A new mental illness?
it ‘hysterical medicine,’
with no apologies for a knee-jerk diagnosis
By Frank Albrecht, Ph.D.
My daughter is the only person I've
ever known who can sprain an
ankle while standing still on a carpeted floor. If you look at her too hard, one of her joints can pop
out. Her life is filled with sprains, strains and dislocations-name something bad you can do to
a muscle, joint or ligament and she's done it more than once. "Accident prone," people said. "School avoidance,"
"attention getting," "drug seeking," they said. All those kinds of things. Finally she was diagnosed with
Ehlers-Danlos Syndrome, an inherited collagen disorder that is common among YPWCs (young persons with
CFS)-and which causes sprains, strains, dislocations and pulls! It wasn't mental or attitudinal after
all, though none of those who said it ever apologized.
She also has had severe abdominal pain.
Sonograms, X-rays, CAT scans,
MRIs-nothing! All in her head, they said. Exaggeration, bad family dynamics, could be it's Munchausen
Syndrome by Proxy, but certainly there is No Physical Cause! The TESTS are negative, they said, and that
proves it! It's mental!
Finally a specialized scan showed a condition my wife and
I had never heard of-varicose pelvic veins. Most doctors have never heard of it either. It's an extremely
painful condition that's hard to detect.
The veins were fixed and the pain is gone.
But again, no apologies.
It's certainly common for persons with CFIDS to face disbelief from
practitioners, friends and relatives. People get just absolutely sure you have a mental condition. I call
this hysterical medicine. The doctor does his exam. It's negative. He rounds up the standard suspects
by doing whatever tests occur to him. These too are negative. So he decides without further consideration
that the cause is in the mind. "Been under a lot of stress lately?" he asks. "Problems at school?"
he asks the kids. "How's your marriage doing?" he says to adults. And if the patient says, "No, no problems,
except that I'm sick," then of course the point is proven. She's in denial!
just happen to PWCs. Recently a physician told me about the case of a woman with projectile vomiting caused
by paralysis of the stomach. The treatment should be a surgically implanted feeding tube. But the surgeon
insisted the patient had anorexia nervosa and put her in a psychiatric ward. Eventually she was diagnosed
with an atypical multiple sclerosis (and got a feeding tube), but not before she had to endure months
of frustration and humiliation-and no apologies, either!
Hysterical medicine has a long history.
In the 13th century, for instance, people "knew" you wouldn't get bubonic plague if you lived a simple,
carefree life with many enjoyable but not overly stimulating activities. In the 18th century, gout was
regarded as a payback for overindulgence in liquor and luxury foods. In the 19th century everyone understood
that it was emotionally sensitive people-poets, painters, artistic people generally-who got tuberculosis.
The 20th century has been no better. When I was in graduate school in the late '50s, we took for granted
that asthma was a direct outcome of unresolved Oedipal conflict, and until the '90s everyone I knew accepted
as fact that ulcers came from stress and working too hard, being too competitive.
tuberculosis and many ulcers are caused by bacteria; asthma starts with allergy and creates physical alteration
of the airways; gout is a metabolic problem. The fact is that no illness affecting a diverse population
has ever turned out to be primarily or predominantly mental. It is hard, though, to get this point across.
work in a large mental health clinic and often see people with CFS or CFS-related problems. Getting them
appropriate medical help is difficult. Recently, for instance, I saw a 17-year-old who had been on home
instruction for a year because of dizziness, weakness, fatigue and visual problems. She'd had an extensive
workup at a university medical center without getting any diagnosis at all. Everybody said she was a mystery.
So I got her. Maybe she was depressed! Yet her symptoms fit the pattern so often seen in CFIDS, and she
also had obvious orthostatic problems (sitting or standing made her symptoms worse). I gave her a "poor
man's" tilt table test, 10 minutes of quiet standing. At the end her hands and feet were purple, her heart
was going too fast, her dizziness, pain and visual problems had increased, and she could no longer stand
up without support. I sent this information to her primary-care doctor. He phoned me and said he could
find nothing wrong with her! My client's mother then went in to see him,
Then went again, and again.
Finally he consented to refer her to a cardiologist for tilt table testing. After a positive test, the
cardiologist put her on some medication and she's now a lot better.
The primary-care doctor
produced no apologies-of course!
In my business we have a diagnostic manual, the DSM, that
lists all the mental disorders and their criteria. It's put out by a psychiatric association. I'm going
to write this group proposing that hysterical medicine is an overlooked mental illness, afflicting many
physicians and some members of the general population, characterized by irrational beliefs in imaginary
illness causes, deficits in good manners, and inhibition of the apology reflex.
do you think? If they turn me down, will they apologize?
Frank Albrecht has several family
members afflicted with CFIDS
and maintains a web site for parents of sick and worn out kids at www.bluecrab.org/health/sickids/sickids.htm.
He is a therapist and coordinator of special projects at Regional Mid-Shore Mental Health Services in