January - February
Psychiatrists expressed dismay about
the either/or argument that
dominates discussion of CFS: Either it is a medical disease or it is a psychiatric disorder.
Ian Hickie said psychiatrists,
by being openly dismissive
of CFS, have been interpreted as saying there's nothing wrong with these people. Meanwhile, people in
the CFS community want to have nothing to do with psychiatry, arguing it has nothing to offer. In fact,
he said, while fatigue exists independently of psychiatric disorders and appears to have its own genetic
and environmental determinants, there are overlaps and relationships between fatigue states and psychiatric
disorders that need to be understood so that effective treatments can develop.
Michael Sharpe said
it is unfortunate that the societal
stigma against psychiatric illness makes it difficult for CFS patients to take advantage of the treatments
that might be helpful to them following an appropriate psychiatric evaluation. He suggested that making
a specific psychiatric diagnosis may not be helpful; rather, the question should be what psychiatry has
to offer CFS patients in terms of treatment.
Leonard Jason noted
that the lack of practical definitions
for some of the overlapping criteria between CFS and depression, coupled with misapplication of psychiatric
assessment tools and the desire to establish higher prevalence rates for the illness, serve to complicate
understanding of the illness.
Dr. Gurwitt denounces
automatic psychiatric referrals
"Why this morbid,
tiresome and destructive
preoccupation with ferreting out any shred of evidence of psychiatric difficulties?"
a child psychiatrist, began the
psychiatric morbidity session with an impassioned call to doctors to give up their "morbid fascination
with psychiatric illness." He described a patient, a young medical student, who he said clearly had no
previous or concurrent psychiatric condition but nevertheless was referred to him for evaluation. She
was afraid that simply having the evaluation would affect her career, and it made her feel ashamed of
"There should be no reason for shame
at all," Gurwitt said. "Shame
related to this illness is, in part, caused by the medical community itself."
The patientís primary care physician
should be quite capable of taking
a careful psychosocial history that would have revealed a great deal of useful information about the patient,
and Gurwitt said he found the "too ready tendency" to refer patients to psychiatrists distressing.
"The existence of a pre-illness psychiatric
condition may or may
not have anything to do with the onset or course of CFIDS. There are times when such a psychiatric evaluation
is valid, helpful, useful, but to do it automatically as if itís a routine part of the assessment is completely
"When there is so much accumulating
evidence--good science by good
scientists, as we have witnessed at this conference--when there is so much that is being learned and so
much that tells us there is a biological illness going on, and when these biological factors cannot at
all be explained by psychiatric conditions, whether they exist or not, then we have to ask: Why this morbid,
tiresome and destructive preoccupation with ferreting out any shred of evidence of psychiatric difficulties?
"Would not the all too limited research
funds better be devoted to
furthering biological research already in progress or waiting to be funded, or devoted to developing ways
to improve physician interest and education?
"Psychiatrists and child psychologists
do have something to contribute
diagnostically and therapeutically, and weíve heard some very good reports from them, but not by lending
themselves to flawed research techniques and unfounded biases. We need to move away from what seems to
be an unwritten edict that a psychiatric evaluation should always be part of the diagnostic work-up. No,
no, no! Only when there are very good diagnostic and therapeutic reasons and only when the physician and
the patient have a good working relationship so that a possible referral does not act to shame, to embarrass
and symbolically abandon the patient."