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Psychiatry, misattribution and the issue of misdiagnosis

Posted Mar 20 2009 3:14pm
A Response to the recent New Scientist article.


19th March 2009

Stephen Ralph DCR(D) Retired

I am a retired diagnostic radiographer and I became ill back in 1996 after a viral infection of Tunisian origin.

I was diagnosed with CFS or ME and since then I have discovered the work of Professor Wessely and his like minded colleagues.

I discovered that the physical illness I had was said to be caused by faulty or unhelpful illness beliefs, psychological distress or stress from being a perfectionist.

None of these psychiatrists had ever met me but they had written this about my ill health without ever having to examine me.

They also concluded that my illness could be effectively treated and cured with CBT and Graded Exercise because my symptoms, I was told, were due to somatising and deconditioning.

At present a group of somatoform specialists are attempting to have ME and CFS reclassified from the present International Classification of Diseases ICD 10 where they now sit under G93.3 diseases of neurological origin.

The plan is called the Conceptual Issues in Somatoform and Similar Disorders Project and it can be found by any search engine.

The plan is to get CFS and ME placed in ICD 11 under a new Somatoform Disorder section along with the inclusion of CFS and ME for the first time in the new DSM V Axis III.

This CISSD lobbying Project has had it's funding managed by Action for ME.

At present the World Health Organisation in Geneva have said that CFS ME and PVFS are staying exactly where they are.

In 2004 after being 80% bedbound and 95% housebound for 8 long years, I changed my GP on moving house and I found myself being told by my new GP that I had some form of immune disease going on.

I am now taking the full dose of a drug called Celebrex and I am also now almost at the end of a path to a diagnosis of Behçet’s disease.

I am told that ME or CFS is probably the most common misdiagnosis for Behçet’s disease and Professor Wessely told me late last year that he has never seen a case of Behçet’s through his clinic.

This is no surprise to me because Professor Wessely is for example not a Professor in immuno-pathology with a special niche interest in Behçet’s disease.

Rare and complex medical conditions such as mine are usually suspected and confirmed after multiple consultations to different specialists at high level and not including psychiatrists. .

This is in my view the Achilles Heel of functional psychiatry.

Thanks to the artificial construct of CFS/ME and those who somatise the symptoms of patients - symptoms that are identical to those common in biomedical diseases, I and many others have suffered years of untreated symptoms that have left us disabled and debilitated - told to educate ourselves and exercise to get better.

I have suffered years of illness in a darkened room with doctors telling me there was nothing they could do.

CBT and Graded Exercise are worthless as treatments for anyone with Behçet’s disease and they have also been found via surveys to be worthless for people with severe or even moderate ME yet nearly all the symptoms of ICD 10 M35.2 Behçet’s disease are shared in equal severity and debility and range as ICD 10 G93.3 ME.

I know this because I have met people who are just as ill as I have been and am now. Or, did they have Behçet’s disease and were they misdiagnosed? Did anyone care?

Behçet’s disease is rarely reliably diagnosed by a positive test or scan as it is a disease of the immune system causing the inflammation of blood vessels that then cause symptoms that are neurological, arthritic, fatigue on exertion, breathlessness, cognitive dysfunction, sensitivity to light and sound, heart and circulatory problems.

Some with Behçet’s disease may not always have many refractory mucosal mouth ulcers or any genital ulcers like me so if the signs become few the risks of a medical misdiagnosis become proportionally greater.

A psychiatrist or a GP would in my view be poorly qualified to suspect or diagnose such a disease because very little time is given to training for such a condition at medical school.

Yet GP's and psychiatrists are allowed routinely to make a diagnosis of CFS or ME.

I lost my career because of the efforts of those who created and now promote "the chronic fatigue syndrome" and lets not forget that CFS/ME is a heterogeneous construct as stated by the Chief Medical Officer's Report into CFS and ME from 2002.

Meanwhile as others have stated, Professor Wessely has never debated the issues constructively with his biomedical scientific colleagues who fundamentally disagree with his views and beliefs.

If Professor Wessely would like a constructive debate then we would all like to have one on a level playing field.

But there is no level playing field and that can be proven by the total lack of biomedical funding thanks to the closed goal posts placed by the Medical Research Council and the support of NICE for the CBT and GET agenda.

People have died and are going to inevitably die because their presumed and assumed somatised symptoms have been cheaply and wrongly ascribed to a mental health disorder.

All those who have died, died through complications of ME just as some die of the complications of Behçet’s disease and the autopsies of either illness are as difficult to carry out.

In spite of the starvation of biomedical funding at State level, biomedical research has already revealed a great deal of useful information - information Professor Wessely chooses not to mention.

In the end as with Parkinson's disease and Multiple Sclerosis, biomedical research will win the diagnostic argument.

I have lived a personal nightmare because of the NHS and I am only one of thousands of others who were unfortunate to suffer being given the diagnosis of CFS/ME.

Many patients with Behçet’s disease and other diseases suffer because of the chronic fatigue syndrome and those who somatise illnesses they know little about.

Can psychiatrists create an illness that only exists in their collectively reinforced thoughts?


Stephen Ralph DCR D Retired.

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