No. No it is not. No matter what certain psychiatrists have opined. David Tuller and I have an essay on Medical Humanities -- titled "The concept of ‘illness without disease’ impedes understanding of chronic fatigue syndrome" -- explaining how psychiatry has frequently mischaracterized biomedical diseases, including ME/CFS. Here is the gist:
In a recent essay in Medical Humanities, Professors Michael Sharpe and Monica Greco assert their belief that chronic fatigue syndrom is an "illness without disease," best treated with psychological and behavioural interventions, because "doctors can find no good objective evidence of bodily disease to account for it." At the same time, Sharpe and Greco discount the prospect that "given enough time and resources, the disease will surely be found," thereby repeating a classic and timeworn misapprehension. In fact, many medical conditions that had once been attributed to psychological or other non-physiological factors were later determined, following rigorous research, to have been biomedical all along. Nonetheless, Sharpe and Greco express dismay at the resistance of patients to certain strictly rehabilitative therapies, such as cognitive behavioural therapy (CBT) and graded exercise therapy (GET), as Sharpe has done for many years.
As we will explain, however, patients suffering from chronic fatigue syndrome (also called myalgic encephalomyelitis or ME/CFS) do not reject Sharpe and Greco’s preferred psychological and behavioural treatments because they refuse to accept the nature of their “illness without disease,” but rather because the research base for those therapies is deeply flawed and unreliable.
***
In other words, it is not only patients who challenge the psychological and behavioural paradigm championed by Sharpe and Greco. Much of the larger scientific community no longer accepts the findings of the PACE trial—and, by extension, other studies that appear to support the CBT/GET approach but suffer from related flaws. Since Sharpe and Greco simply assume the validity of their model, they do not comprehend that patients reject it not because they fear “undermining the moral status of their illness,” or because they reject psychiatry as a form of treatment, but rather because the research base is fraught with unacceptable methodological lapses. Moreover, patients know that increasing activity levels can trigger severe relapses—a phenomenon called “post-exertional malaise” or “exertion intolerance” that is widely recognized as the cardinal symptom of ME/CFS. Stanford’s Ronald Davis, a world-renowned biochemist and geneticist who is currently investigating the disease, has noted that “if you exercise it gets worse,” and that prescribing exercise for ME/CFS patients is therefore a “break of your Hippocratic Oath”.
Given psychiatry’s long history of mistaken theories of disease causation, there is an almost wondrous grandiosity to Sharpe and Greco’s proposed solution to the supposed “paradox” that troubles them. Rather than conceding that CBT and GET may be failed therapies for ME/CFS, and that biomedical research may ultimately hold the key, they instead call for “a major long-term change in thinking” on the part of patients, clinicians and scientists who do not share their particular views regarding the “moral connotations of illness and disease”. The illness-without-disease concept can be a useful tool in exploring interactions between patients and health care systems, but only if it is recognized as highly contingent and subject to the admitted limitations of current knowledge. Contra Sharpe and Greco, patients would be better served by greater humility accompanied by an understanding that medical categories are always provisional and therefore subject to change with advances in research.
This article has been accepted for publication in The Journal of Medical Humanities following peer review, and the Version of Record can be can be read here (paywalled, but most universities will have subscriptions).
Comments