I thank you for that informative posting. It is my opinion that I
don't care if it is mental, physical, organic, or what ever. After five years
of this stuff, I would welcome a feasable solution to all of this, even if it
meant that I had to get my eggs unscrambled. I did try psychiatry though,
because like many others I was told it was psychological. That turned out to
be a dead end, the psychiatrist found no substantial psychological factor, in
fact, to use his words, "Mandy evidences no psychologigal disfunction that
would evidence itself in this respect. I found nothing in 6mos. of therapy
that would explain her physical dissabilities. I feel that I can no longer be
of any help in the finding of fact in this case." I was both let down and
excited, I am glad to know that I "have my ducks in a row", but was hoping at
the same time that maybe they were right, and he could help. I remain whatever
you are when you have this stuff. My ducks get scattered every once in a
while, but according to the shrink, no more than normal.
Thanks,
Mandy
Doc <doc09(AT)fuse.net> wrote:
I'm not sure I like what is being said. I'd be interested in hearing
the thoughts of others. It may be one of those articles that require
a response. Please let me know what you are thinking.
Doc
from The New York Times March 16, 1999
When Illness Is Real, But Symptoms Are Unseen
By JANE E. BRODY
More than a century ago, physicians encountered a syndrome they called
neurasthenia, characterized by a wide variety of symptoms that variously
included fatigue, weakness, muscle and joint pain, headache, memory and
concentration difficulties, runny nose, disturbed sleep and
palpitations.
Researchers expected that a cause would soon be identified -- a virus,
bacterium or toxic agent -- that would account for these complaints. It
never happened.
Instead, through subsequent decades, a host of disorders with similar
sets
of symptoms were identified. They included so-called "effort syndrome"
that
afflicted veterans of the Civil War and World War I, chronic
brucellosis,
hypoglycemia, myalgic encephalomyelitis, chronic candidiasis and chronic
mononucleosis.
Now the prevailing ailments go by the names of chronic fatigue syndrome,
fibromyalgia, multiple chemical sensitivities, sick building syndrome,
silicone-associated rheumatic disease (from breast implants) and gulf
war
syndrome.
People afflicted with one or another of these syndromes are often
extremely
debilitated and alarmed by the limitations the ailments place on their
lives. Making matters worse is a widespread but erroneous view that they
are not really sick but are fakers or hypochondriacs whose symptoms are
self induced to gain attention, sympathy or relief from their usual
duties.
But the professional debate is not over whether the symptoms are real --
those affected are definitely sick, experts say -- but rather whether
there
is any point in continuing a thus far fruitless search for specific
causes.
A more productive approach, they say, would be to treat these syndromes
as
one and the same and provide effective treatment regardless of the
cause.
In a recent issue of the journal Epidemiologic Reviews, Capt. Kenneth C.
Hyams, who heads the epidemiology division of the Naval Medical Research
Center in Bethesda, Md., noted the remarkable similarities in the
symptom
complexes that are the hallmarks of these diagnoses. All are
characterized
by fatigue, headache, difficulty concentrating, muscle or joint pain,
impaired memory and often depression and/or anxiety, with some
individual
variations.
The unifying fact of all these disorders is that they are defined only
by
their subjective symptoms. No objective criteria or consistent organic
explanation can be found for any of them and, therefore, they are a
challenge to study, diagnose and treat. For example, Dr. Hyams explained
that some patients might be found to have an immunological deficit, but
many others with the very same deficit were not sick.
For others, the illness may have been preceded by a cold or flu, but
there
is no evidence that the infectious virus still lingers in any form.
A more probable explanation, Dr. Hyams and others suggest, is that a
reaction to some physical or emotional stress triggers the symptoms that
characterize these syndromes.
Faced with a lack of objective diagnostic criteria, the particular
diagnosis a patient receives typically depends upon the patient's most
disturbing symptom, the history of exposures the patient reports and the
type of health professional seen -- allergist, gastroenterologist,
rheumatologist, neurologist or psychiatrist.
As Dr. Simon Wessely, professor of psychological medicine and director
of
the Chronic Fatigue Syndrome unit at Kings College in London, pointed
out
in an interview, "Each specialty goes its own way in arriving at a
diagnosis." In other words, patients who see a neurologist may get a
diagnosis of nerve damage whereas those who see a rheumatologist may get
a
diagnosis involving joint or muscle pain.
He added: "Doctors have been searching for the Holy Grail to explain
these
syndromes for the last 150 years without success. Neither single organic
causes -- viruses, immune defects, toxic agents -- nor single
psychological
causes -- childhood sexual abuse, depression or anxiety -- can account
for
them."
Dr. Wessely said that trying to categorize these ailments as either
organic
or psychiatric was a disservice to patients. "If a patient is told the
problem is due to a permanent deficit in the immune system or a
persistent
virus or chronic disability of the nerves or brain, this just generates
helplessness and the patient becomes a victim," he said. "And if you say
the problem is psychological, this generates anger on the part of
patients
who don't regard psychological ills as legitimate."
Rather, Dr. Wessely insisted: "Looking for any single cause misses the
point. Regardless of how or why they may have started, these syndromes
are
multifactorial, like heart disease."
Dr. Hyams emphasized that the lack of objective diagnostic criteria
"does
not mean that these people don't have problems."
"They're ill," he said. "There's no question. They are not malingerers."
For example, Dr. Wessely said, "Going to the Persian Gulf definitely
affected the health of servicemen. We showed very considerable health
effects. But that doesn't mean the disease they contracted is unique to
science. They have legitimate health problems, but there is no single
illness or single cause."
Viewing the problems holistically, Dr. Hyams said: "Even if these
illnesses
were primarily psychiatric, psychiatric illnesses have an organic basis
in
the mind. If a person is sick in any one place, it affects the whole
body.
For example, a psychiatric illness can cause changes in life style that
can
have profound physiological effects."
Dr. Elaine Showalter, professor of humanities at Princeton University
and
author of "Hystories: Hysterical Epidemics and Modern Media" (Columbia
University Press, 1998), said her analysis of the history of these
disorders demonstrated that they represented "a basic human phenomenon
-- the way people react to various stresses, with symptoms that are not organically based.""The symptoms are genuinely experienced, debilitating and absolutely real, but a lot of energy and money have been spent looking for organic explanations and treatments for what is basically a psychological phenomenon that is not caused by a virus, nerve gas, immune defect or any other tissue change," she said.
Dr. Hyams said, "You always find high rates of these kinds of symptoms in any population reported to have been exposed to something."
"People," he added, "are sensitized by reported health threats if they think they've been exposed."
The most effective treatment to date for the syndromes, Dr. Wessely said, is outlined in a report on chronic fatigue syndrome issued two years ago by the Royal Colleges of Physicians, Psychiatrists and General Practitioners. It is intended to deal with factors that perpetuate illness.
Dr. Wessely explains that the profound fatigue and muscle pain that typify these syndromes are best treated by a graded series of exercises to increase stamina. Also, patients are encouraged to shed their beliefs (for example, that any activity will make matters worse) and to restructure their approach to life through 12 weeks of behavioral therapy, intended to enhance self-confidence and a belief in a patient's ability to control his illness. If patients are suffering from serious depression or anxiety, temporary treatment with psychoactive drugs may also be offered, but as a therapeutic aid, not a cure.
Copyright 1999 The New York Times Company
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