Karen Hitchcock (September) tells us that sick people are often “medically well”. This wellness is determined on the basis that their tests for recognised diseases turn out normal. Surely, this kind of diagnosis denies the part of people’s unwellness that is not covered by the tests. On this basis, mainstream medicine largely ignores the diseases she mentions, such as myalgic encephalomyelitis (ME), chronic fatigue syndrome (CFS), multiple chemical sensitivity and Lyme disease. Because of this attitude, many patients have met with contempt and even abuse from some doctors. No wonder they turn to alternative medicine. There, at the least, they get some respect.
It may be that societal contexts need to be considered and some people feel awful because they are miserable, but this doesn’t justify leaping to the conclusion “it’s not your body that is sick” and grafting Freudian speculations onto the patient’s experience as a way of filling the knowledge gap. It is unsafe and unscientific to assume it is all about existential angst and poor self-care.
Dr Hitchcock’s claim that “psychological work and exercise treatment” ought to be recommended is misguided and damaging to many patients in the short or long term. Alas, these are recommended too often. Even the major study on which her claim seems to be based found that 52 weeks of exercise training produced no practical improvement in average walking ability and cognitive behaviour therapy improved it not at all.
Some patients die of these “non-existent” diseases. The autopsy of Sophia Mirza, who died at 32 as a result of ME/CFS and who was assumed to have a psychosomatic condition, showed extensive inflammation of the spinal cord (dorsal root ganglionitis).
Dr Hitchcock’s article, while stating some truths, ignores the imperfections of medical diagnosis and patients’ suffering. It is likely to increase patients’ sense of invalidation and distress.