MAGICAL MEDICINE: HOW TO MAKE AN ILLNESS ... - Invest in ME

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The CISSD project was the brainchild of Richard Sykes PhD (director of the former ME charity “Westcare”
that has now been subsumed within Action for ME) who states that the impetus for it was the suggestion by
many psychiatrists and others that “CFS” should be regarded and classified as a “mental” disorder that falls
within the category of somatoform disorders and the difficulties this caused for patients. The project aimed
to consider the whole spectrum of current somatoform classification; membership comprised over 80
advisors with a core work group of 33 members, the large majority being psychiatrists.
Sykes notes: “It is true that CFS is listed under ‘syndrome’ in Volume III, the Index of ICD‐10, and placed in G93.3,
a category of neurological illness. But there remain problems: (1) some psychiatrists and others contest this
classification of CFS as a neurological disorder and (2) ‘fatigue syndrome’ is listed in ICD‐10 as F48, a mental disorder
– which creates the apparent anomaly that ‘fatigue syndrome’ is a mental disorder, but ‘chronic fatigue syndrome’ is a
neurological disorder” (http://tinyurl.com/yz88mks ).
One respected patients’ advocate commented on Sykes’ summary of his project:
“So basically, Richard Sykes created a “honey pot” for the discussion of CFS in relation to Somatoform Disorder and
all the bees came to the honey pot. We only have his word that there is now a greater chance that CFS will be kept as a
neurological classification. The people who came to the honey pot are still far more powerful than Sykes and what’s
more the combined force of those who came to the honey pot could just have had the effect of making their collective
voice more powerful still.
“ I do not believe that any somatoform psychiatrists have any intention of letting go of CFS. Physical symptoms –
blame the patient – no underlying disease processes found – ignore the available research and evidence. They
demonstrate time and again that these “professionals” really only care for their shared beliefs more than they care for
the facts or the truth or the patients. World wars have been fought to overcome powerful individuals who share this
sort of behaviour” (www.meactionuk.org.uk/commentonsykes.htm).
Many of those who have informed the CISSD Project are highly influential, internationally published
researchers and clinicians in the field of psychiatry and psychosomatics and include Kurt Kroenke, Richard
Mayou, Per Fink, Peter Henningsen, Veronque de Gucht, Bernd Löwe, Wolfgang Hiller and Winfried Rief.
At least five members of Sykes’ Project have gone on to become members of the American Psychiatric
Association Work Groups, with four having been appointed to the DSM‐V Somatic Symptoms Disorders
Work Group (Professors Michael Sharpe, Francis Creed, Arthur Barsky and James Levenson), with Javier
Escobar being appointed a member of the DSM‐V Task Force.
Throughout their professional lifetime many of these psychiatrists have held entrenched views and have
built their careers upon them; it is unrealistic to suppose that they will relinquish those views in the interests
of mere medical science.
Barksy, for instance, is well‐known for his belief that ME/CFS patients’ suffering “is exacerbated by a self‐
perpetuating, self‐validating cycle in which common somatic symptoms are incorrectly attributed to serious
abnormality, reinforcing the patient’s belief that he or she has a serious disease. Four psychosocial factors propel this
cycle of symptom amplification: the belief that one has a serious disease; the expectation that one’s condition is likely to
worsen; the ‘sick role’ including the effects of litigation and compensation; and the alarming portrayal of the condition
as catastrophic and disabling”. He then added another exacerbating factor: “a clinical approach that over‐
emphasises the biomedical and ignores the psychosocial factors”. He continued: “symptom amplification operates in
each individual sufferer. It may also serve as a mechanism for ‘transmitting’ the syndrome from one person to
another”. Barsky ended his article by calling upon the media, saying they must offer “a less sensational, more
accurate and more sophisticated model” of functional somatic syndromes, in which he includes ME/CFS,
fibromyalgia and irritable bowel syndrome (Ann Intern Med 1999:130:11:910‐921).
Letters sent to the journal commentating on the Barsky paper included the following: