Multiple Chemical Sensitivities (MCS): What It Is, What It Is Not, And How It Is Manifested

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www.california.com/~hawk/MCS-Ammunition.htm

SHEILA BASTIEN, Ph.D.

PSYCHOLOGICAL CORP.

2126 Los Angeles Avenue

Berkley, CA 94707-2618

(510) 526-7391

FAX 525-9601

The following talk was presented at the concurrent

session of the 1995 conference of the Association on

Higher Education and Disability. July 20. " Multiple

Chemical Sensitivities (MCS): What It Is, What It Is

Not, And How It Is Manifested – Sheila Bastien,

Ph.D. " :

Multiple Chemical Sensitivities (MCS): What It Is,

What It Is Not, And How It Is Manifested.

I am a neuropsychologist who has served on:

Advisory Panel on Environmental Illness/Multiple

Chemical Sensitivity, California Senate

Subcommittee/Taskforce on the Rights of the Disabled.

Senator Milton Marks. 1993-present.

On an invited panel of 14 experts for the State of

California Department of Public Health and the Agency

for Toxic Substances and Disease Registry (ATSDR) to

develop a research protocol for evaluating multiple

chemical sensitivity (MCS) patients, 1994.

We have reached the age of modern living through

chemistry or , as the TV ads said in the late 1940’s

and early 1950’s (with their lab coats and test

tubes), " Better living through Chemistry. " What has

happened in modern industrial society, however, is the

misuse, overuse, and inappropriate disposal of

chemicals. We now know that many of these chemicals

can be toxic. Some harmful exposures are from

ignorance, some from oversight, some from complacency,

and some are from criminal negligence. The result on

individuals, certain groups, (like the Gulf War

veterans), and entire communities is toxic injury.

Toxic exposure, whether acute or long-term, creates an

overload on the individual which can result in serious

health problems, including multiple chemical

sensitivity, other illness referable to many organ

systems, and in some cases, cancer. Insidious

breakdown in resistance mechanisms takes place;

individuals are often unaware of their developing

sensitivity.

What is multiple chemical sensitivity (MCS)?

Cullin, M.R. ed. (1987) " Workers with multiple

chemical sensitivities " Occupational Medicine; State

of the Art Reviews, defines multiple chemical

sensitivity (MCS) as an acquired disorder

characterized by recurrent symptoms referable to

multiple organ systems, occurring in response to

demonstrable exposure to many chemically unrelated

compounds at doses far below those established in the

general population to cause harmful effects. No single

widely accepted test of physiological function can be

shown to correlate with these symptoms. [Cullen, M.R.

(1987). The Worker with multiple chemical

sensitivities: an overview. In Cullen, M.R. (ed).

Occupational Medicine: State of the Art Reviews.

Hanley and Belfus, Philadelphia. 655-662]

The National Research Council, 1992 workshop on

Multiple Chemical Sensitivities (a group working on

research protocols for clinical evaluation) reported

in Toxicology and Industrial Health [Vol. 10 number

4/5 July - October, 1994 Pg. 259 in ’s

article] the definition of MCS by the National

Research Counsel, 1992: Sensitivity to chemicals. By

sensitivity we mean symptoms or signs as related to

chemical exposures at levels tolerated by the

population at large, that is distinct from such well

recognized hypersensitivity phenomenon as IgG-mediated

immediate hypersensitivity reactions, contact

dermatitis, and hypersensitivity pneumonitis.

Sensitivity may be expressed as symptoms and signs in

one or more organ systems.

Symptoms and signs wax and wane with exposure. It is

not necessary to identify a chemical exposure

associated with the onset of the condition.

Preexisting or concurrent conditions, e.g. asthma,

arthritis, somatization disorder, or depression,

should not exclude patients from consideration.

Ashford N.A. and , C.S. [1991. Chemical

Exposures; Low-Level and High Stakes: (Van Nostrum

Reinhold, New York)]. Their definition is: " The

patient with multiple chemical sensitivities can be

discovered by removal from the suspected offending

agent and by rechallenge, after an appropriate

interval, under strictly controlled environmental

conditions. Causality is inferred by the clearing of

symptoms with removal from the offending environment

and recurrence of symptoms with specific challenge. "

We have come a long way with modern chemistry. Our

wood floors are being replaced, most often with

carpets; old solid wood furniture is replaced with

modern laminates, usually thin wood veneer, laminated

over pressed wood. Among other things, this furniture

exudes formaldehyde. Plain fir or pine boards for

building (sheathing) were replaced with laminated

plywood containing, at the very least, high levels of

formaldehyde and often toxic wood preservatives.

Plaster walls were replaced with drywall, which has

its own contaminants -- and as dry wall mud became

better, they added more chemicals. Wood shingles were

replaced with tar and gravel. Clothing was no longer

simply cotton, wool, nylon or rayon, as new chemistry

brought forth polyesters, non-wrinkle fabrics; and

mattresses and drapes that were treated with fire

retardents, introducing even more chemicals. These new

fabrics are loaded with chemicals, including

formaldehyde. Formaldehyde is a known sensitizer [Carl

Zenz, M.D. S.C.D. ed. Developments in Occupational

Medicine, (1980), Year Book Medical Publishers,

Chicago.], and this adds to the total individual toxic

load.

At the same time, modern buildings were using large

expanses of glass and closed air systems. The oil

embargo/energy crunch in the 70’s brought about more

efficiently sealed buildings; windows which would not

open or were secured shut. Outside fresh air was

cut-off or reduced in the fresh air intakes to save

energy; air was recirculated with all its contents and

contaminates. The systems would often be shut off at

5:00 and workers remaining in the building would be

subjected to inhaling stale air. New carpeting, and

laminated furniture was everywhere in these closed

environments.

Foods and water contain more chemicals than in the

past, including pesticides; multiple toxins are

leaching into our water supply. Even products such as

toothpaste contain more chemicals each year.

Agricultural soils are being depleted of their

nutrients and replaced with chemical fertilizers,

herbicides and pesticides (nutrient depletion is one

of the things that put people at risk for MCS). There

are approximately 2,000 new chemicals introduced each

year which are unregulated; their long term side

effects are unknown. One such chemical brought forth

in 1941 has only now, in the 1990’s, been given health

and safety guidelines. Lag time is enormous.

In the name of progress we saw the growth of

herbicides, pesticides and termiticides. You no longer

had to put up with bugs in your yard, spiders in the

attic, ants in your pantries or termites and beetles

in your house, or even grasshoppers in your crops.

Unfortunately, we overdid it. We finally discovered

that the organochlorines, such as DDT and Chlordane,

were dangerous, cancerous and deadly, so along came

the organophosphates. We are now using these products

to spray for most anything from fleas to ants to

termites. The so-called safe alternative has now been

documented to cause a multitude of problems including

very serious central nervous system problems. [see

Ecobichon, J., and Joy, N. " Pesticides

and Neurological Disease, Second Edition 1994; CRC

Press, Boca Raton, FL.] The long-term effects from

these organophosphates, in the cognitive realm include

impaired vigilance and reduced concentration, reduced

information processing, and psychomotor speed, memory

deficits, visual memory problems, speech problems,

sequencing problems and problem solving difficulties

are also seen. Problems with motor steadiness,

reaction time and dexterity have also been documented.

(Ecobichon, Pg. 227.)

After organophosphate exposure, electrocephalograms

(EEG) are found to be abnormal and have persisted for

one year in studies of primates, (p. 231).

Psychological symptoms such as anxiety, psychomotor

depression, intellectual impairment, and unusual

dreams, were observed in human exposure. The

organophosphate class, which is the most commonly used

pesticide and termiticide, can induce slow onset

(pesticide induced) neuropathies, including

Guillian-Barre syndrome, so this is no small matter. A

high proportion of these patients exposed to these

chemicals develop multiple chemical sensitivity. I

have had occasion to evaluate many such patients,

including one with pesticide-induced polyneuropathy,

and found that those I evaluated had developed

multiple chemical sensitivity secondary to exposure.

Their EEG’s have been abnormal, and when challenged

with a substance to which they were particularly

sensitive, such as perfume, the EEG became more

abnormal (Isaac Silberman, M.D., Neurologist, San

Francisco).

So what are we talking about? We are talking about the

process of environmentally triggered disease. Dr.

Rea, in his first volume on chemical

sensitivity [ J. Rea, M.D., Chemical

Sensitivities, Vol. I, (1992), CRC Press Inc. 2000

Corporate Blvd., NW., Boca Raton, FL, 33431.], wrote

that " rapidly accelerated rate of growth of modern

technology has been accompanied by a proliferation of

a wide variety of new chemicals… 50% of global

pollutants which enter the atmosphere (isolated from

natural products or synthesized) are generated by

man " . He pointed out that in 1987 the American

industry poured 22 billion pounds of toxic chemicals

into the air, food and water.

In 1988 Dr. Rea was named the first professional

Chairman of Environmental Medicine at the Robens

Institute of Industrial Environmental Health and

Safety at the University of Surrey in Guilford,

England. In the introduction to his first volume on

chemical sensitivity, he wrote " modern technology has

given many conveniences and ability to explore the

outer limits of knowledge…allowed us to travel to the

moon,… this technology has led us to uncover secrets

of the Universe and has brought into focus the

severity of environmental pollution on earth; the

Apollo astronauts emphasized the extent of this

pollution when viewing the earth from space, although

they initially called it the " blue planet " , these

astronauts saw at closer range pollution on all areas

of the earth, which led them to state that " man has

fouled his nest and this must be corrected. "

The point, according to Dr. Rea, is that man’s

well-being is a function of his environment; living in

polluted surroundings adversely affects health. He

also pointed out that as the number of dangerous

environmental pollutants continues to multiply so do

reports of numbers of people sensitive to these

contaminants.

Duehring [in Environmental Access Research

Network in an article called " Screening for Nervous

System Damage From Chemical Exposure " ] wrote that it

was a most dangerous illusion that our society has

brought forth, in the false belief, that the chemical

ingredients in our everyday home and office consumer

products, from cosmetics and perfumes to cleaners and

carpets, have been tested for health effects to

protect the public. Most of the chemicals have never

tested and are not under any regulation. There are

three new chemical compounds introduced in the United

States every day. Pre-marketing testing of compounds

as potential neurotoxicants have serious deficiencies.

Many of these neurotoxic compounds came into use

before the passage of the Toxic Substance Control Act

in 1976 and remain untested and are still not required

to be tested (Duehring). The problem is compounded by

disposal of chemicals. Everyday, several millions of

gallons of chemicals are introduced into Lake Erie

which is the source of drinking and bathing water for

most cities from Cleveland, Ohio to Buffalo, NY (Rea).

Our own San Francisco bay is polluted. Two towns near

the Carquinez bridge just 20 minutes from where I

live, have been gassed.

Both organic and inorganic pollutants are a problem.

Dr. Rea adds that " inorganic pollutants include ozone,

carbon monoxide, nitrous oxide, sulfur dioxides, heavy

metals and other metals. Organic pollutants include

pesticides, formaldehydes, solvents such as toluene

and xylene, drugs, terpenes, cleaning chemicals,

cigarette smoke, combustible products, consumer

products (e.g. clothing, building materials, hygiene

products, etcetera) and biological compounds (mold

toxins). The most toxic organic pollutants are those

classified as halogenated aromatic and aliphatic

hydrocarbons " . He also adds that according to the EPA

more than 4 million chemical compounds are currently

recognized.

So what causes chemical sensitivity? According to Dr.

Rea, it can arise in several ways. Individuals

who survive exposures may have lowered resistance to

disease as a result of the condition of their nutrient

pool brought on by exposure, and this can develop into

symptoms of ill health. Upon later exposure, they may

experience enhanced symptoms. Spreading can occur,

which means that they either react to more chemicals

or more organ systems are involved.

He discusses three major instances that have occurred

in the 20th century, that have graphically illustrated

that chemical sensitivity may be caused by a

significant, acute exposure to toxic substances: in

World War I when the troops were exposed to Mustard

Gas with an aftermath and development of chemical

sensitivity; Agent Orange syndrome where veterans had

problems which persisted for years after their initial

contact; and the incident of cyanate in Bhopal, India,

which left an estimated 86,000 people injured, and

" Several months later, many remained afflicted with

recurrent symptoms that are today believed to be

manifestations of chemical sensitivity. " He also added

that chemical sensitivity can occur subsequent to

bacterial, viral or parasitic infection; however, he

said that only 1% of his Dallas patient population

have traced the origin of their illnesses to such an

event. He has evaluated 20,000 people through the

Environment Health Center in Dallas which he founded.

The manifestations of chemical sensitivity are

multiple in nature. They can effect many organ

systems, and which systems are affected most may well

depend on the biological weakness of a particular

system, or previous trauma. Enzyme pathways are

affected. Liver detoxification pathways become

overloaded. Mucosa of the body change. Blood brain

barriers are affected (Rea)

Dr. Rea wrote that " at their onset, symptoms of

chemical sensitivity are almost always reversible. "

This is a very positive statement; however, he added

that when organ involvement increases, responses are

more difficult to decipher and reverse. He adds that

although these various illnesses involve multiple

systems and organs, only one end-organ may ultimately

be damaged as a result of repeated insults, and this

can result in end-organ failure and extreme fixed

named illnesses. He cites the example of a mechanic

constantly exposed to car exhaust who could develop

general symptoms such as aches and pains, malaise,

headaches and fatigue. These symptoms might then

continue for several months until finally renal

failure or some other specific end-organ disease

develops. He wrote that the factors that are

influencing the onset of chemical sensitivity are

total body load, the nutritional state, and

bioaccumulation of toxic substances, as well as other

factors.

As a neuropsychologist, I have tested over 1,000

patients who have been exposed to a variety of toxins

including solvents, formaldehyde, organophosphates,

etcetera; many of these patients have MCS. I began

testing these patients in 1980. Since then, there has

been a lot of interest in Multiple Chemical

Sensitivity, especially in the last few years. A

recent conference in April 1994 in Baltimore land

was sponsored by the U.S. Department of Health and

Human Services, Agency for Toxic Substance and Disease

Registry. The proceedings have been published in

Volume 10, #4-5, July-October 1994. The Agency for

Toxic Substance and Diseases Registry has provided

support for two major national conferences on the

subject of MCS. The first was held at the National

Academy of Science Meeting in 1991. The second was

sponsored by the Association of Occupational and

Environmental Clinics in September of 1991. In the

fiscal year 1993, this agency received a Congressional

mandate which provided funding for chemical

sensitivity/low-level chemical and environmental

exposure workshops. To address the mandate, a panel of

experts was convened. They explored the issues related

to the neurobiological effects of chemical exposure

and particularly the role of the nervous system in

MCS. , M.D., University of Texas Health

Science Center, discusses the historical overview. It

has also been discussed in Multiple Chemical

Sensitivities At Work, a training manual for working

people produced by the Labor Institute in New York

City. (This history is taken from both of these

references.) Theron Randolph, M.D., who practiced in

Chicago, noted the chemical susceptibility problem in

1951. In 1975 the environmental control units were

operated by Randolph and W. J. Rea, a member of the

Science Advisory Board at the Environmental Protection

Agency, at that time, to help identify chemicals and

foods that provoke symptoms in MCS patients. In 1979 a

U.S. District Court in Hawaii ruled MCS disabling, and

ordered the Department of Health, Education, and

Welfare Division to provide Social Security benefits

to an MCS patient. In 1984 a California bill to

require research on MCS was passed in both houses of

state legislature, but is opposed by the California

Medical Association. In 1986 the Oregon Court of

Appeals ordered Worker’s Compensation Benefits for a

furniture store worker on the basis of MCS.

The California Medical Association 1986, the American

College of Physicians 1989 and the American Academy of

Allergy and Immunology in 1986 criticized the clinical

ecologists who were identifying and treating MCS as

" lacking critical thinking and the use of proven

techniques. " An acrimonious debate ensued.

In 1987 the National Academy of Sciences workshop was

held. In 1987 " Workers With Chemical Sensitivities " in

Occupational Medicine: State of the Art Review, was

published. Mark Cullen, editor, was professor of

medicine and epidemiology at Yale University. It was

the first comprehensive collection of articles on MCS.

In 1987 the California Court awarded Worker’s

Compensation Benefits to an employee who was found to

have developed MCS from long-term exposure to

polychlorinated biphenyls. In 1988 workers of the EPA

headquarters became ill when new carpets were

installed and other remodeling took place. Some of the

employees developed MCS. Some of these employees are

still working at home, and many of them still have MCS

or continuing illness. Some have not been able to go

back to work. In 1988 the Social Security

Administration adds a section on MCS to the agency’s

program operations manual for disability

determinations. In 1989 the Indoor Air Quality Act was

amended to address MCS following the National Center

for Environmental Health Strategies testimony before a

Senate subcommittee. In 1989 Doctors Ashford

and prepare a report on MCS entitled

" Chemical Sensitivity, " for the New Jersey State

Department of Health. In 1989 the Ohio Court of

Appeals reinstates an order of the Ohio Civil rights

Commission finding unlawful employment discrimination

for dismissal of a worker with MCS. In 1990 a task

force of the American Public Health Association states

that the government agencies should provide funding

for MCS research and that MCS should not be labeled

psychogenic unless environmental causes have been

ruled out. In 1990 the Indoor Air Quality Bill is

passed by the US Senate, but the house bill never

reaches the floor for a vote. In 1990 the Department

of Housing and Development (HUD) recognizes MCS as a

disability requiring reasonable accommodations under

the fair housing and rehabilitation act of 1973. The

policy was followed by a legal opinion issued by HUD

in April 1992, recognizing MCS as a physical

disability. MCS patients disrupt the San Francisco

meeting of the American College of Allergy and

Immunology, where MCS patients are characterized as

mentally ill. In 1990 the Americans with Disabilities

Act of 1990 recognized individuals with MCS as

disabled. In 1991, at the request of the EPA Division

of Indoor Air, the National Academy of Sciences

organizes a workshop on MCS. They agree on outlines

for research protocol. In 1991 a comprehensive review

of MCS literature entitled Chemical Exposures; Low

level and High Stakes, by N. Ashford and C. is

published. In 1991 environmental health activists

picket the New York city meeting of American College

of Allergy and Immunology. In 1992, US Congress

appropriates $250,000 for MCS research to be

coordinated with the National Center for Environmental

Health Strategies. In 1993 Mt. Sinai Occupational

Health Clinic was awarded $100,000 to conduct an MCS

study. And the seminal meeting (sponsored by the U.S.

Department of Health and Human Services, Agency for

Toxic Substance and Disease Registry) held in April

1994, proceedings which are published in Toxicology

and Industrial Health, Vol. 10.

Many more things have taken place since then, one of

which locally is that many public meetings are no

longer allowing people wearing perfumes to attend. The

Oakland City Council and the Bay Area Rapid Transit

(BART) administration both have recently made this

mandate as a condition to meeting attendance.

Magazines with perfume inserts can be fined up to $100

if they do not remove them before mailing to

California, and so forth. There are so many things

happening that it is difficult to keep up to date with

the current advances. A 1993 Senate committee task

force has been formed in San Francisco and still is

working on access for the rights of the disabled in

terms of MCS. MCS patients are becoming more

organized, more vocal, and increasingly validated by

recent conferences.

points out that many of the patients

often attribute the onset of their illness to specific

exposures (Vol. 10) such as repeated exposures to

solvents, chemical, pesticides in sick buildings, or

combustion products. Patients report more problems and

greater difficulties indoors where air fresheners,

perfumes, and cleaners are used and where there are

such things as particle board and carpets which

outgas. The outgassing releases VOC compounds

(Toxicology and Industrial Health, page 257). These

patients are often funneled off to psychiatrists and

psychologists by physicians who are not familiar with

MCS. " From the patient’s perspective, they have lost

their health, their livelihood, their friends and

sometimes even family. Individuals with professional

careers are likely to view their cognitive

difficulties as most disabling, " Dr. added.

They are often mislabeled as malingerers or given a

psychiatric diagnosis.

Dr. notes that chemical sensitivity has been

reported among distinct demographic groups (page 261):

industrial workers, sick building occupants,

contaminated communities and individuals. A fifth

group, Persian Gulf War veterans, is also mentioned.

She says. " It is especially easy to overlook

environmental causes if complaints are subjective and

nonspecific, such as headache, fatigue, depression or

difficulty concentrating. But the temporal

cohesiveness occurring in a group of individuals

sharing a recognizable exposure, for example several

family members, co-workers, community members or Gulf

War veterans, help physicians recognize the

possibility of environmentally caused illness. The

outbreak of MCS among the technical staff of the EPA

headquarters is an example. "

Recently, I have been working as part of a team of

experts evaluating patients injured from a refinery

release in the town of Crockett (investigating the

results of the Catacarb spill of August-September

1994) adjacent to the Carquinez Bridge in northern

California. UNOCAL had a leak in their tank which grew

and released Catacarb and other toxic pollutants which

drifted onto two entire towns. Over 700 patients have

come into the Good Neighbor Clinic in Crockett (paid

for but not run by UNOCAL) because of symptoms; more

are on the waiting list. Patients in general have

eye-damage; breathing problems; immune abnormalities;

rashes; increased mole size; skin tags; possible

neuroendocrine disorders (abnormal menstrual periods);

neurological abnormalities that include memory,

concentration, decreases verbal fluency, and motor

problems; and one has a serious movement disorder.

Many, but not all, have developed MCS.

About 25 of these patients have been evaluated by me

at this time. Neuropsychological testing shows

problems in cognitive flexibility; calculation;

visual-motor ability; verbal fluency; memory;

attention and concentration; and often lateralized

motor and tactual sensory abnormalities. These motor

abnormalities could not be accounted for by anxiety or

depression alone. Many of these patients have a

post-traumatic stress disorder. Children are having

problems in school; their grades are dropping, and

they have abnormalities on neurocognitive tests. Many

of the patients would meet the criteria for dementia,

secondary to a medical condition; probably toxic

encephalopathy. Many people are moving out of town.

Real estate values have plummeted.

Iris Bell has discussed MCS in her article

[ " Neuropsychiatric Aspects of Sensitivity To Low-Level

Chemicals: A Neural Sensitization Model, " prepared for

the conference on Low-Level Chemical Exposure and

Neurobiologic Sensitivity; sponsored by the Agency for

Toxic Substances And Disease Registry in Baltimore

land, April 6 & 7, 1994.] She has reviewed the

literature on MCS as a psychiatric disorder and found

serious flaws with the sample size and methodology In

these studies. She has also completed six surveys of

over 2,000 individuals (in a population of half young

adults and half active retired older adults in

southern Arizona) who report at least one chemical

odor that makes them ill. Roughly 15 percent have

identified at least three out of five chemicals

(pesticide, perfume, car exhaust, paint and carpet)

causing frequent illnesses. In addition 30 percent of

the samples endorsed as true a single question " Do you

consider yourself to be especially sensitive to

certain chemicals? " Therefore, there is a significant

proportion of the normal population that is sensitive

to chemicals, or considers themselves sensitive to

chemicals. In discussing the classic psychiatric

disorders, Dr. Bell reported that MCS patients state

that they become irritable, depressed or confused for

a few minutes or hours only during days involving

chemical exposures. They usually return to normal

cognition thereafter. They express interest in their

usual activities, except when reacting to chemicals.

This is different from depressed patients who report

depressed moods most of the days and nearly everyday

report a generalized loss of interest. MCS patients

have poor balance and/or clumsiness, a rare presenting

complaint of depression. She states that all of the

studies of MCS patients point to the central nervous

system as a major site of involvement. She also cites

neuroimaging studies, single photon emission

photography, and brain (SPECT) scan studies of MCS

patients [Heuser et al. 1993; Simon et al. 1992;]. Dr.

Bell reported that they found diffuse cortical

deficits, especially in frontal, temporal and parietal

regions. The abnormalities appear bilaterally but more

in the right hemisphere. Heuser concluded that the

pattern resembled vasculitis. Simon noted (Dr. Bell)

it looked like abuses of stimulants and solvents with

possible small infractions (This study has now been

published by Heuser and Mena and differs for age

groups.).

What have I found? I have found that patients, for the

most part, are not malingerers (over 1000 patients). I

have had one or two patients who have exaggerated

their symptoms, and one that may have been a

malingerer. However, in general these are patients who

suffer from a variety of problems that include

concentration and memory problems, irritability,

anxiety and depression, spatial confusion, insomnia,

headaches, nausea, palpitations, chest pain, muscle

spasms and aches, joint aches, difficulty calculating,

fatigue, and confusion. Many have breathing problems,

asthma, and carry inhalers or oxygen.

These Patients often have either had a previous

history or concurrent history of hypothyroidism or

thyroiditis, in my clinical observation. In my

population and in the research literature, there is a

spreading phenomena. They seem to get worse later on;

the sensitivity generates from things that can vary

from an original acute/chronic agent(s) to

low-level/multiple-chemically unrelated substances,

(Bell, Rea) such as perfume, car exhaust, carpets,

newsprint, tobacco and car exhaust. Patients report

new sensitivities to perfumes, everyday cleaning

products, alcohol, foods and medications. There is a

cross-sensitization. Once initiated, heightened

susceptibility to chemicals and foods, which are

mixtures of inorganic chemicals, persist indefinitely

(Bell). Problems spread to more organ systems. Gradual

symptomatic improvement follows long-term avoidance of

triggering of substances. Dr. Bell notes that

resumption of frequent intermittent exposures can

reactivate symptoms at any time as in kindling and

sensitization. This is fairly complex; kindling has to

do with the stimulation of the limbic system, which

creates an electrical response, which increases

cortical irritation over time, and can lead to

seizure. Some of the patients do have seizures,

especially on exposure. In fact I have seen several in

my office.

What have we found on formal neurocognitive testing?

We often find concentration problems, with Digit Span

being lower on the Wechsler Adult Intelligence

Scale-Revised. Typically Arithmetic is one of the

lower scores, with evidence of dyscalculia. It often

depends on the kind of chemical exposure as to whether

abstract reasoning is impaired; it is more likely to

be non-verbal abstract reasoning that is impaired.

Visual discrimination (Picture Completion) often shows

scatter, indicating higher premorbid function, and is

one of the lower scores. Perceptual tasks are often

impacted such as Block Design, as is eye – hand

coordination and visual motor speed (Digit Symbol). On

the Halstead-Reitan Neuropsychological Battery, the

impairment index is often in the mild or borderline

range of impairment. These patients often have trouble

shifting sets (Trailsmaking and the Category Test).

Visual scanning is often impaired. The most curious

finding is on the Tactual Performance Test (a test of

sensory-tactual abilities) where the left, nondominant

hand (99 percent of my patients are right-handed) is

usually impaired or more impaired; this is consistent

with the more right parietal hemisphere findings in

toxic injury that have been reported in the

literature.

There are often lateralized and localized motor

abnormalities. There are memory impairments both

verbal and visual. There is often serious visual

memory impairment. Knox Cubes, a test of visual

sequencing and memory, is almost always impaired in

this population. And finally the MMPI-2 usually shows

significant elevation on several of the clinical

scales. This has been reported in the research by

Rosemarie Bowler, Ph.D., on toxic injury patient

profile and separately by King, M.D., on the MCS

profile on the MMPI.

The MMPI-2 is consistent with a large subgroup of

CFIDS patients. The MMPI-2 cannot be interpreted in a

normal way with sick patients. See research from

Hopkins

Commonly, investigators of psychiatric traits or

psychiatric disorders in medical illness use a flawed

strategy… That is, psychological tests are

administered or psychiatric interviews are conducted

and the resulting profiles are interpreted solely in

terms of psychopathology. In some cases, those medical

symptoms that are most central to the condition are

subtracted from the analysis. However, the

non-specific medical symptoms associated with a

chronic illness or its treatment and the psychosocial

consequences of chronic illness are often not

acknowledged or taken into consideration. Although

patients with medical illnesses of known

pathophysiology are sometimes spared the psychogenic

explanation for their condition, they are often

burdened with secondary psychiatric diagnoses.

Moreover, such constructs as " cancer personality, "

although out of favor at present, suggest that

patients with medical illnesses are sometimes

stigmatized with psychogenic explanations and burdened

with responsibility for their illness…

In our judgement, the mental health of chronically

sick people should

not be judged by the same norms that are used to

evaluate the mental

health of healthy people (21-22).

( " Inferences From Psychometric Data About Psychiatric

Traits and Psychogenic Origins in Conditions of

Unknown Etiology, Focusing on Multiple Chemical

Sensitivities Syndrome, " Ann L. off, Ph.D.,

Fogarty, MA, Division of Occupational Health,

Department of Environmental Health Sciences, School of

Hygiene and Public Health, 1995).

So what is multiple chemical sensitivity? It is a

multi-system disorder usually brought on by toxic

exposures which are acute, or low-level long-term

exposure such as in sick building, which increases a

person’s total toxic load, depletes nutrient stores,

and causes problems in many systems and organs in the

body. Upon re-exposure, the individual becomes

increasingly sensitized, and often there is a

spreading effect where they are bothered by many more

chemicals (It often spread to food, medications, and

molds), and many more systems in the body are

involved. It almost always seems to affect the central

nervous system, and the results that I am primarily

interested in are the effects that it has on memory,

concentration and learning. These are all dramatically

impaired when a person is exposed. This is very

important in terms of accommodation in a classroom or

work situation. If exposed, a person may not be able

to process what is said, or store the information

processed in a lecture, for example. A child may not

be able to learn.

It may be possible for them to sit in the corner of a

classroom, wearing a charcoal filter mask, near an

open door. It may be useful to have whole room

filters. It may be possible to move the class. Certain

classes are very difficult, such as chemistry classes,

because a charcoal filter cannot get rid of all the

chemicals. These persons/patients seem to take more

time to do things than other people do; and giving

them more time on examinations would be one kind of

accommodation. Letting them sit as far away from other

people as possible, near open windows, is also

helpful. Videotaping a class may be an option.

Two young men (twins), now residing in Arizona, were

having problems in high school, were very chemically

sensitive, and were having trouble in their high

school classes and could not pass. They were allowed

to take the GED examination outdoors and were in the

99th percentile when tested in a clean environment.

We have done testing in our office, which is a

relatively clean environment, and then allowed the

patient to expose themselves to perfume or other

irritants, and we have watched the differences. We

have also done this blind on occasion and found

dramatic differences. As a follow-up, we have sent

these patients to Dr. Isaac Silberman, a neurologist

in San Francisco, who has done baseline EEGs, which

are usually abnormal on baseline. However on

challenge, with the same substance that we have used,

the EEGs become more abnormal. So that is what MCS is.

What it is not, is a psychiatric disorder, although a

chronic illness of any kind causes anxiety and

depression. Its manifestations are complex and

multiple. We are really talking about toxic injury;

MCS is just the tip of the iceberg.