Vol. 20 No. 20 · 15 October 1998
Simon Wessely (
Letters, 17 September) now claims that he sees a distinction between ME and CFS, two years after his instrumental role in the Royal Colleges committee whose final report specifically (and, many felt, inappropriately) recommended that ‘ME’ should be renamed ‘CFS’. Even if he now makes a distinction between the two terms, he certainly did not do so in his
Guardian article, on which I based my assumption that he disagreed with the position Elaine Showalter took on CFS and class in
Hystories.
In that book Showalter suggested that, CFS, like neurasthenia, ‘was most commonly seen among the upper social classes’. In the
Guardian, using the same historical parallel, Simon Wessely said that in Victorian times CFS was, ‘oddly enough’,
thought to be an illness that predominantly affected the upper echelons of society. So is it yuppie flu, then? The Victorians gradually learnt that it wasn’t, and we are slowly finding the same. My clinics do contain rather more teachers, doctors and nurses than one would expect, but when we extended our studies to general practice and the community we found that CFS was common in all social classes.
In his letter Wessely suggests that in his
Guardian article he was writing about CFS, and that Elaine Showalter had been giving an account of ME. In his article, however, he uses the two terms as though they were interchangeable, and writes under the title ‘No-name illness’. The only distinction he made between them was this: ‘ME is the term that dominates the clinic and the media, but doctors talk and write about CFS. Encephalomyelitis … is a misnomer while chronic fatigue syndrome is instead neutral … but is
it, whatever we call
it, new?’ The implication must surely be that he sees (or then saw) the two terms as different names for the same thing, not as ‘different constructs and concepts’, as he now claims.
In her book Showalter also used the two terms as though they were synonymous, noting that ‘ME’ is the name ‘used in the UK’. ‘Whatever the official definition or name of the syndrome,’ she went on to say, ‘doctors use it in lax and general ways.’ This last point certainly seems to be true, and it’s the reason for the British ME charities’ aversion to the term ‘CFS’, which they see as a large and unspecific category, consisting of many sub-groups with different causes and symptoms. Their point has usually been that as it is already widely used in Britain, the term ‘ME’ should continue to be used here until a more satisfactory alternative can be agreed on. However, neither Showalter nor Wessely mentioned sub-groups in what they wrote. The symptoms Showalter described, as well as her historical account of the illness, clearly indicate that she was writing about CFS as a whole and was not making the distinction Simon Wessely now makes in his letter. In print, if not necessarily in intention, there can be no doubt that Wessely did contradict Showalter’s views on this issue.
Sarah Rigby
Norwich
