cfshacker

They are in this case. I think it's probably helpful to distinguish between "old school" mental illness (hysteria, neurosis etc) and "modern" mental illness (e.g. how depression, bipolar etc are treated these days). Wessely has long talked about CFS/ME as neurosis, or suggested mass hysteria with a modern angle.

In Wessely's own words on a related illness "Sufferers from mysterious condition that lie outside conventional medical practice no longer consider themselves to be oppressed by spirits and demons but by mystery gases, toxins and viruses. This is particularly visible in the changing nature of mass hysteria." http://www.cfsinfo.be/Documentatie/AA%20%20Strijd%20classifi...

Thanks! Generally speaking, I think you have to understand the nature of "mental" illness that's being discussed. Depression, for example, is taken seriously as a "mental" illness but is quite comfortably discussed in medical terms (hence SSRI's, NDMA antagonists, etc); as well as Cognitive Behavior Therapy where it's been reasonably demonstrated that improving your thought patterns can improve your emotional wellbeing. I'd describe this as the modern form of "mental illness".

The kind of "mental illness" we're talking about here with CFS & the Wessely/UK psychiatry school of though though is old school _neurosis_. You're not sick, you're neurotic. You want to save face by coming up with symptoms. You need validation from a doctor. You remain sick because of the 'secondary gain' you receive in terms of attention. You need to avoid personal responsibility and blame, and so on.

It's horrible stuff. For quotes from the horse's mouth, see: http://www.cfsinfo.be/Documentatie/AA%20%20Strijd%20classifi... , and hopefully you can see why his views have been so controversial.

It's true that CFS is something of a catch-all for a variety of illnesses, from post-viral syndromes (see Dr Lerner), hypothyroid problems, diet and gut-related illnesses (undiagnosed coeliac patients, for example), neurological syndroms (some people are helped by neurofeedback, and Jay Goldstein wrote some fascinating books on the neuroscience of CFS/ME), hormone disorders (e.g. adrenal, but also others), possible retroviruses (XMRV looks 95% unlikely, but a handful of people did well on antiretrovirals), possible hit-and-run viral brain injury (as Australian research has indicated) and on and on. Hell, I recently came across a guy who recovered almost immediately and totally after 30 years of debilitating fatigue by taking a relatively recent IGE-binding drug (Xolair). Plus, there's the potential of an underlying viral or other cause that in turn causes a differing array of symptoms.

The problem is not just that we don't know what CFS/ME is (to the extent that it's a uniform thing), but we're pretty lousy at dealing with all the other surrounding illnesses as well. (Hypothyroid is a great case in point, IGE is relatively new, etc etc,.)

What's pretty clear, however, is the vast, vast majority of these patients, whether suffering CFS for known or unknown reasons, are not neurotic, and for The Economist, or anyone, to insist that "neurosis" should be taken seriously as a basis for medical diagnosis and treatment in 2011 is simply appalling.

edit: ugh, Wessely, not Wessley. my bad.

Well, you wouldn't say someone with AIDS had problems with "Stress, bad diet, lack of social interaction", for example. Yet Dr. Nancy Klimas got interested in CFS patients when she found they were sicker than her AIDS patients. (Of course, outcomes for AIDS patients are far worse!)

"I still think it's a mental illness."

Why? What does "mental illness" mean to you? You go on to say it's a diagnosis of exclusion, and you don't know for sure what you had/have -- isn't that the point?

I guess we need to be careful with our definitions of "mental" in "mental illness". For example, major depression responds rapidly to ketamine (http://www.newscientist.com/article/dn9696-ketamine-relieves...), and other NMDA antagonists may prove clinically useful in treating that "mental" illness.

However, there's also the "maladaptive beliefs" side of "mental illness" which may be applicable to depression -- change how you think, change how you feel emotionally -- but their application to CFS as anything other than a mild management technique is absurd and has been proven time and again to be a dead end. Nevertheless, the implication from the psycho-social CFS school is that if you change how you think about your illness, you can think yourself out of your condition. That's absurd. They talk in terms of validation, needing respect, and saving face by coming up with symptoms; i.e. that you, the patient, are neurotic. It's pernicious nonsense.

The focus on viral aspects is far from a dead-end - see the work of Dr Martin Lerner and his use of valacyclovir and valgancyclovir, for example.

There was also research done in Australia that CFS may be a "hit and run" brain injury cause by a virus or viruses -- is a physically damaged brain a case of mental illness or just plain illness? Either way, it's not something that changing "maladaptive beliefs" will solve.

Psychological theories for CFS have been around for decades and have yielded very little by way of testable hypotheses or treatment, despite millions of dollars spent on research.

Wessley's highly controversial views and work have been subject to much criticism -- absolutely none of which is reflected in this disappointing puff piece. There's plenty of more news-worthy stuff that's been happening in the CFS world (both good and bad) in recent times than years-old revelation that people don't much like Simon Wessley.

The core problem is simply that this conclusion isn't true: "But a psychiatric explanation would not delegitimise CFS. And it might improve treatment and help patients get better, at last." Wessley's theories have been studied. They offer very little to very sick people. They don't get better. It does delegitimise the extremely severe nature of the illness. If they did legitimise, and -- far more importantly -- cure sick patients, great! That would be wonderful. But they don't. We know they don't. Shame on the Economist for not saying so.

Psycho-social explanations of CFS seem to be nothing more than "hysteria" rebadged for more modern times. It's easier to say "Well, maybe it's your fault!" than to accept the hopelessness of not knowing what's going on.

Actually, that's not true, there has been (and is) plenty of work on the physical abnormalities. For those interested in current happenings in the CFS world, it's worth following: http://phoenixrising.me/ .

Rubbish. The reason CFS hasn't seen more mainstream research is a chicken-and-egg problem of having no specific angle to research, therefore research isn't done, therefore there's no specific angle to research. When the XMRV stuff broke the research community did swing into action. Scientists haven't decided not to study CFS because someone on the internet hurt their feelings. Medicine isn't omniscient. Blaming extremely sick people for the lack of research into their predicament is absurd.