Musings of a phenomenologist

Science, psychiatry and random musings

It’s all in the mind surely?

Posted by soveda on January 5, 2009


I was navel gazing and having a look at which of my rants was the most read, it seems that it was the one on electrosensitivity. So lets have a talk about medically unexplained symptoms shall we?

What are medically unexplained symptoms?

Briefly, if someone presents with physical symptoms and signs that do not appear to have any biological basis they are deemed to have medically unexplained symptoms. This includes pain,  fatigue,  paralysis,  bowel symptoms,  headache,  seizures and rashes (amongst others). This type of presentation is common (see this article) and emotionally charged as people may feel they are being “fobbed off” or told their symptoms are not “real”. On the contrary, such a diagnosis accepts the reality of the symptoms, if it is felt that symptoms are reported but not experienced then someone is “malingering” or has a “factitious disorder” (Munchausen’s).

So what disorders come under this banner?

Electrosensitivity; CFS/ME; Fibromyalgia; Irritable Bowel Syndrome; Gulf War Syndrome; Non epiliptic seizure disorder.

I’ll focus on CFS/ME for a bit because it was mentioned on the Bad Science forum in conjunction with a “treatment” sorry “Training programme”  called the Lightening Process. I have no experience of the Lightening process but I am sceptical of the long term effectiveness of it.

As you can see from the page on I linked to there are some established treatments for CFS/ME and these are being investigated by a multi-centre trial, the PACE trial which is supported by one ME charity but not by others. There is even a NICE guideline on the assessment and treatment of CFS/ME.

The recovery from the symptoms of CFS can be slow and protracted, it takes effort to engage in the therapies that have an evidence base. It is also a chronic condition and may not be aknowledged by primary care physicians and others who do not have experience of the condition. This can therefore lead to dissatisfaction and a search for “alternative” treatments for which the evidence is lacking.


  • The anti-candida diet (has been found lacking)
  • Homeopathy (placebo sugar pills)
  • “Herbalism”
  • “Bio-energy treatments” (spiritual healing etc)
  • Geopathic/Electropathic stress (reduction)

All of which are pseudoscientific and no better than placebo, they can also be expensive and time consuming and result in an individual being symptomatic for longer.

CFS may well turn out to be a common final pathway but due to the nature of the disorder sufferers will continue to be preyed upon by charlatans and quacks.

If anyone with CFS does read this please read the information available here or here. Others services are available throughout the UK.


5 Responses to “It’s all in the mind surely?”

  1. Time for a couple of anecdotes : When I’m depressed, I sometimes suffer from things like tiredness, headaches, and IBS-like symptoms. These symptoms are 100% “real” (and a bloody pain) but I have no problem with accepting that they are an aspect of my depression. when my mood is good I just don’t get them. But if I refused to accept that I was “mentally ill” (as many people do and I did for a while), I can easily see myself getting a (mis)diagnosis of “IBS” or “CFS”.

    On the other hand, a friend of mine who has been diagnosed with both depression and CFS, swears that they feel very different. He has no problem with accepting the diagnosis of depression, but he’s adamant that his CFS is something else on top of that.

    Every patient is unique…

  2. soveda said

    Absolutely, that’s why you have to exclude depression when cfs is diagnosed. There is well documented comorbidity as well as misdiagnosis.

  3. But excluding depression isn’t easy. What if someone is having troubling accepting it themselves? They’d certainly not find it easy admitting it to the person who has to make the diagnosis.

  4. soveda said

    Hence the need for specialist services. Both specific CFS/ME and liaison psychiatry. The interface between so called mental health and physical health is a fascinating and important area for clinical work.

  5. The_Minkey said

    I have been slapped with a diagnosis of cfs. I fell ill back in June last year. I had a moderate level of symptoms initially, thankfully reducing to mild so was able to return to work reasonably quickly. After several months and lots of tests, I requested a referral to a fatigue specialist on the advice of the OH GP at work.

    I was rather surprised to find myself going to see a psychiatrist based at Kings Hospital in London. He ran through my medical history. I was completely frank about being a half pint empty kind of person and about the shit that has occasionally rained down at times I haven’t always been waterproof. However, it was his opinion that the symptoms I have been experiencing were due to cfs not due to depression. The psychiatrist btw had some input into the NICE guidelines (for what they’re worth) on cfs so I have to assume he was qualified to assess the difference.

    So, having had episodes of mild/moderate depression from time to time, none which had caused me to take any time off work, I can certainly attest to the fact that cfs is a different beast. I may have felt bad when depressed, insular, lacking in motivation, pessimistic, lethargic etc but I never felt physically unwell like I had an everlasting hangover. I never felt faint, desperate to lie down or nauseous, I never felt wired tired or unable to tolerate sunlight or noise.

    It’s now 7 months on and I’m not yet able to work to the same level I did before I got ill. I do 4 days a week, with a midweek day off to recover. There have been days, I can count them on one hand where I’ve felt a return to normality. Oh, and how wonderful it feels to be fully functioning. Still, I’m so lucky – it’s only in its mild form most days.

    A diagnosis of cfs is a curse. There’s no advice or support from the GP, whose sigh as you walk into his surgery has become audible. Your boss thinks you’re in the grips of a psychological condition. Your colleagues think you’re swinging the lead. You feel embarrassed having to explain to people why it is you can’t commit to social invites.

    It’s even got a lousy name. Chronic fatigue syndrome sounds like tired a lot of the time, if only it were..

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