ME: the making of a new disease — British physician Michael Fitzpatrick, author of The Tyranny of Health: doctors and the regulation of lifestyle, writes here about myalgic encephalomyelitis, which is what the British call chronic fatigue syndrome or CFS. A working group reporting to the UK’s Chief Medical Officer, the equivalent of the Surgeon General of the US, has endorsed the idea that ME is a real disease and requires prompt recognition and attention. Like me, the essayist is skeptical, and notes that before reaching its consensus statement, the committee was riven by controversy and resignations. My close study of CFS as one of a number of controversial syndromes on the medical-psychiatric interface about which I have written and taught convinced me that, while there is an organic basis for CFS in a small proportion of cases, by and large the diagnosis is misused by self-deceiving sufferers and politically correct clinicians with the misguided notion that it is a stinging rejection to tell a patient that their dysfunction is “all in their head.” This is enabling to patients who are invested in finding a physical explanation for their psychological distress, often personality disorders that are hard to pin down.
The essay also underscores the medical perils of the essentially political nature of the recognition of new diagnoses. This is quite familiar to those of us in the mental health field who watch the squabbling around the periodic revision of the Diagnostic and Statistical Manual, the official ‘bible’ of diagnoses in psychiatry. It should not be surprising in an era when there are pitched battles over paying for medical care. As Dr Fitzpatrick notes, it “represents the capitulation of medical authority to irrationality.”
‘Self-pity and self-deception are the great enemies of Mankind’ writes medical commentator Theodore Dalrymple in his recent book, An Intelligent Person’s Guide to Medicine. Yet both are pervasive in modern society, and nowhere more than among patients with ME, above all in the ME organisations. To any observer who takes a historical or sociological perspective on the emergence of novel diseases such as CFS/ME, their origins in the existential distress of their sufferers is readily apparent – as indeed it usually is in the doctor’s surgery.
The tragedy of the sufferers is their lack of insight into this process, a deficit that is reinforced by the provision of a pseudo-medical disease label. Whereas according to the new policy of the Chief Medical Officer, doctors are now obliged to collude with the self-deception of ME sufferers, for Dalrymple, it is necessary to ‘undeceive’ to achieve change. From his humanistic perspective, it is the doctor’s responsibility, acting with due circumspection, to ‘undeceive the self-deceived’. While the official line ratifies confusion and promotes incapacity, this approach points the way towards enlightenment and recovery.spiked!
