criticism, with some physicians questioning the lack of specificity in the SEID criteria and worrying about the potential for overdiagnosis and even outright fraud. These risks are not trivial, but I would argue that as physicians, our first duty is the recognition and relief of human suffering and incapacity, whether or not we can identify the specific pathophysiology underlying the patient’s condition. With respect to SEID, the IOM report makes it abundantly clear that this condition can have profoundly adverse effects on the sufferer’s social and vocational function.1
To be sure, we must continue to investigate the biological underpinnings of SEID, just as we must in disease states such as schizophrenia and atypical facial pain. When our patients are suffering and incapacitated owing to some internal process, however, we have both clinical and ethical reasons to recognize that disease is present, and to do our utmost to treat it.
What Is “Disease”?
Implications of Chronic Fatigue Syndrome
"Note that the SEID criteria do not require the identification of any specific biological, biochemical, or neuroanatomical abnormality. Rather, they entail a substantial degree of distress and impairment."
"To be sure, we must continue to investigate the biological underpinnings of SEID, just as we must in disease states such as schizophrenia and atypical facial pain. When our patients are suffering and incapacitated owing to some internal process, however, we have both clinical and ethical reasons to recognize that disease is present, and to do our utmost to treat it."
Tricky Tricky Tricky.
We have been left open to being totally stitched up again. So much for SEID clarifying the definition of ME as a serious physical Neurological/Immune disease. Out of the Frying pan and into the Fire.
For those not familiar with the name, Dr Ronald Pies is Editor in Chief Emeritus of Psychiatric Times; Professor in the psychiatry departments of SUNY Upstate Medical University, Syracuse, NY, and Tufts University School of Medicine, Boston, and author of a number of books.
During the DSM-5 development process, Dr Pies commented publicly on several occasions on his concerns for the lowering of thresholds for the Somatic symptom disorder criteria, for which I sent him notes of thanks, at the time.