Misunderstanding on both sides?
I wonder if there is evidence from both sides of the debate within
Hawkes' article (1), and the associated commentary by Cornes (2), of some
of the underlying difficulties and misunderstandings that continue to fuel
In a, perhaps understandable but not justifiable, defence against the
abuse received by Wessely for his work on chronic fatigue syndrome,
Wessely states - "They have personality problems". This to me reads as a
reference towards Personality Disorder, a diagnosis sometimes used in a
pejorative sense by mental health staff referring to a group of
individuals who frequently require support from mental health services,
but raise more than average levels of disagreement amongst staff. (3)
In his at times insightful commentary Cornes refers to an illness
being "in some way psychosomatic" adding the comments "Am I making this
up? Am I really sick?". His statement likely refers to the Somatoform
disorders - a World Health Organisation recognised disease within the
International Classification of Diseases (ICD 10 F45-), excluding in this
case Hypochondriacal disorder (F45.2). Somatoform disorders are an
important category, accounting for a large proportion of general practice
consultations (4). Insight into these conditions is highly variable (5),
however patients will experience symptoms that to them are
indistinguishable from those caused by a medically explained stimulus, and
therefore are "real" to the sufferer.
This ongoing dialogue between sufferers and clinicians seems to
highlight the stigma experienced by those with a mental illness (6), that
in someway their symptoms are not real or that if they respond to
psychological therapy, such as cognitive behavioural therapy, they were
not ill. And yet, there is some emerging evidence that cognitive
behavioural therapy may be of benefit in reducing repeat events in
coronary heart disease, and there can hardly be a more "organic" pathology
then that? (7)
(1) Hawkes N. Dangers of research into chronic fatigue syndrome BMJ
(2) Cornes O. Commentary: Living with CMS/ME BMJ 2011;342:d3836.
(3) Markham D. Attitudes towards patients with a diagnosis of
"borderline personality disorder": Social rejection and dangerousness. J
Ment Health. 2003;12(6):595-612.
(4) Burton C. Beyond somatisation: a review of the understanding and
treatment of medically unexplained physical symptoms (MUPS). The British
Journal of General Practice. 2003.
(5) Dwamena FC, Lyles JS, Frankel RM, Smith RC. In their own words:
qualitative study of high-utilising primary care patients with medically
unexplained symptoms. BMC Fam Pract. 2009;10(1):67.
(6) Dinos S, Stevens S, Serfaty M, Weich S. Stigma: the feelings and
experiences of 46 people with mental illness: qualitative study. The
British Journal of Psychiatry. 2004;184:176-181.
(7) Gulliksson M, Burell G, Vessby B, et al. Randomized Controlled
Trial of Cognitive Behavioral Therapy vs Standard Treatment to Prevent
Recurrent Cardiovascular Events in Patients With Coronary Heart Disease.
Archives of Internal Medicine. 2011;171(2):134-140.
Competing interests: No competing interests