Dr. Katrina Berne is a licensed clinical psychologist. She has had CFS since 1985 with secondary FMS, and specializes in treating patients with CFS/FMS. Obviously, as a patient and a psychologist, she knows whereof she speaks, and how to differentiate physical illness from psychiatric conditions.
"The medical profession often views depression or inability to cope productively with stress as the cause of any symptom for which a physiological cause is not evident. Psychiatry becomes a convenient dumping ground for those with unexplained illness. However, indiscriminate attribution of symptoms to psychological factors is inappropriate.
"... The notion that we cannot handle life, fabricate symptoms, or develop illnesses in order to receive special attention is ludicrous. Attribution of illness to such conscious or unconscious motivation is inaccurate, unfair and insulting. Phrases such as ‘can’t manage stress’ and ‘mind over matter’ add insult to illness. ... Some CFS/FMS patients experience little or no depression.
"Numerous chronic disorders share common features, including symptoms and abnormalities. The similarities are remarkable ... Skeptics who dismiss CFS, FMS ... imply that poorly understood conditions do not deserve the respect afforded ‘testable’ illnesses. This practice lifts a burden from disinterested physicians and blames – even traumatizes – sufferers.
"Double standards allow medical doctors to diagnose psychiatric illness ... in the absence of a known physiological cause, but do not typically allow the psychiatrist or psychologist who rules out emotional causes to rule in physiologic illness. That is, acceptable practice allows a physician to say ‘It is all in your head’ but how often does a psychiatrist or psychologist say ‘Nothing is wrong with your head, the illness is in your body’? ... Illnesses such as MS, rheumatoid arthritis, polio, HIV/AIDS, stomach ulcers and diabetes were once considered to be of psychiatric origin. When markers or diagnostic tests were developed, the diagnoses shifted to ‘real’ illnesses, those of the body. History repeats itself.
"...The history of psychiatric disorders in the CFS/FMS population is similar to that in the general population. ... Depression does not cause these syndromes and is not present in all cases; however, many patients are given a psychiatric diagnosis when a physiological diagnosis is not apparent. Overlapping symptoms ...and simple ignorance causes confusion between CFS/FMS and depression.
"The rate of depression is not necessarily higher in patients with the most severe symptoms. ... Nonantidepressant medications common in CFS/FMS treatment are not effective in treating [depression].
"Psychological tests are frequently used to ‘rule in’ depression and other psychiatric disorders; however, they cannot distinguish between a test-taker’s medical and psychological disorders. One who endorses numerous physical complaints is likely to be labeled depressed. ‘Results in ill populations may be falsely elevated for psychological disorders’ (Jason, Richman, et al. 1997).
"...When ‘neurological’ items were removed from the test and the tests were rescored, all scores dropped to within the normal range, that is, no elevations remained. This finding provides evidence that neurological dysfunction rather than psychopathology accounts for the typical CFS profile.
"CFS and FMS share common factors with somatoform disorders – multiple symptoms, lack of consistent lab findings ... but are excluded from this category by symptom prevalence, age, suddenness of onset, lack of prevalent personality disorders, and exercise and alcohol intolerance.
"The term functional somatic syndromes refers to suffering in the absence of specific medical findings. This term is often inappropriately applied to poorly understood illnesses such as CFS, FMS ... FSS disorders are framed with circular reasoning: ‘You think you have a serious illness but you don’t because we have no specific test for it.’ The alleged secondary gains of illness are typically absent, yet patients are accused ...
"... a diagnosis of FSS more often provides a convenient way to dismiss patients’ symptomatic complaints whose cause is unknown. The absence of diagnostic tests for many known disorders creates fertile ground for physicians who view any difficult-to-diagnose disorder as imagined illness. However an illness that defies current scientific knowledge is still an illness.
"... Although multiple symptoms are seen in somatization disorder, symptom clusters typical of CFS and FMS are not found in this group, nor is sudden onset, which often characterizes CFS/FMS.
"... Many diseases are labeled psychiatric or 'stress' disorders until causal agents or illness markers are identified, at which time they graduate to the status of legitimized, genuine illness."
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One of the things that was used in the early days of CFS to prove that patients were not merely hypochondriacs was the ability of patients who did not know any other patients to recite the exact same symptoms as the others.
One doctor accused me of being a hypochondriac because I showed up in his office in response to my husband reading a magazine article that described the symptoms I'd been having -- now that we recognized it as a serious condition that wouldn't go away on its own, we wanted medical help, but the doctor chose to believe the symptoms showed up only after I'd read the article (I wasn't well enough to read the article myself, so how could that be?).
The next doctor observed that I could not be a hypochondriac, because I was describing accurately symptoms that were NOT in the article, or in any other published article for the general public. The only way I could know what the next dozen symptoms on the list were (not just the half dozen in the article) was if, in fact, I had those symptoms. He had no difficulty giving me the correct diagnosis. I wasn't just picking symptoms at random, I was describing the same symptoms as every other patient; the odds of doing that by chance are astronomical.
Psych consultants have repeatedly stated that they find nothing to support a depression diagnosis. They know the difference between medical illness and depression, and I'm not saying the right things to convince them I'm depressed; I'm describing only those symptoms of depression that overlap with symptoms of the flu, and then I'm describing other symptoms that are definitely physical, because they're not seen in depression. Yet, the unanimous vote of the psychs that I'm physically ill has not prevented me from having a series of MDs contradict them by giving a psychiatric diagnosis that the psych experts themselves refuse to support.
As each piece of the puzzle falls into place, I get abnormal blood tests, etc., it's that much more damning evidence that those who think the problem is purely psychiatric are wrong. When I had the same symptoms that are now being blamed on mydivorce DURING the marriage, they were blamed on being married and I was told they'd go away if I got a divorce. That doctor refused to listen that the symptoms started BEFORE the marriage. (We've heard the same story from other women: those who are single are told they don't like being single and the problems will go away if they get married, and those who are married are told the cure is a divorce, and some are married/divorced/married/divorced and have the symptoms no matter what their marital status.)
My chiropractor gave me a "diagnostic profile test", and rather than just relying on the computer's numbers, he reviewed the actual answers. While the computer flagged me as depressed, he noted that everything I'd marked in that section was also cross-referenced in a physiological section of the profile; none of my answers in the depression category were to questions that would only point to depression -- the same questions were in the categories for chronic pain and other physical problems. Just like Dr. Berne's rescoring of the tests after removing the "neurological" questions proved the problem was neurological rather than psychiatric.
There's already more than adequate evidence that CFS is a physical illness, not a psychiatric one. Eventually, that evidence will become common knowledge, and those who have made erroneous psychiatric diagnoses and refused to accept the reality will be ostracized as uninformed and behind the times.
As Dr. Yunus has said "it's not the patients who are disturbed ... it's the doctors." They can't open their minds enough to accept the reality that CFS is, as patients have described, post-viral, and that the symptoms, while seeming disjointed to a PCP, made perfect sense to a neurologist, who instantly recognized the pattern.
