Feeling Tired? Low on Energy?
He drew her closer, caressing her gently. Her body tensed slightly, her breathing becoming faster, louder. Together they moved in unison, entwined in an ever-rising surge of ecstasy. Suddenly, she closed her eyes and gave a soft cry, "EEEEOOOORRRR!"
THAT got your attention, didnít it? Right, enough of that, itís back to work nowÖ
"Abnormal" illness behaviour in chronic fatigue syndrome and multiple sclerosis
Tingwell, Hatcher, Johnson, Stanley and House; BMJ Volume 331 1995 (p 15-18)
What is this paper about? Well, chronic fatigue syndrome (Iíll call it CFS for the sake of my fingers) is one of those conditions that no one knows that much about. Itís characterised by being tired a lot, can be very disabling, and like a plot line from Neighbours, it can come back again and again. Suggestions to what causes CFS include specific viral infections, immunological dysfunction, or maybe itís all psychological.
Some doctors think itís a variety of somatisation or abnormal illness behaviour. This draws on Mechanicís concept of illness behaviour and Parsonsís concept of the "sick role" (See Ogden, Scambler et al, as they can explain these far better than I ever could). Abnormal illness behaviour can include things like abnormal bodily perception, perceiving health care wrongly, and doing things wrong based on these perceptions (note the heavy use of perception Ė itís a psychosocial buzzword, that). The authors wanted to find out whether this is true by getting patients with CFS or multiple sclerosis (MS) to fill out an illness behaviour questionnaire, and then comparing the 2 groups. What did they find?
The illness behaviour profile in CFS in the same as that in MS. Both groups were anxiously concerned about the state of their health (general hypochondriasis), convinced that a physical disease actually existed (disease conviction) and more concerned with the physical side of it rather than the psychological (psychological versus somatic concern).
Since MS and CFS profiles are virtually identical, you canít take the scores on the illness behaviour questionnaire as evidence that CFS is abnormal illness behaviour. Triumph for people suffering from CFS? Well, you canít actually say that CFS isnít abnormal illness behaviour either. The illness behaviour questionnaire is therefore as about as useful as a chocolate teapot when it comes to using it for measuring abnormal illness behaviour in CFS.
CFS sufferers and MS patients could have come up with the same profile but for entirely different reasonsÖ Close your eyes for a moment (donít do it right now unless you can read with your eyes closed) and imagine this scenario: youíre suffering from CFS. You feel youíve got no energy left and you canít do your work properly because youíre very tired. The doctors run a few tests but canít find anything they can point at and blame. What do you do? Damn it, you have to try and convince people that youíre suffering from a REAL DISEASE here. [disease conviction] You canít accept the explanation that it may be psychological Ė think of the stigma youíll get! [psychological versus somatic concern] As a result you become more preoccupied with your health. [general hypochondriasis]
In contrast, MS patients are told they have a physical disease, have no reason whatsoever to believe that their condition is psychological, and are worried about physical symptoms because MS is a notorious relapsing and disabling disorder.
As a final point, to understand how patients represent their illness to themselves and others, we need to know more about the origins of how they actually form the illness beliefs, especially as they are important in seeing what the outcome is.
"Act. Donít react."
A reminder that we mustnít just go through life in a daze, and wonder later what we might have done differently
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