"From the psychiatrist’s perspective it is parsimonious to ask whether a diagnosis of CFS is ever necessary or appropriate when the symptoms can always be described by a psychiatric diagnosis? This unsatisfactory situation is an artefact of parallel medical and psychiatric diagnostic systems for patients with somatic symptoms unexplained by disease. Consequently whether one uses a ‘medical’ diagnosis of CFS or a ‘psychiatric’ diagnosis of somatoform disorder is merely a matter of choice." (Wessely & Sharpe, NOToP, p1038)
". . . Wessely considers the natural history of chronic fatigue and myalgia syndromes, which are becoming increasingly fashionable. He considers that such disorders as myalgic encephalopathy, post-viral fatigue states and chronic Epstein-Barr virus are the true heirs of neurasthenia - and serve the same social purpose. Both the patients and those making the diagnoses believe that the patient is suffering from a physical illness, so there is an avoidance of guilt and blame despite the fact that about two-thirds of such patients satisfy diagnostic criteria for depressive illness." (Goldberg & Sartorius, PdiGMS p3)
"Just when you thought a stake had been driven through the heart of Chronic Fatigue Syndrome (CFS) (link is external) it comes roaring back, propelled this time by a committee of the Institute of Medicine (part of the National Academy of Sciences). It’s a committee that the CFS patients’ lobby has roped, captured, and hogtied." (Shorter, PT, Feb 19 2015)
"The recognition of PVFS by the Department of Health can be viewed as an attempt to legitimise the sick role, and thus regard the chronic illness behaviour manifested by the patients within the ambit of 'normal' illness behaviour. Furthermore, the patients' illness behaviour is likely to be perpetuated by adhering strictly to the advice given by the powerful self-help group, the 'M.E. Society', which advocates total rest." (Woods & Goldberg, PFS p912)
"CFS came out of that whole brew of toxic beliefs about being tired all the time that arose in the 1970s; it became crystallized with the diagnosis “Chronic Epstein-Barr Virus Infection,” then morphed into Chronic Fatigue Syndrome (Myalgic Encephalomyelitis, or “ME,” in the UK). Finally, the wind went out of this particular sail late in the 1990s when it became apparent to the patients that nobody believed they had a distinct organic disease, as real as mumps, called “CFS.”" (Shorter, PT, Feb 19 2015)
"The description given by a leading gastroenterologist at the Mayo Clinic remains accurate: 'The average doctor will see they are neurotic, and he will often be disgusted with them. Often he sends them away with as little ceremony as possible' (Alvarez, 1935). Thus, attitudes toward psychiatric illness affect both patient and doctor with equally adverse effects on prognosis." (Wessely, PDiGMS/CF&MS, p90)
"There have been no convincing new studies, no breakthrough findings of organicity, nothing. And there never will be." (Shorter, PT, Feb 19 2015)
"In the context of fatigue states, the attribution is usually to an infective agent, especially a virus. This has been true since the discovery of such agents (Rabinbach, 1982), but it is of interest that the "germ theory" of nonspecific illness is gaining popularity among primary care patients at the expense of a decline in the acceptance of personal responsibility for illness (Pill & Stott, 1981). Such attribution conveys certain benefits, irrespective of accuracy. 'The cardinal attribute of terms is external.. There is no malevolence or "maleficium" involved' (Helman, 1978). In other words, there is an avoidance of guilt and blame (unless the germ is sexually transmitted)." (Wessely, PDiGMS/CF&MS, p92)
"Once sanctioned by a doctor, the symptoms are more likely to persist; the persistence of the symptoms is mistaken for confirmation of the diagnosis." (Woods & Goldberg, PFS p911)
"What drives this process? Patients hate having a diagnosis that nobody believes in; they dread the words, “Madame, it’s all in your head.” So, many CFS sufferers moved on to other delusional illness attributions, some involving the environment rather than the mysterious collapse of their “immune systems.”" (Shorter, PT, Feb 19 2015)
"Some patients may adopt safety behaviours that interfere with the experiment of increasing activity. These include walking very slowly, carrying a walking stick, and telling others that they are ill and not to expect too much. If they are to regain their belief in their own ability to function normally, these behaviours need to be dropped." (Sharpe, S&PoCBT p401)
"For many sufferers, ME appears to be an all-consuming political cause and a way of life. It gives purpose to an existence otherwise emptied of meaning. In this respect it resembles the wilder shores of feminism, or racism awareness, more than it resembles a disease." ("Dr Rodney Silver", aka Anthony Daniels/Theodore Dalrymple, The Daily Telegraph, Mar 30 1994)
"CFS lobbyists actually sat on the committee, and in the several public hearings the CFSers appeared in mass to pour out their tales of woe. In its report the committee emphasized that it is “taking into account the clearly expressed views of hundreds of patients and their advocates. Now, committee capture works like this: It is impossible to say to some woebegone victim – who has now become a committee colleague – “We don’t believe that your symptoms are caused by an organic disease.” The public hearings were a circus, with moaning and groaning victims right and left. How do you say to this kind of psychodrama: “We are scientists and insist on evidence other than the tireless repetition of your subjective complaints.”" (Shorter, PT, Feb 19 2015)
"Finally, the medical profession may adversely influence the course of the illness in two ways. . . second, by introducing new diseases. Creating new diagnoses may legitimize much of the above behaviour. For example, 'chronic brucellosis' has been described as a 'spurious disease construct which legitimizes and thereby perpetuates chronic illness behaviour (Eisenberg, 1988). The inevitable result is that the symptoms persist, so the diagnosis is confirmed, and the process continues. The successors to chronic brucellosis that appear in this chapter are inadvertently fulfilling the same role in many patients." (Wessely, PDiGMS/CF&MS p93)
"The tragic element is that becoming involved with a CFS advocacy group is a recipe for lifelong disability, further entombing the patients in their symptoms. Yet it is precisely the advocacy groups that are driving the whole carnival, that have captured this wacky committee of the otherwise august Institute of Medicine. This is the politics of health care at its worst: giving over to noisy advocates the responsibility for defining disease entities. It encourages patients to believe that they have a non-existent illness, and it intimidates physicians from making the correct diagnosis and ensuring that these patients receive proper care rather than Rose of Sharon Oil." (Shorter, PT, Feb 19 2015)
"Finally, attribution to a disease for which the person has no responsibility may function to avoid blame for being ill." (Wessely & Sharpe, ToFSS p292)
(PdiGMS = Psychological Disorders in General Medical Settings; CF&MS = Chronic Fatigue and Myalgia Syndromes; S&PoCBT = Science and Practice of Cognitive Behaviour Therapy; PFS = Postviral Fatigue Syndrome, BMJ47, 1991; ToFSS = Treatment of Functional Somatic Symptoms; PT = Psychology Today; NOToP = New Oxford Textbook of Psychiatry)
