A dualistic view of illness does not help people with ME/CFS | Letters
We agree with George Monbiot that the death of Maeve Boothby O’Neill was tragic and should have been avoided. Unfortunately, Monbiot draws generalizations from her sad death based on a view of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) that is itself outdated (Maeve Boothby O’Neill died because of a discredited view of ME. How was this allowed ?Is it going to happen?, October 18).
Monbiot suggests that such diseases are generally considered physiological or psychological. This is an outdated dualistic view of any disease, let alone ME/CFS. Many such diseases have been shown to be the result of a dynamic interaction between biological, psychological and social mechanisms. Just one example from our own research showed the important role of certain viruses in causing the disease.
Monbiot then dismisses rehabilitation treatments, such as cognitive behavioral therapy and graded exercise therapy, based on research he said was flawed. Yes, this research, some of which we led, has been criticized by some, but it remains valid; no relevant article has been withdrawn and many systematic reviews and meta-analyses have found the approach to be useful. Remarkably, the National Institute for Health and Care Excellence (Nice) has indeed withdrawn its previous support for these treatments, leaving patients without evidence-based ways to get better. But these new Nice guidelines are being challenged because they are based on a flawed assessment and interpretation of the evidence, as shown an analysis by us and 48 other international experts.
We agree that those who suffer most need to be listened to, and that care for such patients is sometimes inadequate. Therefore, we should not dismiss treatments that have been shown to help many.
Peter White
Emeritus Professor of Psychological Medicine, Queen Mary University of London
Trudie Chalder
Professor of Cognitive Behavioral Psychotherapy, King’s College London
Michael Sharpe
Emeritus Professor of Psychological Medicine, University of Oxford
George Monbiot says ME/CFS is “as physiological as a broken leg”. However, if I repeatedly break my leg due to the urge to jump from rooftops, or due to my exposure to a hazardous work environment, then these psychological and environmental factors are also worth considering. ME/CFS is to a broken leg what the Amazon rainforest is to your local park – it is a hugely complex, multifactorial chronic illness that remains poorly understood from a medical perspective. As a clinical psychologist who has been working on my own recovery from the condition for almost five years, I have come to see ME/CFS as something that exists at the confluence of body and mind. This is not intended to psychologize those of us living with ME/CFS. The symptoms are real, debilitating and can make life completely miserable.
However, we humans are psychobiological organisms whose brains and bodies adapt to our social environment. People with ME/CFS have often experienced periods of chronic and acute stress in the period before they became unwell. It is not unusual for them to carry the ‘allostatic burden’ of adverse childhood experiences, and as a result they may have learned to encounter the world in adaptive but unsustainable ways – for example, becoming high achievers, perfectionists and self-sacrificers. are. Ultimately, the straw that breaks the camel’s back comes, usually in the form of a viral infection such as Covid or glandular fever. This latter stressor places the body in a state of dyshomeostasis that appears to become at least partially persistent due to sensitization of the central nervous system.
Emerging research is helping us better understand possible physiological mechanisms of ME/CFS. However, a key question we must ask ourselves is this: what are the biological, psychological and social factors that create the conditions for this state of imbalance in the whole organism?
Dr. Jake Hollis
Brighton