Thursday, June 4, 2009

A Psychologist Explains CFS

As a professional with the relevant expertise, I am surprised to note that
the psychiatrists who have been active in the psychologisation of CFS (with
one exception) appear to have spent considerable money and time on a project
to see if their psychologisation can be formalised.  For examples of their
psychologisation, I recommend articles by Barsky and Borus and Henningsen
and Priebe, which one can Google or find cited on the website below. I
should particularly draw attention to the views of Dr. Barsky, part of the
team, who suggested that cases of CFS may have developed as a result of
reading about it on the internet. My response to that was published as one
of several letters challenging his selective discussion of CFS in Ann Int
Med 1999.

No objective scientist/clinician has ever claimed that CFS is a somatoform
disorder, or that it should be classifed as such, or anything similar.
However, one could argue that those participating in the the project are
helping to sow the seeds of doubt. I see the 'manure' being used to promote
their growth.

Five minutes on PubMed would make serious scientists see that CFS can not be classified as a somatoform disorder or any other kind of 'mental' disorder. For one thing, 'it' is not an 'it'. CFS is a term covering a mixed
population. Some subsets can be related to infection. That rules out a
diagnosis of somatoform disorder. We know too much. Of course, no one is
contesting that having CFS makes one immune from depression or anxiety, and
reading the reports on CFS and somatoform disorders certainly depresses me.
CFS needs a new case definition. While it is an umbrella term, there seems
little point in reclassifying 'it'.

Another point rarely considered. The scientists involved in the project did not and do not consider factors such as nutritional deficiences and dysbiosis as possibe explanations for the symptoms of CFS. It is therefore not surprising that the illness can be dismissed rather easily as 'medically
unexplained'. If you stop looking after routine tests, then one will often not find a cause.
Diagnosis of CFS should not be  an end point but a cross
roads. We need to identify which subset a patient belongs to and manage

The whole project, in my view, reflects reductionistic thinking. All
patients with fatigue are lumped together and they are trying to find a neat
box to place them in. Apparently, G93.3 does not suffice. (In a sense, being
a dustbin diagnosis, it doesn't. When it was listed in the index under
G93.3, - and there's nothing odd about that -, the case definition for CFS
was very different to the one used now.). However, this is not the time to
reclassify but to clarify and that requires a better definition.

I regret that anyone with CFS may have contributed funds to this project.
There wasn't a problem re reclassification, but now there is.

Ellen M. Goudsmit

No comments: