Letter, Re: Lonely? Shy? Sad? Well now you're 'mentally ill', too (Independent, 10 February 2012)

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The Independent Letters.

The crucial importance of the name given to an illness. in understanding

its cause and improving chances of recovery from it, is illustrated with

sufferers of M.E. before and after Psychiatrists have re-labelled them,

both since 1988 (Holmes et al.) and as they wish to revise further in

their next Diagnostic and Statistical Manual of Mental Disorders, DSM-5.

(Lonely? Shy? Sad? Well now you're 'mentally ill', too, Independent, 10

February 2012 --

http://www.independent.co.uk/life-style/health-and-families/health-news/lonely-s\

hy-sad-well-now-youre-mentally-ill-too-6699884.html).

Before: Patient has Myalgic Encephalomyelitis, as recognised in the

World Health Organisation Handbook (Issue ICD-10, 2010, Category G93.3,

" Other disorders of the brain " NOT a fatigue syndrome. F48.0, in

" Neurotic, stress-related and somatoform disorders " ), which suggests

different treatments for M.E and Chronic Fatigue Syndromes. Onset of

M.E. was viral infection OR adverse reaction to vaccination; patient is

not malingering, previous good attendance work/school; not

hypochondriacal; no previous personal or family history of mental

illness. More biomedical research needed. Meantime, treatment options:

Patient experience and research evidence (Twisk & Maes, 2009) suggests

that Cognitive Behaviour Therapy (CBT) is disappointingly ineffective

and Graded Exercise Therapy (GET), makes a majority worse, some

irrecoverably so. Alternative and radical, unproven, treatments given

by unregulated charlatans are expensive and raise false hopes and even

may be the last straw that has led to suicide attempts. Low spirits, due

to social isolation, unemployment, poverty and fractured relationships

should not be confused with depression; therefore antidepressants will

not help and may cause addiction. Best options: treat any symptoms, such

as pain, sleep problems etc; demonstrate belief in illness; support in

benefits and welfare claims; visit at home when house or bed bound.

Encourage patients' enquiries and discussion of latest biomedical

research findings. Support blood and tissue bank initiatives. In event

of death, encourage post mortem and, especially, call for investigation

of inflammation in areas found in others who died after having M.E.

After: Chronic Fatigue Syndrome is now preferred term. Discourage

patient using M.E, as if more serious medical condition. Even if onset

is organic, illness is maintained by faulty beliefs (somatisation).

Treat all with CBT and GET. Encourage patients to try other treatments,

suggest can do no harm. Psychological effects are depression, therefore,

treat with antidepressants even if addictive. Encourage back to work,

even if there are relapses due to trying; do not support for

unemployment or disability benefits. Discourage patients' own research

and questions. If patient resists voluntary treatments, threaten

compulsory; if persistent, send people to break down door and section

under Mental Health Act. After death, discourage need for post mortem.

Encourage more research into behavioural management of chronic fatigue

illnesses and expansion of service to provide above treatments.

Independent journalists may be shocked if they were to enquire into the

numbers of people who have been and who are currently affected by these

practices. It is why hundreds of thousands of people in the UK, millions

around the world, remain ill and neglected with this dreadfully

disabling neurological illness, which should be treated discretely as

M.E. and not part of a fatigue bundle.

Yours sincerely

drjohngreensmith@...

Dr H Greensmith

M.E Community Trust.org