Edward Shorter’s view of Chronic Fatigue Syndrome

A confession.

Until I was diagnosed with ME, I didn't really believe it was a serious, debilitating and potentially life long condition.

Most of what I knew about it was from what I read in the newspapers. Now I'm not saying I was judging other people, I never really gave it much thought.

So, when I was diagnosed with ME it was initially a huge relief. also a surprise - ME really? But I'm in so much pain & feel so ill. I was relieved, phew, thought I had something serious there for a bit. :rolleyes:

I was diagnosed in the 90s in the UK. I doubt I'm the only one who thought ME was a fairly trivial disease from which a full recovery would be made and who just thought people with ME were just tired & had no stamina.

So, why would you choose, consciously or otherwise, to imitate a disease that you don't really consider particularly debilitating. Why and how would you, consciously or otherwise, develop symptoms that you didn't know other people with ME had?

I wonder how Shorter would answer that?
 
Details of Shorter's biography seem surprisingly sketchy for a professor. One can learn that his PhD was from Harvard and that he became holder of the Hannah Chair of History of Medicine at Toronto in 1991. From the preface of one of his books on Amazon he seems to have been at Toronto in 1989. Does anyone know when he left Harvard for Toronto. I think this is a significant detail. Some of his views seem very similar to those expressed by Eisenberg.

It would also be interesting to know what influences led to him being invited to chair, along with Kleinman, the CIBA Conference in May 1992 which put the US believers in close proximity to the UK believers.

As Shorter's book was published in 1992 it came after the Wessely paper Old wine in new bottles (or was that "whine"-I forget) from 1991. I suspect that both were influenced by the Harvard based ideas of Eisenberg and Kleinman.
 
Excellent piece Michiel and Evelien. Nitpick: there is a broken link in this paragraph (on the word "Studies")
A third problem is that ME/CFS is just too disabling and isolating for Shorter’s hypothesis to work. Studies have suggested that ME/CFS patients are more disabled than patients with other chronic conditions including multiple sclerosis, congestive heart failure, depression etc.
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If necessary here is a list of references:

Roma, Maria et al. “Impaired Health-Related Quality of Life in Adolescent Myalgic Encephalomyelitis/Chronic FatigueSyndrome: The Impact of Core Symptoms.” Frontiers in pediatrics vol. 7 26. 15 Feb. 2019, doi:10.3389/fped.2019.00026

Winger A, Kvarstein G, Wyller VB, et al. Health related quality of life in adolescents with chronic fatigue syndrome: across-sectional study. Health Qual Life Outcomes. 2015;13:96. Published 2015 Jul 3. doi:10.1186/s12955-015-0288-3

Kingdon CC, Bowman EW, Curran H, Nacul L, Lacerda EM. Functional Status and Well-Being in People with MyalgicEncephalomyelitis/Chronic Fatigue Syndrome Compared with People with Multiple Sclerosis and Healthy Controls.Pharmacoecon Open. 2018;2(4):381-392. doi:10.1007/s41669-018-0071-6

Eaton-Fitch N, Johnston SC, Zalewski P, Staines D, Marshall-Gradisnik S. Health-related quality of life in patients withmyalgic encephalomyelitis/chronic fatigue syndrome: an Australian cross-sectional study. Qual Life Res. 2020;29(6):1521-1531. doi:10.1007/s11136-019-02411-6

Falk Hvidberg, Michael et al. “The Health-Related Quality of Life for Patients with Myalgic Encephalomyelitis /Chronic Fatigue Syndrome (ME/CFS).” PloS one vol. 10,7 e0132421. 6 Jul. 2015, doi:10.1371/journal.pone.0132421

Nacul, Luis C et al. “The functional status and well being of people with myalgic encephalomyelitis/chronic fatiguesyndrome and their carers.” BMC public health vol. 11 402. 27 May. 2011, doi:10.1186/1471-2458-11-402
 
He sees ME/CFS as a form of somatization where patients “do not in fact have an occult organic illness called ‘ME’ but have suggested themselves into their chronic pain, fatigue and dizziness because the culture says those are appropriate symptoms.”
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We're being asked to believe in magic, or that is how it comes across. How would this wonderful self-suggestion work?

Also, if patients don't have a real disease because there is insufficient objective evidence, why are we being asked to believe in other things without any evidence, like this magical somatization or mass hysteria claims? What is the objective evidence for them?

To be honest I am not sure it's a good way to use your productive time to examine Shorter's ideas as if they were something to be taken seriously. The proper response is ridicule and move on.
 
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He's on Twitter:

"Finding a link between COVID-19 and subsequent psychiatric symptoms has resulted in renewed interest in the psychiatric sequelae of pandemics. The first such instance was apparently the encephalitis lethargica pandemic which arose around the time of the First World War, moving in the shadow of a repiratory virus pandemic".
 
An excellent review, @Michiel Tack. You cited Shorter's Feb 23 2015 blog on Psychology Today - you might be interested to know that that particular blog was a revision of a post made on Feb 19 2015 which was far more revealing (and far more abusive).

The original was removed from Psychology Today and even archive.org after something of a backlash, but is still available on archive.vn.
 
Adrian said:
He would probably just dismiss you as a woman, my feeling is me is driven by misogony rather than anything else and from what I remember that drives his other research as well.
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He probably would. The personal attack or dismissal by way of deflecting from the content of the discussion.

The facts remain though.

Also, when assessed early on by a psychiatrist, this discussion came up. I made some of the arguments as @Michiel Tack does on his blog, though not nearly so well.

I also pointed out that I already had a history of migraines and surely if I was either consciously or unconsciously creating or inflating symptoms to avoid dealing with life's difficulties why would I create a whole new set of symptoms? Why wouldn't my migraines simply get worse or appear to? The added advantage being that you get a lot more sympathy & support.

Why choose the one diagnosis that would guarantee you would face ridicule G disbelief.

If his opinion of women is so low then I'd love to hear him have the courage of his convictions and come out and say so. Then I'd want to know if this means he wouldn't get on a plane flown by one or delay life saving surgery because the only surgeon available was female.
 
Invisible Woman said:
A confession.

Until I was diagnosed with ME, I didn't really believe it was a serious, debilitating and potentially life long condition.
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Yes, so many of our stories don't fit his narrative at all.

I was a child/teenager who had never even heard of it (or CFS!). I refused diagnoses for several years, with a strong expectation that my body was going to spontaneously recover! (children have minimal concept of chronic illness - I remember when our school had a talk from a guy with cystic fibrosis and I was like... OMG!)
 
As child, I was vaguely aware that chronic illness existed. In other people, distantly, for example in people over the age of 60, who had to take pills for their heart. But not in the close family.

So when my mother was chronically ill, I didn't view it as chronic illness but as some weird thing, a constitutional weakness with unrelated episodes of fatigue that resulted in bed rest and difficulty doing household work. In part because she also didn't really communicate it clearly.

And I also saw my illness initially in the same manner. Just temporary struggling, for no reason in particular. It would surely go away for good soon and just meant I had to try harder.
 
strategist said:
So when my mother was chronically ill, I didn't view it as chronic illness but as some weird thing, a constitutional weakness with unrelated episodes of fatigue that resulted in bed rest and difficulty doing household work. In part because she also didn't really communicate it clearly.

And I also saw my illness initially in the same manner. Just temporary struggling, for no reason in particular. It would surely go away for good soon and just meant I had to try harder.
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Same here. And to this day my mother refuses to acknowledge that there is anything in particular wrong with her even though her activity levels continue to decline, especially now as she is getting older. When you ask her why she can’t work, can barely do any housework and rarely goes anywhere anymore, it’s always some vague excuse about being deconditioned, overweight, getting older etc. It’s truly amazing to see the lengths people will go to to DENY that they have ME/CFS. I cannot fathom why Shorter thinks symptoms such as fatigue, pain and dizziness are culturally sanctioned expressions of distress. On the contrary, they are considered the most illegitimate symptoms imaginable, a sure sign of shirking responsibilities, constitutional weakness or mental health problem.
 
I was fully convinced that I would naturally recover, and I held on to that belief for the first year or so, while I was undergoing stationary treatment in an MUS clinic, and had not deteriorated into (very) severe condition yet - that came later, no thanks to a forced rehabilitative measure, rather than my eventual ME diagnosis. However, I also was convinced that an organic precipitating factor was responsible, so naturally, my psych at the time ascribed my lack of recovery to that, while completely disregarding my conviction that I'd be well again soon. It does ring true that I hadn't even bothered seeking out anything like a patient community until I had sufficiently deteriorated, but obviously he's got the causality backwards there.

Bottom line is, had it not been that, my psych would've blamed it on my type A overachiever personality, past trauma, whatever aberration would've made itself evident to her. I do not understand why combing a patient's personality for ever-so-minor possible perpetuating factors is in any way more acceptable than running endless biomedical investigations, and blaming it on slightly off micronutrient levels, like an orthomolecular doctor would. Try to adjust your hacked together BPS model for "multiple hypothesis testing."
 
I suspect that because he is supposedly a historian rather than a physician Shorter is sometimes thought to be the source of the historical material relating to neurasthenia. It would be interesting to look to see whether he had any original thoughts on the subject. The Wessely paper preceded his book. Amongst the citations in his CIBA conference paper is reference to this paper by Donna Greenberg of Harvard Psychiatry Dept, published 1990 but received for publication in March 1989. It seems to contain most of what Shorter says about nuerasthenia.

Greenberg, D. B. (1990). Neurasthenia in the 1980s. Psychosomatics, 31(2), 129–137. doi:10.1016/s0033-3182(90)72185-8
url to share this paper:
sci-hub.se/10.1016/S0033-3182(90)72185-8

The question which arises is did Shorter publish on the subject earlier. I do not suggest any academic impropriety. It is merely that before the days of Sci-hub we amateurs may have acquired certain false beliefs.
 
Thank you @Michiel Tack and Evelina, for your excellent article.

A few thoughts about the historian's writings:

Why such energetic dislike for a specific community? What underlies this seeming disgust? What purpose do these writings serve? What is the ultimate goal? Where is the evidence?

Why would millions choose a disease they know is maligned and neglected, and stick to it year after torturous year? Why would healthy, active, often young people choose to upend their lives, and live in misery for decades?

And, there are much more than micro-findings for ME.
 
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