Below is my comment provided to the APA.
Dear Members of the APA DSM-V Review Panel,
Re: Concerns regarding any move to categorize Chronic Fatigue Syndrome (CFS) as a Functional Somatic Syndrome.
This matter presents numerous issues of scientific accuracy, vested interests, professional credibility and public trust which I imagine others will raise with the panel, so I will address issue of Gender Prejudice which I believe is relevant.
I note with interest that the DSM website states (1):
"…the Gender and Cross-Cultural Study Group has tried to determine whether the
diagnostic categories of mental illness in DSM need changes in order to be sensitive to the
various ways in which gender, races and culture affect the expression of symptoms."
I find it troubling that the APA appear to consider it appropriate to lump together Gender and Cross-Cultural issues. There may be some cultural issues that include aspects of gender, but purely gender issues are nothing to do with cross-cultural issues and laws protecting equality in these matters are separate, as they should be. It would be ridiculous if people living in a civilized democracy considered any gender prejudice they encountered to be automatically associated with culture rather than originating from outdated discriminatory attitudes. By appointing a Study Group that apparently combines these completely different issues the APA seem to be guilty of such an attitude.
The US Dept of Health and Human Services states: "Women are four times as likely as men to develop CFS" (2). This raises the question of discrimination which I believe the panel should respond to.
E.g.; Dr Peter Hudgson was a Consultant Neurologist at the Newcastle General Hospital and stated on camera (3):
"I don't know what M.E. is, but what I'm absolutely certain is, it is not an organic illness. I don't want to make too much of the sexist issue, but, er, something like four-fifths if not more of the people I deal with are women in early middle age who have unsatisfactory marriages; who have children that are making life difficult for them…"
Disregarding the contradictions in these remarks they appear to reflect a prejudice that I believe underlies the attitude of some who seek to psychologise CFS.
Of the many people with CFS that I know personally only a small percentage fit the stereotype that Dr Hudgson had to 'deal with'. Yet so entrenched is this stereotype of the 'nervous housewife' that I find this prejudice is widespread.
Johnson (4) remarks on an interview with the CDC's Larry Schonberger:
"It was apparent Schonberger believed that the entity his division would go on to name "cfs" was less a disease than a manifestation of depression in women… Doctors who saw patients, even Harvard docs like Anthony Komaroff, were anathema to Schonberger and his staff; such doctors were rendered unreliable by their bias in favor of the disease existing. Agency staff considered clinical expertise equivalent to clinical ignorance: after all, if you thought depressed, hysterical women had an organic disorder that required medical attention, how credible could you be?"
Prejudice against women in the medical professions is nothing new and is, I suspect, so normalized as to make rational thinking about women's health issues nigh impossible for male-dominated institutions. I do not mean this as a criticism even though this is clearly an unsatisfactory situation; I am simply referring to what is practically feasible.
I do not think it necessary that the review panel comprise 80% women to match the percentage of women diagnosed with CFS; but I do consider it essential that at least 50% of any panel considering this item for the DSM should be women. It would be sexist to convene a panel that did not adequately represent the views of women. Classifying CFS as a somatization disorder would lead to people with CFS being re-diagnosed as neurotically somatizing rather than suffering from a debilitating illness with an as yet, incompletely elucidated etiology. Whether the APA like it or not, this would be viewed as, and may in fact be - sexual stereotyping.
The fact that men are also diagnosed with CFS does not obviate the gender issue, it may rather contribute to it by obscuring the psychological issues of those who seek to subjugate women. It is possibly noteworthy that in the Middle Ages, depending on region, between 5% and 25% of people tried for witchcraft were men. This does not alter that fact that the persecution of witches was a gender crime.
If those whose vested interests lie in categorizing CFS as a mental illness succeed in swaying the APA, I believe this would be viewed as sexist judgment against women. If such a judgment were passed by a male dominated panel this would be completely unacceptable.
Peter Kemp MA (Counselling and Psychotherapy Research)