ME: all in the body?

There’s been yet another news story that purports to ‘prove’ that myalgic encephalomyelitis (ME, otherwise known as Chronic Fatigue Syndrome) is a ‘real’ illness rather than being ‘all in the mind’.1  To quote from the story:

The researchers, from Columbia University in New York, analysed hundreds of blood samples taken from ME patients and healthy people. The blood from those with ME showed a distinct ‘chemical signature’.

It had higher levels of various compounds released by the immune system to defend the body against infection. The link with an immune protein, interferon gamma, was particularly strong, the journal Science Advances reports.

This argument over ME has being going on for decades now and so have these kinds of ‘finally it’s proved..’ stories.  The problem with these reports is that they make good copy but bad science.  There are several issues I want to focus on here, and my intention is not to ‘disprove’ that ME is actually a physical illness (this misses the point completely about the nature of  illness –  ‘physical’ or ‘mental’), but rather to point out that there are some questionable assumptions being made here, particularly by the ‘it’s not in the mind, it’s a real illness’ brigade, which do nothing to help those who suffer from ME. 

The first point may seem a rather dry and philosophical one, but I think it should be noted that a statistical correlation is not the same as a proof of causation.  In other words, the fact – and I’ve no reason to doubt it is – that the blood samples from ME patients have higher levels of various compounds released by the immune system to defend the body against infection, does not prove that ME is caused by such compounds.  It is just as feasible to argue that these higher levels of compounds are triggered by mind, which believes the body is under attack by some some mysterious virus.  I’m not saying this is the case, but merely pointing out that such results have to be interpreted and treated with caution. 

However, I would argue that what’s really behind this is an ideology based on the notion that ‘biology’ equals ‘real’ whilst ‘psychology’ equals ‘unreal’.  In other words, if it can be demonstrated that a particular ‘mental’ or ‘psychological’ condition can be related to genes, compounds, proteins, neurotransmitters, or the like, then this ‘proves’ that such a condition is actually a ‘real illness’.  This kind of ‘reasoning’ is flawed in a number ways, not least because it makes an artificial distinction between ‘physical’ and ‘mental/psychological’.  As any GP will tell you, the mind and body are intimately connected to one another, and one cannot be treated in isolation from the other.  A classic example, of course, is the ‘placebo effect’, whereby a patient is given a ‘drug’ which is actually made up of a completely inactive substance, but because the person who prescribes it is seen by the patient as being in a position of authority, e.g. a medical professional or scientist, they feel a lot better.  This is not to argue that all drugs are placebos – this is patently not the case, but rather that biochemistry cannot be separated from psychology. 

This idea of a ‘mind-body’ split is an age-old philosophical problem, but one which has, unfortunately, real clinical consequences.  What we should be asking, perhaps, is not whether ME (or any other ‘psychological’ illness/condition, syndrome) is ‘really’ a ‘physical’ illness, but, rather, why do ME sufferers object so strongly (and many of them do) to the possibility that ME is a ‘psychological’ condition in the first place?  Is it because they think there is a stigma attached to the idea of having  a ‘psychological’ or ‘mental’ illness or condition, whereas having a ‘physical’ illness is somehow more acceptable (to whom)? 

There is no doubt that there has been – and in some quarters continues to be – a great deal of ignorance surrounding the nature of ‘mental’ illness  However, I would argue that there is no less ignorance surrounding many people’s understanding of ‘physical’ illness.  Unfortunately, the mainstream media do nothing to improve knowledge and understanding, but rather continue to perpetuate the myth that ‘physical’ equals ‘real’ and ‘psychological’ equals ‘unreal’. 

  1. Fiona Macrae, 2015. Proof at last that ‘yuppie flu’ is a real illness. Mail Online. Available at: http://www.dailymail.co.uk/health/article-2972865/Proof-yuppie-flu-real-illness-Study-finds-chronic-fatigue-commonly-seen-professionals-not-just-mind.html [Accessed March 2, 2015]. []