Scotland Herald: 'Chronic fatigue, 'mass hysteria', and Dr Melvin Ramsay', by Helen McArdle, 2024

I do not think this (attached PDF) has been posted anywhere before; it is from Ramsay's book Infectious Diseases (2e, 1977). In the same volume he says of glandular fever that "[p]ersistent fatigue and inability to concentrate are common after infectious mononucleosis and may persist for several weeks or months but ultimate recovery is assured", so this offers a summary of Ramsay's early thinking before the switch to viewing matters as a more general post-viral fatigue state occurred. What Ramsay seems to think of as a manifestation of "hysteria" in these cases is the emotional lability that apparently developed in some of the cases; he refers to this as "functional overlay" in various different works. That is very different to the anatomically incongruent signs in some of the RF cases pointed out by Mc&B.

The average layman's takeaway from Mc&B will be one of concern at their views, expressed in terms uncomfortable in today's era, about "hysteria" and the female predominance. The average physician will glance at the descriptions of stocking/glove anaesthesias and so forth and reach a very different conclusion: that some of those cases were what is now called FND.

Undoubtedly some diseases were missed: if I recall correctly McE&B mention one case who died months later with "disseminated sclerosis" (the old term for MS).

 

The key thing with eg me/cfs is that I guess people are assuming we are deluded in thinking that we will get worse if we try and increase what we do (or list many other things like the idea of exposure therapy for light sensitivity) and of course the more severe we are the more ridiculous what we have to say sounds. I cringe at having to say two weeks to recover from an appointment but that’s not the half of it re: how often I should be lining then up back to back with each other.

the issue is that no one will ever believe us even I imagine if someone was locked in a ward for six months with their exertion controlled then observed for the six months afterwards. And get worse

and we all know in outpatient clinics who only see people without PEM who are polite and nod and leave

but there must be some level of delusion going on from the medic side in the instances where they’ve seen these iller people. You watch it ratchet up as they make fii accusations or ban them from family members or assume maybe they are doing something else first.

once someone has any kind of psychiatric label - both (function back door) of which are as powerful a weapon as each other (only one of which is regulated , sort of or supposed to be) then it says the patient ‘lacks insight’ - and PS this is interpreted (quite honestly) as ‘they are liars’ , which is the behaviourism attitude anyway as they don’t like to treat people as humans who might question as ‘valid’.

By this exact ‘move’ of putting a question mark over that person - regulated of correct it not you invalidate them vs the perhaps deluded medics who believe in the easy options. Question resolved on ‘who is wrong’ and then they go no further to question why someone isn’t improving with sleep hygiene or exercise or anything else other than to say ‘this psychosomatic is extreme’. I actually think they think people can psychosomatic themselves to death and that’s how pwme die. Nothing they can do ‘medicalising’ they belief would make it worse.


which is a major issue for a condition where the added dusabiiity is the medics lacking insight or ability to see what’s in front of them fir what it is.

to allow this free pass. It bars people from ever accessing medical care for anything, being heard or being free if they do get ill.

it’s all very well doing these rhetorical debates about these terms but they are no joke and as harmful a thing you can do to a person it presents a deep removal of themselves and takes their safety and identity and peace when they are as ill as we are and you realise if you did die it would be written off and you wouldn’t even have the dignity of your own story.

But then to this is my other point which is that I imagine there was some learning to do, just as we all have with our illness and trying boundaries vs the typical diagnostic tools and time spans . And surely if something is new then you only know if it’s acute when time elapses. Although ironically I don’t know would they back then have been more used to illnesses without good treatments where they might have calmed down from an acute stage but still remained (and might have further acute stages or deterioration etc )

I also agree with the comments about provocation regarding ‘perceived mood’ if someone is realising these notes and attitudes are going on around them it wasn’t ’at nothing’ in that situation. Plus I suspect it was no better than now regarding the terminology allowed to be used being rude and tactless or certain terms tgat perhaps meant little were derogatory versions like did medics just use hysteria for any upset woman back then?

the thing is that the slowest subject to move on of any even outside medicine inckuded seems to be that psychosomatic end of psychiatry - so they would see what they recognised in the notes wouldn’t they. And if they’d been the only doctors there would they have just assumed it was mass hysteria as a starting point at the time?

 

Ramsay seems to have been very confused about the neuro-myology. He thinks there are central nervous (upper motor neurone) signs, but also meningeal signs (neck stiffness) and signs of local muscle disease, or perhaps muscle denervation which occurs in polio with lower motor neurone damage. Nobody has ever confirmed any specific electromyographic findings as far as I know. So maybe not so much led astray as out of hs depth?

 

I can see that!

Correct. But then we never can because nobody knows if psychosomatic means anything useful.

I think Ramsay is saying more than just that the patients were emotional. He is saying that there were features that he had been trained to regard as 'hysterical' or indeed 'functional' (I had thought that was a newer usage but it seems not). He is arguing with himself about what the signs should be called but getting tied in knots because he hasn't really thought it all through. He just wants to convince people that the patients had a nasty acute viral epidemic illness that looked different. On that score he was very likely right. But it may have been some obscure coronavirus or rhinovirus variant that popped up in 1955 and fizzled out of no great interest - there are probably thousands of these. And the evidence for it being genuinely neurotropic doesn't stand the test of time.

I think we also have to ask why there were two outbreaks of 'ME' in London, both reported by Ramsay - one at Gray's Inn Road and the other at some long gone hospital somewhere in Hampstead or Hendon - which may have been where some of the Gray's Inn Road staff lived but most of the patients did not have links to RFH. The threat of polio may have been particularly high on the agenda of both doctors and the general public in northwest London, which is where the Neasden Fever Hospital was and also the Central Public Health Laboratory at Colindale. My mother was a consultant there in the 1950s, working on typhoid, which was still around, and EBV later. School parents had been known to refer to her as 'a famous polio doctor'.

There are lots of things we will never know. The one thing we do now is that whatever went on has little or nothing to do with ME/CFS now.

 

I read through the accounts transcribed by McE and B and I didn't see any cases that looked like established upper motor neurone lesions as in stroke. Ramsay noted that signs moved around. Central nervous system signs do not do that over a period of hours or days.

 

I may have missed that.

 

In their second article in the BMJ (1970(1):11-15) - on the Middlesex cases, McE&B thought that there was altered medical perception of the community - they were expecting to find polio and so wrongly clustered together a group of people with differing illnesses. I haven't re-read it recently but when I read this particular view for the first time I thought that explanation plausible.

Just had a quick search - what I was thinking of is in the first McE&B paper (BMJ 1970(1):7-11), p3, under "Special Investigations and Histopathology".

 

I'm wondering if this could be similar to an episode I had early on in my illness. 'Hysterical' is inaccurate framing, uncontrollable would be more accurate.

Some of my early problems were a sudden loss of consciousness while watching television at home, I stopped breathing, and it lead to months of terrible lightheadedness and being constantly on the verge of losing consciousness again, very unsteady on my feet. A few weeks after that loss of consciousness, I went to the hospital because it had happened again, during the day.

Later on at the hospital, I was trembling a lot, very intensely, then I had a sudden episode of tachycardia and started hyperventilating. It was odd because I otherwise felt mostly normal, calm, as if nothing was happening. It settled and a bit after that I had a weird episode of intense weeping. It was completely uncontrollable, like someone pressed on a switch. And it was intense, like a newborn type of crying. It subsided after an hour and after that I had a few hours of the opposite: I was oddly giddy, laughed a lot. But it was more low-key, no uncontrollable laughter.

I have no idea what happened. All that was checked was cardiac, but there was nothing there. I had a brain CT scan months later (that's how long it took to get a hold of my GP) but it either showed nothing or I wasn't told if it did (which thinking back, is probably common for minor findings). My thinking is probably some minor stroke or something like that. It never happened again.

I notified someone at the ER when it happened but they just walked by and after that I was too disoriented to say more. I guess this is normal to them, and I never checked but I'm pretty sure that from their perspective, 'hysterical crying' made perfect sense and something like that was in the record. When you know nothing of what goes on inside a system, and you simply judge by its external behavior using biased heuristics, anything can make sense if you want to. And as long as you don't bother checking the assumptions that 'support' it.

Also I don't think we should make too much of the initial description of something by one person. Someone's opinion, even if expert and informed on accurate facts, almost never is the whole answer. This isn't a political ideology or religion, where the word of this or that person is the scripture. Even Einstein needed a lot of help finishing the math of relativity. Science is a process, not a damn religion.

 

And probably says a lot that in one of his early writings dismissing ME, Wessely explicitly named schizophrenia as something that is not a real disease, saying that if ME is a real disease, then so should schizophrenia. Which of course it is, they are both. The man, like the whole school of thought, really has an impressive talent for being wrong, serves as a perfect reverse seer.

 

That's pretty much the whole problem in a nutshell right there. Just as absurd as thinking that they are explaining the unexplained. The real problem is they see nothing wrong with going downstairs and ending up on the roof. Like it's all perfectly normal and expected.

And it has been 'solved' by the usual: "nuh uh, it is you who is irrational", since it can't be them, they reject the premise. Ain't it grand when you can simply use a schoolyard taunt as a professional, and actually get away with it? Well, except for literally everyone it affects, obviously.

 

My bolding

I didn't realise that the term "functional" in medicine had been used as early as 1957. The first time I heard "functional" in the medical sense was in the 1990s.

 

"Functional", in the sense of non-organic, has a much deeper history; I have seen it used in texts from the early 1800s. (Examples? Here's one from 1829 and another one from 1864).

 

Wow, that really surprises me. And your links are very interesting, thank you.