Pres. of the IACFS/ME, has got to go as well, this is the second major
newspaper article where he jacks around with CBT, stress, and all of
that BS. This has no place coming from the President of the IACFS/ME.
From the article-
"Fred Friedberg, an American clinical psychologist and the president
of the International Association for Chronic Fatigue Syndrome. =93Yuppie
flu and other derogatory terms are stigmatising to patients,=94 he
insists. =93Also, the idea that it is psychosomatic implies that it is
all in the mind, rather than a real illness. This is not useful. CFS
probably has multiple causation, including genetic, immune and perhaps
viral factors, as well as an over-stressed lifestyle =96 both biomedical
and behavioural factors are involved.=94
=93People with CFS are over-worked and over-stressed,=94 says Friedberg.
=93They also take little time for themselves and do not value low-effort
leisure time. In other words, their lives are out of balance. So I
view stress as one factor in developing the illness; biomedical
factors are also involved.=94"
B-cell don't stand for B-havioral, Mr. Friedberg!
'Persistent debate'
Dan Roberts
Last Updated: November 15. 2009 4:01PM UAE / November 15. 2009 12:01PM GMT
http://www.thenational.ae/apps/pbcs.dll/article?AID=3D/20091116/LIFE/711159=
972/1196
New research suggests that most cases of chronic fatigue syndrome may
be linked to a virus known as XMRV. The study, by Dr Judy Mikovits and
her colleagues at the Whittemore Peterson Institute in Nevada, found
that XMRV was present in two-thirds of patients suffering from chronic
fatigue syndrome (also known as ME, or myalgic encephalomyelitis).
This news received a rapturous welcome from the millions of people
across the globe suffering from a syndrome that continues to provoke
fierce controversy among medical experts. Many refuse to acknowledge
it even exists, dismissing it and similar illnesses as =93yuppie flu=94.
Why the controversy? Because chronic fatigue syndrome, along with
closely related ailments such as fibromyalgia and irritable bowel
syndrome, is a multi-symptom illness with no obvious biological cause.
Unlike lung cancer, say, or coronary heart disease, physicians cannot
pinpoint a single causative factor, so many insist that the problems
are all in a patient=92s mind. For example, a recent article in the
British Journal of General Practitioners, speaking on behalf of the
nation=92s doctors, described CFS thus: =93The prevailing view in UK
primary care has been that somatisation of mental illness is the basic
problem.=94
In other words, chronic fatigue syndrome is a psychiatric disorder,
not a physical one, and any symptoms are purely psychosomatic. This
provokes a furious response in those whose daily lives are made a
misery by symptoms such as severe muscle pain, wildly fluctuating body
temperature, digestive problems, migraines, nausea and, of course,
severe fatigue. And this debate is far from new. In fact, in the 19th
century, Alfred Nobel, who discovered dynamite and founded the Nobel
prizes, complained: =93I am more seriously ill than my doctors think.=94
Nobel is now thought to have suffered from fibromyalgia. Like chronic
fatigue syndrome, this condition is associated with fatigue and
non-restorative sleep, but also tenderness at 11 or more of 18
designated trigger points, where ligaments, tendons and muscles attach
to the bone. There is no known biological cause, although fibromyalgia
may occur after viral infections, exposure to toxins or emotional or
physical trauma (whiplash suffered in a car accident is thought to be
a common trigger).
But if Nobel had sought treatment for his symptoms at the time,
Sigmund Freud would have diagnosed neurasthenia and treated him with
psychoanalysis, while the world-famous hypnotist Jean-Martin Charcot
would have deemed it hypochondria, requiring a course of hypnotism.
Fast-forward 100 years or so and symptoms such as Nobel=92s would be
dismissed as yuppie flu, a term that angers Fred Friedberg, an
American clinical psychologist and the president of the International
Association for Chronic Fatigue Syndrome. =93Yuppie flu and other
derogatory terms are stigmatising to patients,=94 he insists. =93Also, the
idea that it is psychosomatic implies that it is all in the mind,
rather than a real illness. This is not useful. CFS probably has
multiple causation, including genetic, immune and perhaps viral
factors, as well as an over-stressed lifestyle =96 both biomedical and
behavioural factors are involved.=94
Friedberg, the author of Fibromyalgia and Chronic Fatigue Syndrome:
Seven Proven Steps to Less Pain and More Energy, is also keen to
emphasise how disruptive and unpleasant these conditions can be. =93CFS
is a debilitating illness characterised by at least six months of
persistent abnormal fatigue that is not alleviated by rest or sleep,=94
he says. =93It also includes several flu-like symptoms such as muscle
and joint pain, as well as memory and concentration difficulties. If
you can imagine what it would be like to have persistent flu symptoms
and all the problems they create in getting through the day, then you
have an idea what CFS is like.=94
Adding to these patients=92 misery, says Friedberg, is the fact that in
many cases their physicians remain sceptical and unhelpful, because
there is neither a biological cause nor a simple cure. Happily for
fibromyalgia sufferers, their condition is at least recognised by
rheumatologists as a chronic, widespread pain syndrome. In fact, it is
the second most common diagnosis in rheumatology and may affect up to
six million people in the US alone.
The fact that many physicians remain sceptical is in part due to the
mental illness often associated with fibromyalgia and other
multi-symptom illnesses. Those suffering from chronic fatigue or
fibromyalgia are significantly more likely than healthy people to have
experienced depression, anxiety, physical abuse or a life-threatening
stressful event before the illness developed. In one study by a team
from the University of Washington in Seattle, 90 per cent of
fibromyalgia patients had a prior psychiatric diagnosis. Another
study, at the University of Leeds, found that patients with chronic
fatigue syndrome were nine times more likely to have suffered
stressful events and difficulties in the three months before the onset
of illness than the healthy subjects. So there is clearly a component
of psychological distress, whether that involves a major psychiatric
disorder or poor coping mechanisms for dealing with severe stress.
=93The most common complaint on our helplines and forums is that some
doctors say it=92s just a psychiatric problem,=94 says Martin Westby, the
director of the support group UK Fibromyalgia. =93But I would argue that
if you=92re in constant pain, having difficulty obtaining a medical
diagnosis from your doctor or even being believed by your own family
because there are no outward physical signs, who wouldn=92t get
depressed?=94
Cognitive behavioural therapy (CBT) is also deemed helpful for
fibromyalgia. Westby explains: =93CBT is prescribed by more enlightened
doctors and does seem to help in some cases, because it helps people
manage their thinking,=94 he says.
This is a key point: critics who argue that multi-symptom illnesses
are psychosomatic are missing the point. The connection between mind
and body is something we are only beginning to understand, but experts
increasingly recognise the symbiotic relationship between them. For
example, prolonged stress is linked with a host of physical ailments
including high blood pressure, coronary heart disease, stroke and
cancer. When we think worried or stressful thoughts, the body responds
by secreting hormones such as adrenaline and cortisol =96 these
hormones, in turn, affect the way our mind works, creating negative
thought spirals, and so it goes on.
=93Anyone who has a chronic illness has alterations in biological and
psychological mechanisms,=94 says Dr James F Jones, a chronic fatigue
expert with the US Centers for Disease Control and Prevention. =93You
can=92t really separate the brain and the body, because psychology is
biology =96 everything that takes place in the brain is chemical or
electrical. You can=92t have one without the other.=94
This view is echoed by Westby. =93The psychosocial element to
fibromyalgia is one reason CBT works well,=94 he says, =93because if you
can heal the mind then you will heal the body too.=94
That is backed up by research from Oxford University, which found that
73 per cent of chronic fatigue syndrome patients receiving CBT for a
year returned to relatively normal physical functioning, compared with
27 per cent who only received standard care or rest.
A dualistic, mind-body solution is part of the multidisciplinary
treatment that seems to work best, adds Westby. =93There is no magic
solution, sadly. Sufferers use a range of things to help with their
condition, such as a low-dose antidepressant to help with sleeping,
low-impact exercise, multivitamins for the immune system and gingko
beloba to clear the mind and help with the =91brain fog=92 many people
complain of,=94 he says.
This multidisciplinary approach is also being trialled for those with
chronic fatigue. At King=92s College, London, researchers are currently
conducting a five-year trial using four treatments: CBT, exercise
therapy, adaptive pacing therapy (which teaches patients to carefully
match activity levels to the amount of energy available) and
specialist medical care. And, as researchers look into the role that
the XMRV virus plays in chronic fatigue syndrome =96 whether it is a
causative factor or merely takes hold because of a weak immune system
=96 attention increasingly focuses on the body=92s stress response. This
is thought to play a crucial role in illnesses such as chronic
fatigue, because stress activates the body=92s
hypothalmic-pituitary-adrenal axis, leading to a surge of the stress
hormone cortisol, which suppresses the immune and other bodily
systems. If an outside agent such as a viral infection attacks during
a period of high stress, the system may overreact or even spiral
permanently out of control.
=93People with CFS are over-worked and over-stressed,=94 says Friedberg.
=93They also take little time for themselves and do not value low-effort
leisure time. In other words, their lives are out of balance. So I
view stress as one factor in developing the illness; biomedical
factors are also involved.=94
It seems clear that the debate about these multi-symptom illnesses is
set to rumble on. That offers little comfort for those whose lives are
blighted by constant pain and dragging fatigue. But perhaps one day
soon researchers will discover exactly what causes them and which
treatments work best, and the murky world of psychosomatic illness
will become clear.
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