It’s All in Your Head!

A report from the US a few days ago confirmed that Gulf War Syndrome is a real illness and not simply a variation of Post-traumatic Stress Disorder or a figment of Gulf veteran’s imagination. The syndrome consists of persistent headaches, widespread pain, cognitive difficulties, unexplained fatigue, skin rashes, chronic diarrhoea and digestive and respiratory problems. The Gulf war veterans have been treated with profound medical skepticism for 16 years, since the first case was reported.

I am reminded of the attitude of doctors to Myalgic Encephalomyelitis, the scientific name for Chronic Fatigue Syndrome or so-called “Yuppie ‘Flu” or “Tapanui ‘Flu”. Even now, years after most authorities concede there is indeed such a disease, there are many doctors who still believe it is “malingering” or just another presentation of depression (Note to such doctors: You can find ME in the ICD10 classification of diseases, but NOT in the DSM4 classification of psychiatric ones).

In my various stints in general practice, I have treated many of these people. The attitudes of their bosses, their co-workers and even their relatives and spouses are often quite intolerant. Victims are often treated as if they were simply making up symptoms. They are treated with a disdain that we would hardly use on sufferers of similarly debilitating diseases such as rheumatoid arthritis.

What I find hard to understand, is how we manage to maintain these attitudes in the face of thousands of sufferers. CFS has a prevalence of about 4:1000 which translates to about 20,000 sufferers. The chances are high that you know at least one. Gulf War Syndrome effected about 200,000 US soldiers. This doesn’t strike me as a few malingerers trying to get off work, or opt out of life. These are people with a genuine problem who need our help and understanding. I am saddened that they often cannot find this in their family doctor.

We doctors often attempt to produce an aura of all-knowing infallibility. Patients prefer us to have all the answers – they find it reassuring. We are disturbed when it becomes apparent that there are many things we do not know and cannot explain. People find new ways to fall sick and new diseases arrive. People react in wildly differing ways to the same illness or the same drug. Medicine is, in fact, inherently unpredictable.

Doctors who ignore this uncertainty in their work do their patients a grave disservice. The entire Gulf War Syndrome episode illustrates this well. 200,000 people were denied medical assistance because their doctors had decided that their problem was “all in their heads” – that they had PTSD and needed psychotherapy. Their doctors walked down the path of established knowledge where they felt comfortable and refused to look at their own fallibility, refused to ask “have we got this wrong?”.

By no means do I think that doctors have a monopoly on blinkered arrogance. I just think that such a mindset in medicine leads to consequences that are both unpleasant and tragic. More than in any other area of life, a closed mind in a doctor is a recipe for disaster. 

Our only protection is a good dose of humility. One spoonful as needed, before opening mouth.

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