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General practitioners' perceptions of chronic fatigue syndrome and beliefs about its management, compared with irritable bowel syndrome: qualitative study

BMJ 2004; 328 doi: (Published 03 June 2004) Cite this as: BMJ 2004;328:1354

Rapid Response:

Re: Grey areas at the interface of psychiatry and medicine?

Dr. Naseem A. Qureshi claims the following about a host of unrelated
conditions (and by his implication, ME/CFS): “ Collectively, all of these
disorders appear to be characterized by increased current and lifetime
prevalence of psychiatric disorders, increased nonspecific emotional
distress and increased psychosocial stressors. These undistinguished
conditions have multifactorial models for their etiology, which include
psychiatric disorders (somatic presentation of psychiatric disorders) ,
psychosocial stressors, psychosocial trauma, and concepts underlying
somatosensory amplification and misattribution of symptoms.”

Significantly, he shows no substantiating evidence at all to support
this rather astounding, enormous, generalised, claim. His list of
unrelated disorders are very similar to those in a recent article by Rief
and Sharpe (1) who also place these unrelated conditions as ‘medically
unexplained” and “functional disorders“, again, without substantiating

The oft-repeated claim that ME/CFS is ‘medically unexplained’ is
incorrect. There are a number of biomedical explanations available,
although there does appear to be gaps in knowledge, for which further
research is being undertaken, and needs to be so. In this respect ME/CFS
is no different from asthma, cancer, schizophrenia, AIDS, Parkinson’s,
Multiple Sclerosis, and many other organic diseases. As ‘somatization’
disorders appear to be diagnosed if signs or symptoms are subjectively
categorised by the diagnoser as ‘unexplained’, (2) and there is always the
risk of inadequate biomedical investigation leading to such a diagnosis
(3), the readiness to incorrectly claim ME/CFS as such is particularly

Remarkably, in his assignation of ME/CFS as, ultimately, a
‘somatoform’ disorder (mimicking organic illness), Dr Qureshi managed to
ignore the WHO ICD-10 neurological classification of ME/CFS, the Canadian
Case Definition and Treatment Protocols, and twenty years of biomedical
research into the disease. This is in contrast to, for example, those
approaching ME/CFS from a biomedical perspective, who frequently
acknowledge psychiatric references, even when critically analysing those.
This ignoring of the large, international body of biomedical research is
a common feature among psychiatrists claiming ME/CFS as a
somatization/somatoform disorder.

The psycho-social approach to ME/CFS is heavily contested by
patients, advocates, MEDICS and Biomedical Researchers ALIKE because it
has a number of major theoretical and empirical flaws. And one does not
have to be a rocket scientist to understand this. To expect patients or
parents NOT to resist when flawed psychosocial constructs are applied to
them or their children, especially when these make the sufferer’s health
worse as a result, is arrogant and naïve. This is most likely a key
component of the conflict between certain doctors and their ME/CFS
patients. All the ‘sympathy’, soothing words and mental health
interventions in the world will not overcome the flaws inherent in the
various somatization theories, the crux of a serious, international

1. Rief, W. Sharpe, M. "Somatoform disorders--new approaches to
classification, conceptualization, and treatment" Journal of Psychosomatic
Research, Volume 56, Issue 4, April 2004, Pages 387-390.

2. ‘Somatization Disorder’,American Psychiatric Association. (1994).
Diagnostic and statistical manual of mental disorders, fourth edition.
Washington, DC: American Psychiatric Association.

3. McWhinney, I.R. Epstein, R.M. Freeman, T.R. Rethinking
Somatization, January, 1997.

Competing interests:
Carer, Social Science Lecturer and Researcher, Director of the ONE CLICK Group

Competing interests: No competing interests

08 June 2004
Angela P. Kennedy
Social Science Lecturer
Essex IG8