CFS and the somatic expression of emotional distress: Applying the concept of illusory mental health to address the controversy

[adambeyoncelowe]

Abstract
OBJECTIVE:
The process of somatization in chronic fatigue syndrome (CFS) was investigated using the concept of illusory mental health (IMH). IMH involves self-reporting low emotional distress alongside performance-based assessment of distress.

METHOD:
We studied IHM and physical symptoms in 175 women across four groups: (a) CFS plus depression; (b) CFS with no depression (CFS-ND); (c) depressive disorder without CFS; and (d) healthy controls (HC). IMH was assessed using a self-report measure plus the performance-based Early Memory Index (EMI).

RESULTS:
CFS-NDs were no more likely to have IMH compared with HCs. Among the CFS-NDs, IMH was associated with more physical symptoms. For CFS-NDs, EMI added meaningfully beyond self-reported mental health in predicting physical symptoms.

CONCLUSION:
Findings refute reducing CFS to somatization, but there is a subgroup of CFS whose lacking access to emotional distress is associated with heightened physical symptomatology.

https://www.ncbi.nlm.nih.gov/pubmed/30152867

 

[adambeyoncelowe]

Does the Early Memory Index really show mental illness? Sounds like it might more accurately capture brainfog. Therefore, the conclusion at the end isn't borne out either way.

 

[Sasha]

CONCLUSION:
Findings refute reducing CFS to somatization, but there is a subgroup of CFS whose lacking access to emotional distress is associated with heightened physical symptomatology.

I don't know if I'm interpreting this correctly, but I've found that I can't afford physically to get emotionally distressed because of the horrendous physical payback. I wonder if that kind of 'keeping a lid on it' is what they mean by 'lacking access to emotional distress', because if so, it doesn't suprise me that it's associated with those with worse symptoms.

 

[Philipp]

It is a bit hard to translate with all their cultist language and whatnot, but my guess would be that 'lacking access to emotional distress' means you are doing 'having emotions' wrong. The 'performance-based assessment of distress' probably gauges how distressed you 'really' are by some arcane means and if you self report less than what that assay says you are lacking in access. So the conclusions would stand and fall based on how meaningful the performance assay captures reality which I cannot make out from the abstract.

Interestingly, the 'findings refute reducing CFS to somatization' is similar to what other psychological research has found (ignoring for the moment that this is not what was usually reported, patient selection criteria makes it hard to know to whom the findings apply, how doubtful it is that their questionnaires or whatever they used may be unable to accurately paint a picture of what is going on with someone etc), but the way it is worded - while not technically wrong - may be misread by people who lack contextual expertise. I would assume that 'heightend physical symptomatology' will for sure be associated with not processing emotions or avoiding situations that could take an emotional toll exactly like @Sasha described, so the conclusions are what is to be expected - but I would not be surprised if someone reading this might misinterpret it as 'if we give those people access to their own emotions they may get a bit better', but that is subject to further study as it stands. I do believe that this should actually pan out if done correctly and the payback from e.g. leaving the house does not outweigh the benefits - talking to friends about what ails me makes me feel better (up to a certain point obviously).

 

[adambeyoncelowe]

I don't know if I'm interpreting this correctly, but I've found that I can't afford physically to get emotionally distressed because of the horrendous physical payback. I wonder if that kind of 'keeping a lid on it' is what they mean by 'lacking access to emotional distress', because if so, it doesn't suprise me that it's associated with those with worse symptoms.

'Lacking access' isn't simply avoiding emotionally taxing events, as far as I can tell. It's sublimating or burying emotions. I.e., a pathological refusal to deal with feelings. I.e., more victim blaming. You're more sick because you won't accept that you're mentally ill.

Avoiding stressful situations would be called avoidance in extremes, but isn't usually pathological behaviour. It's healthy to avoid drama so long as you don't fear activity itself because of a minute risk of stress.

 

[Hoopoe]

I doubt they know what they're actually measuring. I can't access the paper and have no idea what test they actually performed.

 

[Louie41]

Maybe @Brian Hughes can shed some light here. Either that, or he's got another example of psychology in crisis.

 

[Cheshire]

This paper (Cloning the clinician: A method for assessing illusory mental health 2003) explains what the Illusory mental health concept is.
To sum up:
It is based on the idea that when recalling the past memory of an early childhood event, some distress, that the patient is not aware of, can be detected (based on a somewhat psychoanalytic approach).

The patient is asked to recall 5 early memories (oldest one, second oldest one, first memory of your mother, first memory of your father, memory of an important event).
Then the way the patient talks about it and the content of the memories are analysed using a scale:

 

[Arnie Pye]

So, from the point of view of doctors and therapists, if they can't find a reason to put you in the mental health bin based on current behaviour, then they'll get you there based on something that happened when you were 2 or 3 or 4 years old?

This determination to paint everyone as mentally ill is a severe mental illness in itself, suffered by the medical professionals and therapists.

 

[alex3619]

(based on a somewhat psychoanalytic approach).

(red flag in case the link dies)