Can people think themselves sick?
This is what psychiatrist Simon Wessely explores. His research into the causes of conditions like chronic fatigue syndrome and Gulf war syndrome have led to hate mail, yet far from dismissing these illnesses as imaginary, Wessely has spent his career developing treatments for them.
Q: How might most of us experience the effects of the mind on the body?
A: In an average week, you probably experience numerous examples of how what's going on around you affects your subjective health. Most people instinctively know that when bad things happen, they affect your body. You can't sleep, you feel anxious, you've got butterflies in your stomach...you feel awful.
Q: When does that turn into an illness?
A: Such symptoms only become a problem when people get trapped in excessively narrowexplanations for illness -- when they exclude any broader consideration of the many reasons why wefeel the way we do.
This is where the Internet can do real harm. And sometimes people fall into the hands of charlatanswho give them bogus explanations.
Q: Is that how chronic fatigue syndrome can start?
A: Often there is an organic trigger like glandular fever. That's the start, and usually most peopleget over it, albeit after some weeks or months. But others can get trapped in vicious circles ofmonitoring their symptoms, restricting their activities beyond what's necessary and gettingfrustrated or demoralized. This causes more symptoms, more concerns and more physical changes,so much so that what started it all off is no longer what's keeping it going.
One of the enigmas is why certain infections, like glandular fever, have an increased likelihood oftriggering chronic fatigue syndrome (CFS), while others, such as influenza, do not. We also don'tknow why people who've had depression are twice as likely to develop CFS. I get cross with peoplewho want to explain one and not the other. Some people take too psychiatric a view of CFS andignore the infective trigger, whereas others want to think only about the infection.
Q: So how do you treat CFS?
A: The first thing you have to do is engage people. I see them for two hours, which enables me totake a proper history to ensure I understand their symptoms and how the illness is affecting them.This helps people to open up, as they can see I'm interested in their problems and taking themseriously.
With many people, I genuinely don't know why they're ill. Or if I do, if they had glandular fever fiveyears ago, say, I tell them there's nothing I can do about the original trigger. What makes adifference is what happens next. Then we get on to the practical stuff, such as finding out howpeople deal with the condition. Are there things they are doing that may not be the best forrecovery?
Then I recommend cognitive behavioral therapy and tailored programs of gradually increasingactivity levels.
Q: How successful is your treatment of CFS?
A: Roughly a third of people completely recover and a third show good improvement. About a thirdwe can't do much for.
Q: What about those people who have such severe CFS they're bedridden?
A: In that kind of disability, psychological factors are important and I don't care how unpopularthat statement makes me. We also have to consider what those years of inactivity have done to theirmuscles.
People know that if you break your leg, when you take the plaster off there's nothing much left. Ifyou've been in a wheelchair for some years, the laws of physiology haven't stopped.
Q: Your most cited paper claims that conditions such as CFS, irritable bowel syndrome andfibromyalgia are all the same illness.
A: If you ask people with irritable bowel syndrome whether they suffer from fatigue, they all sayyes. It's just gastroenterologists don't ask that question. Likewise, if you talk to someone with CFS,you find that nearly all of them have gut problems. If you systematically interview people with theseillnesses, you find that a big proportion of these so-called discrete syndromes have a large overlapwith the others. You have to think that we have got the classifications wrong.
Q: So do you think these syndrome labels are arbitrary?
A: Each country has different syndromes. They don't have CFS in France; they have a strange one,spasmophilia, where a person has unexplained convulsions. In Sweden, they have dental amalgamsyndrome, which hasn't really caught on here. In Germany, they believe low blood pressure is bad.
Q: Where does Gulf War Syndrome fit in?
A: I'd read about people with Gulf war syndrome in newspapers. They looked incredibly like myCFS patients except they were in uniform.
Behind them was an interesting scientific conundrum calling out for epidemiological research.Someone had to ask: "What are the rates of illness in those we sent to the Gulf compared with thosewe haven't?" And that's what we did. We showed that serving in the Gulf had definitely affected thehealth of a proportion of those personnel, even though this was not a new "syndrome".
Q: Is looking into Gulf War Syndrome how you came to focus on military health?
A: Yes. I like dealing with military personnel -- I admire what they do. Looking back on my career,it is military research that has given me the most straightforward pleasure, and the satisfaction ofknowing we have had a positive impact on policy.
Q: What kind of input has your team had on military policy? A: We have provided information on rates of psychiatric disorders in troops. For example, alcoholis a bigger problem than post-traumatic stress disorder (PTSD). We've shown that extendingoperational tour length has a bad effect on people's morale and mental health. We also did acomprehensive review of prior research into PTSD and concluded that psychological debriefing aftera traumatic incident doesn't help. Normal soldiers need to keep away from people like me --psychiatrists and counselors.
Q: Your recent research is on people who claim that mobile phones make them ill. What's going onthere?
A: My colleague James Rubin and I showed that people who believe they're sensitive to mobilephones aren't able to tell the difference between sham and real phone signals. So are these people allmaking it up? Of course not. They've got themselves into a situation where a mobile phone triggerssymptoms, but it doesn't do so through electromagnetic radiation.
Q: What's it like to receive hate mail?
A: There have been times when it has been pretty unpleasant. But it goes with the territory. I'm nottargeted by my own patients. If I ever thought that my patients or peer group thought I was a badperson, I would be worried. What matters is that the research we do is good quality. That's what youstand or fall by.
Simon Wessely trained in epidemiology at the London School of Hygiene and Tropical Medicine and psychiatry at Maudsley Hospital in London. He founded the Chronic Fatigue Syndrome Research and Treatment Unit at King's College London and the first specialist NHS clinic for CFS at what is now King's College Hospital.