The Sickening Mind: Brain, Behaviour, Immunity and Disease. Paul Martin

The authoritative Centers For Disease Control and Prevention in the USA has concluded that approximately 45 per cent of all CFS sufferers have some form of identifiable psychiatric disorder before the onset of CFS. Researchers at the University of Connecticut School of Medicine found that as many as three out of four of the chronic fatigue cases they examined could be more easily explained by psychiatric problems such as depression. To add to the picture that the mind plays a central role in the illness, Australian researchers have discovered that CFS patients exhibit significantly more signs of hypochondria than other medical patients.

      Psychological theories of CFS have tended to focus on depression. Over half of all CFS sufferers exhibit clear signs of clinical depression. Often the depression appears to have preceded the chronic fatigue, suggesting that it might be a cause rather than a consequence of the syndrome. Severe depression is usually accompanied by prolonged reductions in physical activity which could, in turn, lead to a debilitating decline in muscle function. People who lie in bed for long periods become physically weak. The sleep disturbances that typify some depressive disorders might also exacerbate the sufferer’s fatigue. Furthermore, it is known that severe depressive disorders are associated with changes in the immune system.

      But hold fast. It is equally clear that many CFS sufferers become depressed as a consequence of their illness. It is hardly surprising that those suffering from a debilitating but unexplained illness should become depressed and abnormally preoccupied with their health. Although more women than men suffer from CFS this should not be interpreted as evidence that CFS is primarily a psychological disorder, as a few sexist pundits have implied. There are several perfectly respectable organic diseases, such as rheumatoid arthritis, which show a marked preference for one sex over the other.

      At present it is probably safe to conclude that the case for CFS being primarily a psychological disorder remains unproven. The evidence for some sort of immunological malfunction is too good to dismiss. There is, however, no doubt that CFS sufferers’ psychological reactions to their illness do have an important bearing on their wellbeing and recovery. Whether depression is a cause or an effect of the syndrome, it becomes a major problem in its own right and can seriously impede recovery.

      The controversy over CFS is further complicated by the attitudes of those who suffer from it. People who are afflicted by a serious and debilitating disorder such as CFS want their illness to be publicly recognized as having a medically respectable cause. For most people this means a physical cause, such as a virus or an immunological disorder, rather than a psychological cause. Any suggestion that their symptoms might result from a psychiatric problem tends to provoke outrage.

      This attitude is understandable. Talk of psychological causes often carries with it an unjustifiable connotation that the illness is not quite genuine. There is usually a strong whiff of ‘get a grip on yourself and snap out of it’ in the air. Moreover, even in the late twentieth century there is still a wholly unreasonable stigma attached to mental illness. The average person would rather admit to having a physical illness, albeit a vague ‘mystery’ virus or obscure immunological malfunction, for this absolves them of any accusations of malingering, neuroticism or weakness of character. One unfortunate outcome of this desire for a physical explanation is the tendency, in some countries at least, for CFS sufferers to shop around until they find a physician who will give them the diagnosis they want.

      Ironically, it turns out that the CFS sufferers who believe most strongly in a purely physical explanation have greater difficulty in recovering from their illness. This may be because they fail to confront and deal with the psychological problems that invariably accompany the illness.

      Evidence to support this conclusion has come from a study conducted by Michael Sharpe and colleagues in Oxford. They found that a form of cognitive behavioural therapy, in which CFS sufferers were helped to re-evaluate their attitudes towards their illness, was of major benefit. More than 70 per cent of CFS sufferers who received the behavioural therapy regained their ability to function normally, compared with a success rate of 27 per cent for sufferers who received only standard medical care.

      The pressure to attribute CFS to purely physical causes has also had a substantial influence on how the popular media deal with the subject. Newspaper and magazine articles, TV features and self-help books tend to emphasize physical explanations for CFS and neglect its psychological aspects.

      A survey by researchers at the University of London found that 69 per cent of all articles on CFS which had appeared in national newspapers and women’s magazines since 1980 had favoured physical causes, compared to a mere 31 per cent of research papers in scientific and medical journals. There appeared to be a systematic bias in the popular media towards reporting physical as opposed to psychological explanations. Even the choice of name was affected. Whereas scientific papers typically used the neutral term chronic fatigue syndrome, the popular media instead favoured the more medical-sounding myalgic encephalomyelitis (ME).

      Similar attitudes apply to other illnesses which, like CFS, have been tarred with the psychosomatic brush. Asthma and allergies are familiar examples. So too are inflammatory bowel disorders such as Crohn’s disease and ulcerative colitis. The pendulum of opinion has swung violently back and forth over the years. Half a century ago asthma was widely regarded as an essentially psychological illness. Nowadays it is normal to play down the role of psychological and emotional factors and instead focus almost exclusively on its immunological mechanisms and physical triggers, ranging from fitted carpets to car exhaust fumes. In truth, there are good grounds for believing that both immunological and psychological factors play important roles in these diseases. Nevertheless, the overwhelming tendency is to opt for one explanation to the exclusion of the other.

      As we shall see in subsequent chapters, this centuries-old opposition between mind and body, mental and physical, psychosomatic and organic, is a snare and a delusion. It has impeded scientific understanding and acceptance of some very important phenomena. There is nothing ‘alternative’ or scientifically dubious about the fact that what goes on inside someone’s brain influences their physical health.

       2 Shadows on the Sun

      Had she been light, like you,

      Of such a merry, nimble, stirring spirit,

      She might ha’ been a grandam ere she died;

      And so may you; for a light heart lives long.

      William Shakespeare, Love’s Labour’s Lost (1595)

      In Tobias Smollett’s epistolary novel The Expedition of Humphry Clinker (1771), Mr Matthew Bramble makes this perceptive observation in a letter to Dr Lewis:

      I find my spirits and my health affect each other reciprocally – that is to say, every thing that discomposes my mind produces a correspondent disorder in my body; and my bodily complaints are remarkably mitigated by those considerations that dissipate the clouds of mental chagrin.

      Is the centuries-old notion that the mind plays a pivotal role in physical disease an established fact or unsubstantiated folklore? In this chapter we shall consider some of the many strands of scientific evidence for and against that notion. Precisely how the mind affects physical health is a question we shall leave until later. But first we must clear a conceptual hurdle out of the way.

      The perfectly sensible idea that the mind can influence our susceptibility to disease is often muddled with the different, but equally venerable, notion that the mind can by itself conjure up phantom illnesses which have no physical basis. We are about to encounter the psychosomatic fallacy.

      According to one fairly representative modern definition psychosomatic illness is ‘any illness in which physical symptoms, produced by the action of the unconscious mind, are defined by the individual as evidence of organic disease and for which medical help is sought’ [my italics]. By this definition, the unfortunate victim might feel ill even though he or she has no underlying physical disease. In other words, mental state is the sole and sufficient cause of the physical symptoms. Such things do, of