CFS psychological or physical?This seemed such a stupid question that I never bothered to consider it. I estimate I must have now seen over 1,000 patients with CFS and it is clear CFS is primarily a physical disorder. It is only when patients have been ill for several months and been told by their physicians that nothing is wrong that they get secondary psychological problems. The only place where CFS does not exist is in the brains of small-minded doctors.
The reason the "physical or psychological" debate continues is because the usual tests for pathology come up showing normal results. GPs find ill patients, do the usual screening tests which come up normal and feel this allows them to turn round to patients and conclude there is nothing physically wrong. If, however, the screening tests included SPECT scans, sensitive tests of the hypothalamic-pituitary-adrenal axis, T cell subsets, biopsies to look at mitochondrial abnormalities, enterovirus sequences in muscle and brain, trace element levels, vitamins, essential fatty acids and amino acid profiles, then lots of abnormalities would be found. Doctors would diagnose serious metabolic and hormone problems and patients would be taken more seriously.
I believe the fundamental problem in CFS patients is that they have lost their ability to respond to stress, be this physical, mental, nutritional, emotional, infectious, financial etc. Our systems can be likened to a car - when we are pottering, we are in first gear. But as soon as the pressure goes on, we need to move up a gear or two, or three gears, or occasionally into overdrive, to cope with the situation. We can do this by releasing stress hormones from the hypothalamus, pituitary and adrenal glands producing adrenaline, cortisol, sex hormones etc. This effort can be sustained for a short length of time but eventually the person must "recharge the batteries" with good food, holidays, fresh air and sleep.
A CFS patient is burnt out - usually by overstressing him/herself with work, sport, family commitments combined with insufficient rest, poor quality food, allergies, acute or chronic infections, excessive alcohol/smoking/sugar, chemical overload etc. He/she has lost the ability to produce stress hormones and is stuck in first gear. Increasing stress (accelerator pedal) simply makes the engine scream without going faster. Furthermore, the patient often does not sleep well and this compounds the problem. I could stock a good Olympic team with CFS sufferers - top athletes stress themselves hugely and put themselves at greater risk of getting CFS.
With any illness there is a psychological component, but with CFS this is secondary to a physical illness. I am always amazed how well adjusted are my CFS patients and depression is not a common feature. The difference is that CFSs want to do things, but if they do they feel ill. They also tend to wake late. With depression, patients don't want to do anything, but if you push them to exercise, they actually feel better. Usually they have early morning wakening. I suspect this is why the "stimulating" antidepressive drugs seem to make CFS worse - they increase the desire without improving the performance and therefore worsen the frustration.
This describes my general state of mind perfectly. I also know that graded excersize and low level anti-depressents do nothing for me except worsen the symptoms - just as he says. This is why I'm now a little concerned about the CBT I'm undertaking.
On the one hand I do have a lot of issuse I need to resolve and I think this lass may be able to help with that, but as far as the CFS itself is concerned, I don't think it will have much of an effect.