When Illness Is Real, but Symptoms Are Unseen

[Guest guest]

Jane Brody, Kolata and Fumento keep rehashing the same old

theories and writing the same story over and over - despite the research,

despite the tests - they have their minds made up. Personally, I think the

NYT should be ashamed of itself for printing such mealy-mouth psychobabble

nonsense. Who do they think they are fooling?

http://search.nytimes.com/search/daily/bin/fastweb?getdoc+site+site+23465+1+

wAAA+chronic%7Efatigue

When Illness Is Real, but Symptoms Are Unseen

By JANE E. BRODY

ore than a century ago, physicians encountered a syndrome they called

neurasthenia, characterized by a wide variety of symptoms that variously

included fatigue, weakness, muscle and joint pain, headache, memory and

concentration difficulties, runny nose, disturbed sleep and palpitations.

Researchers expected that a cause would soon be identified -- a virus,

bacterium or toxic agent -- that would account for these complaints. It

never happened.

Instead, through subsequent decades, a host of disorders with similar sets

of symptoms were identified. They included so-called " effort syndrome " that

afflicted veterans of the Civil War and World War I, chronic brucellosis,

hypoglycemia, myalgic encephalomyelitis, chronic candidiasis and chronic

mononucleosis.

Now the prevailing ailments go by the names of chronic fatigue syndrome,

fibromyalgia, multiple chemical sensitivities, sick building syndrome,

silicone-associated rheumatic disease (from breast implants) and gulf war

syndrome.

People afflicted with one or another of these syndromes are often extremely

debilitated and alarmed by the limitations the ailments place on their

lives. Making matters worse is a widespread but erroneous view that they are

not really sick but are fakers or hypochondriacs whose symptoms are self

induced to gain attention, sympathy or relief from their usual duties.

But the professional debate is not over whether the symptoms are real --

those affected are definitely sick, experts say -- but rather whether there

is any point in continuing a thus far fruitless search for specific causes.

A more productive approach, they say, would be to treat these syndromes as

one and the same and provide effective treatment regardless of the cause.

In a recent issue of the journal Epidemiologic Reviews, Capt. C.

Hyams, who heads the epidemiology division of the Naval Medical Research

Center in Bethesda, Md., noted the remarkable similarities in the symptom

complexes that are the hallmarks of these diagnoses. All are characterized

by fatigue, headache, difficulty concentrating, muscle or joint pain,

impaired memory and often depression and/or anxiety, with some individual

variations.

The unifying fact of all these disorders is that they are defined only by

their subjective symptoms. No objective criteria or consistent organic

explanation can be found for any of them and, therefore, they are a

challenge to study, diagnose and treat. For example, Dr. Hyams explained

that some patients might be found to have an immunological deficit, but many

others with the very same deficit were not sick.

For others, the illness may have been preceded by a cold or flu, but there

is no evidence that the infectious virus still lingers in any form.

A more probable explanation, Dr. Hyams and others suggest, is that a

reaction to some physical or emotional stress triggers the symptoms that

characterize these syndromes.

Faced with a lack of objective diagnostic criteria, the particular diagnosis

a patient receives typically depends upon the patient's most disturbing

symptom, the history of exposures the patient reports and the type of health

professional seen -- allergist, gastroenterologist, rheumatologist,

neurologist or psychiatrist.

As Dr. Simon Wessely, professor of psychological medicine and director of

the Chronic Fatigue Syndrome unit at Kings College in London, pointed out in

an interview, " Each specialty goes its own way in arriving at a diagnosis. "

In other words, patients who see a neurologist may get a diagnosis of nerve

damage whereas those who see a rheumatologist may get a diagnosis involving

joint or muscle pain.

He added: " Doctors have been searching for the Holy Grail to explain these

syndromes for the last 150 years without success. Neither single organic

causes -- viruses, immune defects, toxic agents -- nor single psychological

causes -- childhood sexual abuse, depression or anxiety -- can account for

them. "

Dr. Wessely said that trying to categorize these ailments as either organic

or psychiatric was a disservice to patients. " If a patient is told the

problem is due to a permanent deficit in the immune system or a persistent

virus or chronic disability of the nerves or brain, this just generates

helplessness and the patient becomes a victim, " he said. " And if you say the

problem is psychological, this generates anger on the part of patients who

don't regard psychological ills as legitimate. "

Rather, Dr. Wessely insisted: " Looking for any single cause misses the

point. Regardless of how or why they may have started, these syndromes are

multifactorial, like heart disease. "

Dr. Hyams emphasized that the lack of objective diagnostic criteria " does

not mean that these people don't have problems. "

" They're ill, " he said. " There's no question. They are not malingerers. "

For example, Dr. Wessely said, " Going to the Persian Gulf definitely

affected the health of servicemen. We showed very considerable health

effects. But that doesn't mean the disease they contracted is unique to

science. They have legitimate health problems, but there is no single

illness or single cause. "

Viewing the problems holistically, Dr. Hyams said: " Even if these illnesses

were primarily psychiatric, psychiatric illnesses have an organic basis in

the mind. If a person is sick in any one place, it affects the whole body.

For example, a psychiatric illness can cause changes in life style that can

have profound physiological effects. "

Dr. Elaine Showalter, professor of humanities at Princeton University and

author of " Hystories: Hysterical Epidemics and Modern Media " (Columbia

University Press, 1998), said her analysis of the history of these disorders

demonstrated that they represented " a basic human phenomenon -- the way

people react to various stresses, with symptoms that are not organically

based. "

" The symptoms are genuinely experienced, debilitating and absolutely real,

but a lot of energy and money have been spent looking for organic

explanations and treatments for what is basically a psychological phenomenon

that is not caused by a virus, nerve gas, immune defect or any other tissue

change, " she said.

Dr. Hyams said, " You always find high rates of these kinds of symptoms in

any population reported to have been exposed to something. "

" People, " he added, " are sensitized by reported health threats if they think

they've been exposed. "

The most effective treatment to date for the syndromes, Dr. Wessely said, is

outlined in a report on chronic fatigue syndrome issued two years ago by the

Royal Colleges of Physicians, Psychiatrists and General Practitioners. It is

intended to deal with factors that perpetuate illness.

Dr. Wessely explains that the profound fatigue and muscle pain that typify

these syndromes are best treated by a graded series of exercises to increase

stamina. Also, patients are encouraged to shed their beliefs (for example,

that any activity will make matters worse) and to restructure their approach

to life through 12 weeks of behavioral therapy, intended to enhance

self-confidence and a belief in a patient's ability to control his illness.

If patients are suffering from serious depression or anxiety, temporary

treatment with psychoactive drugs may also be offered, but as a therapeutic

aid, not a cure.