The Great Imitators Part One
Topic: Medical Care

The Great Imitators are those pesky diseases which have symptoms in common with other conditions. This makes the job of determining the proper diagnosis a bit more tricky in some cases. The Great Imitator label was originally applied to Syphilis, but now equally fits and applies to other diseases as well including Lyme Disease, Fibromyalgia, Lupus, MS, CFS/CFIDS/ME, AIDS and various others. The great imitators are often bacterial or viral in origin. Some of these conditions are better understood than others, and the medical research continues....

Some interesting information about the great imitators which will be explored in this series includes:

• People with Lyme Disease and Lupus can test false positive for Syphilis

• Some of these great imitator illnesses have similar effects on the heart

• Patients with Lyme can develop brain lesions and myelin damage just like patients with Multiple Sclerosis

• MS may very well be a spirochete bacterial infection-caused disease

• Patients with Lupus appear less likely to get HIV/AIDS

• Patients with CFIDS/ME develop defective red blood cells

• Patients who have CFIDS/ME or chronic Epstein Barr are at a higher risk for developing lymphoma. And interestingly, sometimes lymphoma is misdiagnosed as Fibromyalgia

• The Lymerix Lyme vaccine was pulled from the market following a class action lawsuit by injured patients, because people who have the gene HLA-DR4 can develop permanent and debilitating autoimmune illnesses after receiving the vaccinations

• There are links between the Lyme Borrelia bacteria and some cases of ALS, Autism and Alzheimer's Disease

• Some patients with Lupus are diagnosed with Fibromyalgia as a co-condition.

Beware The Fibromyalgia Diagnosis Part Sixteen
Topic: Medical Care

The Dangers of Designating Fibromyalgia and Chronic Fatigue Syndrome as “Abuse Illnesses”- Part 2

Fibromyalgia and Chronic Fatigue Syndrome as forms of Hysteria

Sigmund Freud once asked “what do women want?” and the behavior of the psychotherapists who followed his model showed how poorly they understood. The way that psychiatry and psychology diagnostic manuals are written today, women with chronic pain are expressly singled out as much more likely to have psychosomatic, rather than real pain conditions. The long list of very real chronic illnesses once thought to be psychiatric demonstrates that this is a position of prejudice, not science. It is institutionalized misdiagnosis, based in an ancient belief that the womb makes women hysterical. To treat women as dysfunctional males and so to disregard the health and welfare of half the human race not only damages the scientific efforts to understand the medical health of women, but of men as well. To fail to understand women’s health is to fail to understand human health.

Although women are more likely to have autoimmune diseases and chronic pain conditions, men have these conditions and are treated with prejudice too. All people in pain can potentially be treated as if they have a mental health problem, or drug problem, instead of a physical condition by doctors. All these patients have families and communities who are impacted by these conditions. When pain and chronic illnesses are dismissed, misdiagnosed as mental conditions, and under-treated, everyone suffers.

(“A Manifesto for May 12: What do we want?”, by Stephanie Hall http://sa-hall.livejournal.com/16752.html)

 

Hysteria may likewise be interpreted as the product of a paranoid-schizoid dynamic in which individuals who have split off and disowned their own aggressive and destructive impulses suffer from phantasies of attack and an abiding sense of being made ill by hostile forces, either within the body (as in “fibromyalgia syndrome” and “chronic fatigue syndrome”) or outside it in the environment (as in “environmental illness” or “multiple chemical sensitivity”), but in any case from outside the self.

We have described the tendency of hysteric patients to regard their symptoms as residing in the body but unrelated to the self, that is, existing as a foreign, invading force, in but not of the patient. In paranoid-schizoid functioning, the subject may disown or evacuate his internal bad self and objects, project the split-off contents and, as a consequence, perceive the external world as independently bad and dangerous. To complicate matters further, in an attempt to manage the external persecutors thus created, he may reintroject them. Segal’s observation regarding the introjection of persecutors and subsequent hypochondria (in which the persecutors are felt to be attacking from within the body) illustrates the conjunction between paranoia and hysteria...

According to Segal, “The projection of bad feelings and bad parts of the self outwards produces external persecution. The reintrojection of persecutors gives rise to hypochondrical anxiety”... While there are grounds for maintaining the distinction between hypochondria and hysteria, viewing the former as one type or manifestation of the latter, it is reasonable to extrapolate a reciprocal connection between paranoia and hysteria by way of this connection between paranoia and hypochondrical anxiety. Both involve projection and a resulting experience of attack and persecution, in one case from without, in the other from within. But the psychoanalytic literature has tended to treat paranoia and hysteria as discrete conditions, and these citations from Segal (1964) may be one of the few places where paranoia and hypochondria, and correspondingly hysteria, are explicitly brought together.

(pp. 37-39, Fugitives From Guilt: Postmodern De-Moralization and the New Hysterias”, by Donald L. Carveth, Ph.D. & Jean Hantman Carveth, Ph.D., http://www.yorku.ca/dcarveth/Hysteria.htm)

 

Fibromyalgia as an 'oppression of women' based-illness

Most important, although classified as a‘chronic’ illness, it can be so completely treated that I’d almost be tempted to use the word "cured." The only problem with stating "cure" is that if the same circumstances that brought the disease in the first place manage to return — resetting the stage, so to speak — then symptoms begin reappearing. If, however, someone with fibromyalgia learns from the experience, deals with whatever set the stage, and makes appropriate life changes, the condition can disappear. Forever...

Symptoms as Messages
When annoying, persistent, or especially uncomfortable sensations persist in the body, we call these sensations "symptoms." Sneezing is a symptom but may not mean a disease. Most symptoms, in fact, do not mean "disease," and do go away by themselves. Even longstanding symptoms are frequently just messages that your body would like you to heed. Painful knee when you jog? Stop running for a while. Get a headache at four o’clock every day? Regard the headache as a message, and think about changing your lunch. If you change your habit and the headache vanishes, you’ve learned something and found a way to improve your health.

Now let’s apply some of this "body message" stuff to fibromyalgia. That the condition afflicts mostly females begs us to hunt for some meaning. There’s a message here...and it’s really no surprise. After years of listening to life stories from patients of both sexes, I am thoroughly convinced that women go through life both experiencing and then internalizing more day-to-day stress than any male could ever imagine. Any historically oriented feminist will tell you the situation: by being compelled to share the planet with creatures whose testosterone hard wires aggressiveness, and by being deprived of sufficient muscle mass to defend themselves, women, from the moment they are born, struggle, endure, and too often must submit to a hostile, polluted, threatening world they might never ever have created had they been in charge.

So here is a sweeping generalization about fibromyalgia: virtually every single case I’ve encountered in my practice has emerged when the background "white noise" of chronic stress either becomes intolerable or is escalated by new events in a person’s life. And, to take this one step further, fibromyalgia is not so much a disease with a definable villain (like a virus, or an immune problem) but rather a physical reaction to stress that spins out of control. Fibromyalgia is a system breakdown, sort of like what would happen to your car engine if you floored the accelerator with the transmission in neutral. Stressed men tend to get heart attacks and ulcers, or languish in depression. Stressed women might be vulnerable to fibromyalgia.

The Body Reacts to Industrial Strength Stress
First, let’s talk about muscle pain. Here’s a piece of troubling data: a study from England showed that about 15 percent of women with fibromyalgia came from abusive homes. Imagine yourself in this painful scene: you’re a child with an alcoholic, violent, and unpredictable father who is arriving home from the pub. You’re seven years old and one of the household gods is angry. You just might get hurt. You brace yourself for the worst. Stop now and picture what "brace yourself" means: body into a protective position, muscles taut, head down, shoulders forward, back rigid to ward off real (or imagined) blows. Whether or not you actually get hit, you assume this basic instinctive posture. Protective posture is present in children of both sexes, but some of us carry it into adult life. ("I carry all my stress in my neck"). We instinctively tighten our necks and upper backs when attempting to protect ourselves from stressors, physical and emotional, perhaps warding off the blows from life itself. Eventually, something changes in the muscles themselves: locked in a position to protect the body, key points, the "tender points" are palpable areas that really hurt when touched. The chronic stress and the chronically "locked" position have somehow changed the muscles.

But although the neck and back are fibromyalgia’s most painful points, sufferers report discomfort throughout the body, as if all the muscles were in spasm. In fact, they are. Intense muscle contractions are one of the "correct" responses to a sudden unexpected stress, through a complicated but involuntary pathway involving both the nervous and endocrine systems. An example: you’re walking down the street and suddenly confronted by a mugger. There’s an immediate involuntary transmission of information through your nervous system ("DANGER!"), relayed from your brain, down through your pituitary (or‘master’) gland, to release adrenaline and cortisol from your adrenal glands. These tighten your muscles in preparation for fighting or running away. Your adrenals: two bean sized glands atop the kidneys, which release a variety of hormones during any stress. However, we only need these hormones for special occasions, as we’re not constantly getting mugged. Or are we?

Remember, stress — real unadulterated stress — may well be the unwanted traveling companion for many of us, especially women. Going through a day expecting to be physically or emotionally attacked, or simply trying to survive in a world where there’s no sense of control, one’s adrenal gland switch stays "on." What follows are just about every one of the accompanying symptoms of fibromyalgia.

Here’s a list of what chronic and inappropriate cortisol and adrenaline secretion can cause: adrenal exhaustion (fatigue, a weakened immune system, low blood pressure); brain fog (excessive cortisol is toxic to brain cells); weakened thyroid (fatigue, cold intolerance, weight gain despite calorie restriction); "fear" responses (cold hands and feet, palpitations, chronic anxiety, tightness in the throat, insomnia, irritable bowel syndrome). In turn, the weakened immune system predisposes to recurrent colds, vaginal yeast infections, sinusitis, and intestinal parasites. In other words, all the symptoms of fibromyalgia...

Again, I can only repeat...virtually every case of fibromyalgia I’ve seen begins with a series of heightened stress "events," usually uncontrollable, as stressors often are, and just endured. Here’s a typical comment: "Well, I’m always a wreck, but the year before my‘fibro’ began was the worst year of my life. My husband lost his job and I had to go back to work full-time. After a slow course, my mother died of cancer. I took care of her without any help from my brothers. Then I discovered my teenager doing drugs. I can’t believe I made it through the year."...

Who gets "cured" of fibromyalgia? The lawyer who walks away from her eighty-hour workweek and takes a lesser-paying job at a bank (or becomes the forest ranger she always wanted to be). The middle-aged empty nester who finally throws her chronically unfaithful husband out of the house and returns to the sculpting career she gave up 30 years earlier. The victim of childhood sexual abuse who, through counseling and support, need not forgive her abuser, but at least can move on with her life.

(“Fibromyalgia”, by David Edelberg, M.D. http://www.consciouschoice.com/1999/cc1202/fibromyalgia1202.html )

The Fibromyalgia Diagnosis and Socioeconomics and Criminology

There's an underlying social-class and criminological aspect to the Fibromyalgia diagnosis as well. These patients are lower class poor and lesser educated women who are the offspring of the dregs of society- mentally ill, drug and alcohol abusing criminals whose targets are often their own family members via wife beating, child beating, child neglect, child molesting and child rape. These highly dysfunctional families are from socioeconomically depressed areas with higher crime rates. The physically and emotionally 'damaged goods' female fibromyalgia patients further extend their lowly status by staying lesser educated, by working in low wage jobs, and by abusing substances themselves. They remain in socioeconomically depressed and unsafe neighborhoods which increases their risk of further sex crime victimization. And they choose lovers and spouses from the societal low-life pool of girlfriend/wife beaters.

Studies conducted in the last few years show that fibromyalgia patients have a significantly increased risk of having a history of sexual, physical, or drug abuse, eating disorders, mood disorders, attention deficit disorder, phobias (unrealistic fears), panic, anxiety, somatization, and a family history of depression and alcoholism. They also show that fibromyalgia patients cope less well with daily problems than others and are more susceptible to psychological stress....Certain studies also suggest that there is more alexithymia, a longstanding personality disorder with generalized and localized complaints in individuals who cannot express their underlying psychological conflicts. As a consequence, some behavioral experts have proposed that fibromyalgia is an affective spectrum disorder in which a primary psychiatric disorder with a possibly inherited abnormality leads to pain amplification and fibromyalgia-related complaints. (pp. 74-75, “Fibromyalgia”, by Janice Brock Wallace)

Fibromyalgia and Chronic Fatigue Syndrome: the direct result of physical and sexual assault and abuse

Fibromyalgia:

Physical or sexual abuse is another type of trauma that may lead to fibromyalgia. Some people were subjected to physical or sexual abuse during their childhood, while others are abused in adulthood. Jeanne calls herself an “incest survivor” because a family member sexually abused her when she was a little girl. Jeanne says that she suffered from extreme stress that stemmed from the abuse, and she later developed fibromyalgia as well.

In another case, Sara, who was physically abused by her husband, says that various doctors suspected that her fibromyalgia was triggered by a near-death beating that she suffered, during which she suffered a serious head injury and neck trauma.

Some people who were abused as children continue to be abused as adults by their spouses or other individuals. All that physical battering can eventually take its painful toll on the human body, and sometimes the “price” is fibromyalgia....

Being treated and getting counseling for factors such as domestic violence or childhood abuse may be as important in your therapy as any medicinal treatments. (pp. 39-40, “Fibromyalgia for Dummies”, by Roland Staud, Christine A. Adamec)

Chronic Fatigue Syndrome:

The idea that some CFS patients have a form of post-traumatic stress disorder (PTSD) is an attractive one, since a history of child abuse is fairly common, and so is high life stress prior to onset of illness. (p. 154, “Chronic fatigue syndromes”, by Jay. A. Goldstein)

Fibromyalgia and CFS:

...many clinical and physiological clues appear to link fibromyalgia/CFS to a traumatic etiology. The predominance of fibromyalgia and CFS in women (> 75 percent), gender prevalence of physical and sexual abuse in women, and the tendency for women to dissociate with trauma and to develop typical PTSD...place them at greater risk for both conditions. Similar hormonal markers, arousal sensitivity, and symptom complexes of fibromyalgia/CFS and PTSD demand consideration for an etiological relationship between trauma and the fibromyalgia/CFS syndrome. (p. 80, “The body bears the burden”, by Robert C. Scaer)

Fibromyalgia and CFS equated with a lifetime of relationship abuse:

Women who were raised in addicted, mentally ill, abusive, or pathological families often have the most severe and lingering of medical symptoms and diseases. One reason is that they have an accumulative effect of stress-related disorders because of the length of time they have been 'stressed.' Since many women who were in disordered families go on to pick disordered men, their stress simply rolls over into the next relationship.

Or if she is able to avoid the disordered intimate relationship, her previous exposure to the disordered family or resulting stress may go untreated. In those cases, the stress is still stored in the body.

We now know that stress has to go somewhere. It goes into your body as deep as the cellular level as well into your muscles and tissues. This type of stress storage can result in diseases that effect the muscles and tissues like MS, Lupus, Fibromyalgia.

Stress attacks the immune system and renders it ineffective. This can result in diseases like Chronic Fatigue Immune Dysfunction Syndrome, Epstein-Barr Syndrome and other auto-immune disorders like Lupus and Fibromyalgia that end up moving from the immune system to the muscles and tissues...

Stress screams to be managed which is why so many women end up with addictions trying to 'manage' the chronic stress condition -- addictions with anxiety medication, pain meds, street drugs, alcohol, food, sex, religion and overachieving....

Over the past 20 years of treating women, I've seen everyone of these disease processes at work in women. PATHOLOGICAL RELATIONSHIPS ARE A LEADING NEGATIVE CAUSE IN WOMEN'S HEALTH ISSUES ON EVERY LEVEL!

If we want to improve women's health in this country, we need to address these pathological relationships that are killing her!

Stress hides because we are adaptive in some ways and become 'use to' the level of stress we are currently under OR have ALWAYS been under since childhood. But that doesn't mean we aren't highly damaging our bodies with it. Some women only become aware of their stress if it jumps markedly. By then, you are in the severe category of stress disorders which by that point, you probably have several of the conditions listed above.

By far, the condition of the 21st century for most people is stress. Women with histories of abuse or current pathological relationships have even higher stress levels than people without these contributing factors.

(“Your Medical Conditions—Is the Root Your Relationships” by Sandra L. Brown, CEO of The Institute for Relational Harm Reduction & Public Psychopathy Education

http://howtospotadangerousman.blogspot.com/2008/05/your-medical-conditions-is-root-your.html)

Theories versus realities:

If women and girls, particularly low-income white women and girls, weren't abused by the men in their lives, Fibromyalgia and CFS wouldn't exist, according to this theory. The reality is: Middle income and even a smaller number of upper income patients are being diagnosed with this illness. Men are diagnosed with it too- these are not just women's illnesses. Blacks, Hispanics, Asians and American Indians are diagnosed with these conditions. Police officers, firefighters and EMTs are being diagnosed with FMS and various other autoimmune disorders. Nurses are apparently at a higher risk for developing CFS. Every one of these patients isn't a physical or sexual abuse victim either. Every one of them isn't mentally ill. Nor are they all fragile hot-house flowers who aren't capable of understanding their own feelings, who can't handle the stress related to life's ups and downs.

So what is really going on here with all the game playing with pretending these two illnesses are the psychosomatic disorders of poor white women with little education who've been abused their entire lives?

Playing Games with the Serious Issue of Child Abuse

Child abuse and neglect are not laughing matters. Intentionally setting aside two medical diagnoses, (which are then deemed as psychosomatic in nature) to serve as the diagnostic dumping grounds for low-income white females who are abuse victims does nothing but re-victimize these patients. Labeling all the physical health problems and medical conditions they develop and experience as 'mental illnesses' dehumanizes these patients and strips them of all credibil ity as human beings. What is essentially being said is abuse victims are all emotionally unstable flakes with no real medical problems who 'fake' illnesses because they can't deal with the emotional turmoil of being abuse victims. These are people who are never to be taken seriously. The especially sad part to this is people from life-long socioeconomically deprived backgrounds are often the most at risk for developing various (and multiple) physical chronic medical conditions specifically because their life-long economic deprivation has left them vulnerable to malnutrition issues; to exposure to pollutants and toxic substances in their air, water and soil; to exposure to mold, peeling lead paint and diseases wrought by vermin (rats, roaches, mice, fleas) by living in substandard housing; and poor and inconsistent access to decent quality healthcare- these are all conditions which can cause or greatly contribute to ill health and the development of chronic illnesses and diseases.

Under these circumstances, a fibromyalgia and/or CFS diagnosis can be potentially harmful to any patient, from any socioeconomic background, considering these diagnoses come with a lot of 'bad baggage' attached to them- baggage which newly diagnosed patients may be totally unaware. This baggage can destroy the patient's credibility among some care providers. The patient merely becomes a flaky, non-credible, attention-seeking hypochondriac 'head case' whose physical medical problems aren't real, but are actually psychiatric-disorder based.

The Fibromyalgia Diagnosis as a 'cause celebre' for preventing child abuse:

Stephanie Hall's rather telling and disturbing blog entry: “What do you do when your therapist goes crazy?” serves as a warning which should be heeded regarding game playing within the psychotherapeutic community by using Fibromyalgia patients as pawns over the child abuse issue. Stephanie- a patient with Hashimoto's Thyroiditis and Fibromyalgia- was forced to fire her therapist over the therapist's obsession with Fibromyalgia as a child abuse-caused illness and her dogged determination to make Stephanie conform to that belief. Her former therapist's words to Stephanie during her exit interview say it all:

http://sa-hall.livejournal.com/11043.html#cutid1

The Chronic Fatigue Syndrome Diagnosis as a 'cause celebre' for preventing child abuse:

It seems as though every time we discover how truly damaging child abuse is to people throughout their lives, we learn even more facts about the effects of abuse and neglect. Emory University School of Medicine, in Atlanta, Georgia conducted a study that draws a direct connection between child abuse and neglect and the onset of Chronic Fatigue Syndrome during adulthood. The study was published in the January 2009 issue of the Archives of General Psychiatry.

People diagnosed with Chronic Fatigue Syndrome have a high incidence of experiencing neglect and/or abuse during their childhood. In addition, the subjects in the study with CFS also had suppressed levels of the hormone, Cortisol....

It is known that chronic stress and trauma, as occurs in abusive situations, ramps up the immune system, keeps it activated more than it should be until the system reaches a point where it is no longer able to produce enough cortisol to keep things running smoothly. In this case, the result is Chronic Fatigue Syndrome.

This degenerative process can continue into adulthood if stress and abuse continue. In addition, there is nothing to prevent the same process from starting once already into adulthood. In other words, trauma and stress, if they are chronic, has damaging physical effects at any point during life.

It is estimated that 2.5% of the adult U.S. population suffers from CFS. It is also estimated that four in every 1000 people have experienced abuse when they were children.
How do we stop this problem?

(“Child Abuse and Chronic Fatigue Syndrome” by Allan N. Schwartz, LCSW

http://www.mentalhelp.net/poc/view_doc.php?type=weblog&id=591&wlid=5&cn=5)

Beware The Fibromyalgia Diagnosis Part Fifteen
Topic: Medical Care

The Dangers of Designating Fibromyalgia and Chronic Fatigue Syndrome as “Abuse Illnesses”- Part 1

An Analysis of the “Typical Fibromyalgia Patient” Profile

The so-called typical fibromyalgia patient is a middle-aged white woman from a low-income household. She is minimally educated and likely grew up in an unstable and violent household and community, and has carried this instability forward into her adult life through poor personal life choices. She carries “bad thoughts” in her head, and engages in “bad lifestyle” habits which are destroying her body. She chooses the wrong men (men who are physically and/or emotionally abusive towards her) to date and/or marry. Repeated physical abuse and sexual abuse victimization are part of her life experiences, likely throughout both childhood and adulthood. Consequently she cannot handle stress, and cannot fully understand nor deal with her inner emotional turmoil which causes her to develop mental health issues. All these events create a 'perfect storm' which causes both her psyche and body to break down, resulting in “fibromyalgia”.

She's diagnosed with fibromyalgia because she's a poor white girl with no education

...A Swedish study also found a relationship between FMS and occupational rank (Hallberg and Carlsson 1998). This study was based on interviews with twenty-two Swedish women with fibromyalgia. Among other things, the researchers found that unsatisfying work- including that which was low status, strenuous, and tedious, and that over which women exercised little control- characterized the occupational settings of women with FMS. With few exceptions, these women had low levels of education, and worked in female-dominated occupational catergories in the “reproductive” sector, including healthcare, childcare, and eldercare services...

Overall, there is strong evidence that education is inversely related to FMS symptomology in both clinical and community populations. A large community prevalence study conducted in Wichita, Kansas clearly demonstrates this relationship (Wolfe et al. 1995). For example, this study found that the odds of not completely high school were three and half times higher among those who met the FMS criteria than among those who did not. Clinical studies also reveal the negative association between the prevalence and severity of FMS symptoms and educational attainment, including a reduced likelihood of completing high school and of graduation from college (Goldenberg et al. 1995; Wolfe and Michaud 2004).

...Kevin White et al. (1999) found that patients with FMS were less likely than other patient sufferers to have completed high school and less likely than the general public to have a college degree. Makela and Heliovaara (1991) found a dramatically higher incidence of FMS among those who attended only primary school compared with those who graduated high school...In sum, the negative relationship between FMS and education is found in community and clinical populations both within and outside of the United States.

Together, these data on income, occupation, and education, suggest that FMS is associated with less rather than more class privilege....At the same time, however, there is a curious underrepresentation of women from certain social groups that are associated with the very least class privilege, namely, racial and minority women. Startling, for example, is the fact that among low-income African Americans (most of them women) with musculoskeletal pain, only 3 percent met the FMS criteria (Bill-Harvey et al. 1989).

...FMS is not primarily a disorder that affects privileged women, but neither is it found uniformly across all categories of disadvantaged women. Community prevalence studies that are not biased by differences in health care access or utilization consistently find racial and ethnic minorities underrepresented among those who meet the FMS criteria. (pp. 169-170, “The fibromyalgia story”, by Kristin Kay Barker)

The bad thoughts spinning around her head

Fibromyalgia patients are portrayed as women with self-esteem problems and psychological issues. Their thoughts are filled with underlying rage and anger towards others, combined with self-hatred issues. Consequently their minds are filled with repetitive and racing negative thoughts and emotions which they don't know how to process, work through and resolve. They cannot describe their feelings to others and cannot even describe their feelings to themselves. This “stinkin' thinkin'” is viewed as an important causative factor behind their illness. Fixing this flawed and dysfunctional thinking is seen as a crucial part of their recovery.

Before you start any recovery program, follow these eight steps.

1. Get rid of the negative thoughts in your head. Don't be your own worst enemy. If you really believe your fibromyalgia is a fait accompli, the inevitable outcome of the bad luck that has befallen you in this miserable life, it's time to change the direction of your thoughts. Get the negative thoughts out of your head. Negative thinking is not only a wellspring for the symptoms of fibromyalgia but is also the driving force behind many other chronic health conditions. (p. 123) (“Healing Fibromyalgia”, by David H. Trock, Frances Chamberlain)

There are many good reasons why it is helpful for a person who has fibromyalgia and/or chronic myofascial pain to keep a journal...

• When your thoughts are constantly racing around in your head and the same negative ideas are repeating over and over, like a record stuck in the same groove, you get the most devastating type of negative reinforcement. You become your own worst enemy. You will find that putting your thoughts down on paper will enable you to sort and examine your ideas and feelings. Doing this can help silence the inner negative dialogue that can be so harmful to your self-esteem and sense of self.

• A journal is a safe place to deal with negative emotions. Think of it as a completely trusted friend. It can be like a drain in an infected wound, allowing the negative emotions of the past to seep away, so that true healing can begin. The pain, rage, or fear that you might be unable to express to another human being can be safely expressed on paper. When you have finished writing, the negative emotions may have lost some of their intensity and some of their ability to make you unhappy may be diminished. You may be able to think more clearly, or to think new thoughts, and you may gain a broader perspective. (pp. 194-195, “Fibromyalgia & Chronic Myofascial Pain Syndrome: A Survival Manual, Second Edition”, by Devin Starlynal and Mary Ellen Copeland)

Portrayal of the “Typical Chronic Fatigue Syndrome” Patient

Chronic fatigue syndrome patients are also portrayed as abuse victims suffering from psychological problems and mental illnesses. But unlike fibromyalgia sufferers, CFS patients are better off socioeconomically and educationally than their FMS suffering friends. CFS patients are the overly ambitious workaholics whose endless hours on the job cause their bodies to physically break down resulting in a chronic fatigue illness.

...High rates of personality disorders, including histrionic, borderline, obsessive compulsive and avoidant have been diagnosed in CFS patients...

...Two studies using the Minnesota Multiphasic Personality Inventory (MMPI), which assesses personality traits, have reported elevated mean profiles on the hypochondriasis, depression, hysteria and neuroticism subscales...This finding suggests that certain personality traits in CFS patients may not be solely a response to the illness. It may be that these personality traits are risk factors for the development of the illness...

Perhaps more relevant to CFS is sufferers' personal portrayals of their premorbid personalities. CFS patients typically report that prior to their illness they were highly active, ambitious people who were constantly on the go, taking more care of others' needs than their own. (p. 64, “Chronic fatigue syndrome”, by Rona Moss-Morris, Keith J. Petrie)

The Fibromyalgia and CFS Diagnoses as a modern version of 19^th century “female hysteria”

Fibromyalgia as a “hysteria” condition is the modern day version of 19^th century attitudes towards women as emotionally fragile hysterics, as a result of their inferior female sex. There's a definite Freudian bent to this as fibromyalgia and CFS are supposedly psychosomatic illness related to reactions towards sex and other forms of 'touching' done by men- in this case inappropriate touching and sexual contact via child beating, child molestation, child rape, wife/girlfriend battery, and adult rape- which causes the weak female psyche to break down and develop somatoform illnesses. Another less violently themed tack along the same lines equates the development of fibromyalgia with women's reactions to oppression by a patriarchal society and culture, or as an emotional reaction to being jerked around in romantic relationships.

Excerpts from “The Bewitchery of Medusa. Fibromyalgia: Parallelism Between Myth and Illness” by Jorge Alberto Pina Quevedo:

...In our souls exists all that we human beings have experienced over and over again since the very beginning of human existence on Earth, and this wisdom becomes visible through several expressions including dreams, art, myths and in some cases a physical illness. When people are ill, there is for them an opportunity to find out what is going on deep in their souls because, frequently, a physical illness is an expression of a wound in the soul.

This may be the case of people with diagnosis of Fibromyalgia....Fibromyalgia is a very old feminine illness or better said, an ancient illness of the feminine.

The Bewitchery of Medusa

The diagnosis says: "Fibromyalgia is a generalized, diffuse, intense and profound pain all around the body accentuated in the back of the neck and from there extending to the shoulders, for a period of at least three months". But it would not be fair to ignore the many more symptoms which make hard and painful the simplest daily activities. People diagnosed with Fibromyalgia suffer at three levels: physical, cognitive and emotional.

Among others, the physical symptoms include fatigue, headaches, colds, inflammations, stomach disorders, rheumatoid conditions, vertebral disc problems, lost of hair and high levels of metals in the blood. At the cognitive level the diagnosed people have to face difficulties to understand and to express ideas, to solve common job and home problems and the lost of recent memory. At the emotional level they experience, frustration, rigidity, depression, and stubbornness.

My presentation refers to the parallelism I have found between the Fibromyalgia syndrome and two Greek myths: The first one is the myth of Medusa....the story of Medusa speaks metaphorically about the psychological root of the illness, in particular the first wound inflicted to a woman by an older woman. The second one is the myth of Perseus, which on the one hand is related to complementary aspects of the origin of the illness, specially about the second wound inflicted to a woman by a man, on a daughter by her father...

The Myth of Medusa tells the story of an enchanting woman whose most beautiful characteristics were her skin, her voice and her hair, and because of her feminine, sensual and lovely appearance many men and even gods desired to be close to her. One day, Poseidon raped Medusa at the temple of Athena. The goddess got angry and nearly crazy but took no revenge on Poseidon the god for the offense. Instead, she discharged her anger upon the human, upon Medusa herself, by turning her white skin into a green and scaly one, her voice into a thunder and her beautiful hair into a bunch of whistle snakes. Besides, Medusa was granted with the power of turning into stone any living creature daring to look at her face directly.

How does the myth relates to women with Fibromyalgia? Let’s think for a moment about Athena and Medusa, two very important archetypal images to be found at the inner world of a woman. Athena is the virginal aspect of the feminine dedicated to protect and promote the masculine activities and patriarchal values. She symbolizes the psychic creation and reflection; the social intelligence. Medusa, is the aspect of the feminine dedicated to sensuality and relationship. Both aspects live consciously related in the myth as well as within the girl’s psyche until the rape from a masculine force. At that moment and to preserve nothing but life the Self of the woman makes a split in her soul. Since that moment, what was joined before is now divided.

The split in the soul of a woman with Fibromyalgia is experienced at the ego level in specific ways, for example: She longs for a love relationship and she dates with a man. Inside her heart there is a memory about the time when she was an undivided woman. Her own Medusa with her sensual gifts is activated and begins to play the seduction game. After a time and when the man is falling in love due to the enchant of that sensual and lovely woman, deep from her unconscious, the rape comes again and Athena appears to play her roll in the opus. The ego of the woman is possessed by Athena and the diagnosed woman shows the man that she is more adapted to the masculine and the external world than he is, and you know that many men are afraid when they are exposed to the presence of a woman who works and thinks better than them. So the man begins to look around and wonder: Where is she? Where is the sensual and lovely woman gone? I can not see her anymore! Why is she hiding? The woman notes the man’s hesitation and looks for a reason but she can not find an answer because she is not aware that the curse of Athena is active again and what the man feels now terrifies him. He is about to look directly the face of Medusa and if he remains close to the woman sooner or later he will be petrified.

At the outside world, the woman is hurt because the man goes away and once again she experience, just like Medusa, the punishment of living in isolation and misunderstanding. Then comes fear, loneliness, sadness, and finally rage because the woman, just like Medusa, is paying for a crime she did not commit.

Following one of the most important ideas of Dr. Jung, as to say that “inside is like outside”, it is appropriate to look at the myth as an event within the soul of the woman and, from that point of view, we shall see that certain positive aspects of her inner masculine energies go away because, on the one hand, Athena, as the goddess she is, has the power and the capability to perform the activities that should be done by the inner man. On the other hand, Medusa, as the human she is, does not have the power to continue performing her original nature because since the curse took place, her sensual skills were erased from the surface and remain invisible. So, as a consequence of the presence of Athena and the curse of Medusa, the inner man of the woman faces emptiness because there is nothing to be related to....

I began my investigation with two questions in mind: Is it possible for people with some specific attitudes to suffer from a physical illness? Is that the case of women with Fibromyalgia?...

Exploring the myth, I found that there are many images of Athena and Medusa which give us a message about the lack of expression of their inner world. On the one hand, it seams to me that was not allowed for Athena to speak about her pain and she only shows it symbolically by wearing a medallion engraved with the face of Medusa to protect her heart. Athena had to be what the patriarchal energies forced her to be. So are women with Fibromyalgia...

Here you have a living image of the world as experienced by the diagnosed women. In first place, nobody understands what they try to say. Next comes the brutal expression of rage. The thunder that comes out of their mouths frightens and prevents anyone from coming closer, touch the wound and make conscious the pain. The guard of the prison is at work. The Bewitchery of Medusa.

When it all began? Well, about thirty thousand years ago the human beings recognized the existence of an image within their psyche, an image whose characteristics belong to an all-powerful woman. It is without discussion that the first deity that governed the destiny of humanity was a feminine figure linked in a direct and close way to the basic facts and elements which make possible and support life. After twenty seven thousand years, began the arousal of patriarchal culture. For three thousand years, the feminine was devaluated and repressed. The wound took place, the damage was done and is present today as Fibromyalgia....

....People suffering from Fibromyalgia have many times forced their needs and desires to wait until the necessities and desires of other people, regarded as important, are taken care of. In order to do so, they had to lose contact with their own feelings, and with their physical and psychological temples, their own bodies. A headache is the price to pay for an excessive rationality.

...As a general rule, people with Fybromialgia avoid conflicts and if there is no choice they solve them as quickly as they can ¡to get out of there! Inflammation is the metaphorical expression of what happen when a feeling is coming and people does not know what it is or what to do with it so anxiety shows up. Then repression takes place and remains in charge until the anxiety slows down. Inflammation speaks through the body what can not be expressed by words...

...The stomach works day and night restless until after a long time its enormous capacity diminish and digestive disorders, common among people with Fibromyalgia, appear. People with Fibromyalgia have problems to express their feelings and sometimes they do not even know what they are feeling, just like Athena and Medusa.

...When people with Fibromyalgia can not move or they move with pain, it seems that their bodies are trying to make them conscious about the fact that there is not possibility to keep moving anymore. Most of people with Fibromyalgia have been working very hard for many years. Of course, painful and difficult movement is terribly unpleasant and frustrating for these people, along with the fact of not being able to carry out all of the usual activities. Rheumatoid conditions are the equalyzers. When people with Fibromyalgia have to face the fact that they can not do what they used to they become frustrated, just like Medusa can be. Anger begins to emerge and then repression appears, which demands a great deal of energy and impedes anger to arise. This is one of the roots of tiredness and fatigue....

...The cervical discs are located at the cranial base and the first one, located at the skull’s basis is named Atlas, a well know titan’s name linked with carrying the world upon his shoulders. Curiously, people with Fibromyalgia do the same because they take great amounts of responsibilities, their own and others. Many times they are in charge for their fathers, mothers, brothers, sisters, employers, friends, etc. Medusa, symbolically, is carrying upon her neck and shoulders the weight of the wounded and repressed feminine and the devaluating masculine energies, just like people with Fibromyalgia.

...To breath is difficult, the nose is blocked, the throat is irritated, the voice does not come out easily and sneezing is like a warning for the people to stay away from us, to swallow is very hard too, by so the communication is nearly impossible. Athena does not permit a man to come close to her, she is a virgin goddess. Medusa wants a man to come close to her, but if he dares she turns him into stone.

...Usually people with Fibromyalgia carry a lot of anger and guilt. Besides, they live worried because they think that they have to pay for their real or unreal sins. Their superego is huge and powerful and they try to compensate by caring for others and reaching perfection. In most families of people with Fibromyalgia expression of anger was avoided and what should be an environment of confidence and knowledge to face life is a prison instead. Both, Athena and Medusa live at their own prison. The former at her head the later at her body....

My conclusion is that whenever a human being has to unwillingly abandon an aspect of the feminine nature within, is about to suffer: The Bewitchery of Medusa. You can argue that this is the experience of many women and not all of them develop Fibromyalgia, and you are right. The difference is that, as you know now, it is necessary a second betrayal from the relationship between the feminine and the masculine..

The liberation will come when the positive masculine energies that for a long time remained undeveloped within the woman's psyche grow enough to stop flying, descend to Earth and be able to recognize and to honour what has been disregarded for years....

I presented this paper at the First International Academic Conference sponsored by IAAP and the Department of Psychoanalytic Studies of the University of Essex in Colchester, England in July of 2002.

http://www.cgjungpage.org/index.php?option=com_content&task=view&id=711&Itemid=40

 

Beware the Fibromyalgia Diagnosis Part Fourteen
Topic: Medical Care

Don't Question, Just Accept

Fibromyalgia and CFS Patients are endlessly portrayed as emotionally broken people who need to be psychologically fixed, whose illnesses are simply the physical manifestation of their emotional dysfunctions. Good luck at finding the rare arcticles, studies, and books which don't portray these patients in a negative light to some extent or another. Fibromyalgia and CFS online and print literature often contains Cogntive Behavioral Therapy-style advice and is rife with psychotherapy lingo, with a heavy emphasis on coping and acceptance. Both are used in relation to Fibromyalgia and CFS versions of "The Five Stages of Grief", and in terms of helping all these emotionally dysfunctional Fibromyalgia and CFS patients fix their defective personalities which supposedly either caused their illnesses or greatly contributes to their symptoms and the severity of their conditions. Many of these acceptance and coping-skills related articles and book excerpts use similar, or even the exact same words and phrasings, all to relate the same message- If you have been diagnosed with Fibromyalgia and/or CFS it's because you're emotionally damaged goods and need emotion-based fixing in order to heal. "Heal" being a term used mostly in a psychological sense, as the symptoms of these illnesses are supposedly caused by traumatic "body memories" which bring physical pain to their "victims".

Unlike other physical illness and medical condition treatment protocols, Fibromyalgia and CFS treatment protocols, beyond the insomnia and chronic pain treatments, are often largely based upon dealing with feelings and emotions. It's all about stress, fear, anger, feelings of wrongness or badness, poor self-worth, feelings of inadequacy, feeling maligned by others, being out of touch with oneself and one's thoughts, feelings and needs, having boundary issues, lacking trust, needing validation from the wrong people, and other touchy-feely stuff which needs to be treated with Cognitive Behavioral Therapy, postive affirmations, support groups, various other self-help methods like self-hypnosis and guided imagery, and standing up to the bossy people in one's life. Unfortunately, this somewhat resembles the Stuart Smalley skits from Al Franken's stint on Saturday Night Live, with Stuart's trademark affirmation: "I'm Good Enough, I'm Smart Enough, and Doggone It, People Like Me!” http://en.wikipedia.org/wiki/Stuart_Smalley

You Spin Me Round Like A (Broken) Record Baby...

From "Fibromyalgia Lesson 3: Coping: the psychological aspects” at Suite101.com:

Learning Acceptance

Accepting fibromyalgia is similar to coping with the death of a loved one. It starts with denial. As happy as we were to get a diagnosis at last, we start thinking that maybe it's wrong. This can't be the way it's going to be from now on! We all go through it – although not everyones experience is identical....

We need to move to the final stage - acceptance. Accept our limitations and see what we CAN do despite them...

Raise your self-esteem. Fibro victims tend to be over-achievers. We have had unrealistic expectations of ourselves all of our lives. It's time to get real. Set some new goals. They don't need to be large- just realistic. http://www.suite101.com/lesson.cfm/16603/16/2

 

From: "Acceptance for Living With Fibromylagia":

How Acceptance Can Help With Managing Your Illness

A chronic illness like fibromyalgia (FM) changes your life. It can be hard to accept those changes, especially when it means giving up things you care about.

When you're adapting your life to chronic illness, it's normal to go through a grieving process, just as if someone close to you had died.

The final phase of the grief cycle is acceptance. Some people confuse "acceptance" with "giving up," but acceptance actually is a means of looking at your situation realistically so you can set reachable goals.

http://chronicfatigue.about.com/od/copingwithfmscfs/a/acceptance.htm

 From BellaOnline's Fibromyalgia and CFS Newsletter Archive:

 The word "grief" is usually used in connection to losing a loved one in death. However, grief can occur as the result of other unfortunate events such as the end of a relationship, the loss of a pet, loss of hopes, dreams, and plans for the future. To persons living with fibromyalgia and chronic fatigue syndrome, loss is a way of life. It's more than accepting the diagnosis and the loss that we experience initially, but the losses that follow throughout our lifetime. We may find ourselves grieving repeatedly.

Although responses to loss are as diverse as the people experiencing it, certain stages are common. Dr. Elizabeth Kubler-Ross identified and named the Five Stages of Grief. Knowing these five stages can sometimes help through the grieving process, and we can see the light at the end of the tunnel. Most people may experience all five stages, but they may not experience them with the same duration, in the same order, or with the same intensity....

Acceptance

The final stage is acceptance. You have to accept the loss, not just try to bear it quietly. We come to the realization that our former self is gone, and that it's not our fault that we got sick, and that we didn't do this to ourselves. Seeking the good that can come out of the pain of loss will lead to finding comfort and healing.

We may have gone through all of the above stages and in many cases once before getting to acceptance. We may even experience these stages after every loss that we have while living with fibromyalgia and/or chronic fatigue syndrome. Even when we reach the acceptance stage, it does not mean that we no longer get sad about our losses from time to time, but the sadness no longer overshadows us and does not keep us from functioning normally most of the time. Over time, the intensity of the sadness generally diminishes, and we learn how to cope. http://www.bellaonline.com/newsletter/fibcfs

  From the “Fibromyalgia: After the Diagnosis...” article:

You've just heard the words,"You have fibromyalgia." How do you feel? Some of you are elated. After years of pain and uncertainty and visits to multiple doctors, often wondering if "they" were right and maybe you really do have serious psychological problems, you finally have confirmation that you have an actual illness. There is a real name for your suffering. Others of you are stunned and frightened. You've just been told you have a disease for which there is no cure. You feel like some of your worst fears are coming true. With dozens of unanswered questions churning through your mind, you wonder what--if anything--the future holds for you. Both reactions are perfectly normal. Regardless of your initial reaction, the question remains...what next? What comes after the diagnosis?

Once you have been diagnosed, you will begin a journey that will lead you through five stages. These stages are very similar to the five stages of grieving and death identified by Dr. Elisabeth Kubler-Ross. Although fibromyalgia (FM) does not cause loss of life, it does bring about a loss of our former lifestyle. It is both normal and necessary for you to grieve any significant loss....

STAGE 5- Acceptance/Re-Evaluation
Acceptance is not resignation. It is understanding -- understanding that your life will be different, but that different can be better; understanding that you can accept your pain without becoming your pain; understanding that your life can still have a positive and productive purpose. At this stage, it is time to re-evaluate your life and your lifestyle.

http://www.fmaware.org/site/News2?page=NewsArticle&id=6313

 From the article, “How I Created a Good Life with Fibromyalgia”:

During the early years, I went through a kind of death, the loss of the person I was before FMS. I began with denial....

...To deal with the anger, despair and depression I was experiencing, I started therapy, which helped me come to terms with all the negative emotions I was having along with my FMS...

By 1998 I had attained what I call conditional acceptance. It took me seven years to reach this stage. I found a good balance of activity, rest, exercise. I learned stress avoidance and stress reduction techniques. I evaluated my life in all areas and chose exercise, activities, relationships, and stress reduction techniques that supported my feeling as well as possible. Based on my experience of having symptom reduction, rather than symptom erasure, I decided to focus on a coping strategy. ..

Reframing My Thoughts

It became very clear that a positive attitude was crucial if I was going to attain acceptance and peace with my illness and my life. I finally learned that how I perceive myself and my chronic illness can greatly affect my quality of life. One way was by reframing my thoughts. Reframing is a term used in psychology to mean learning to look at something from a new perspective. Taking a situation, and looking at it in a different way, can help one accept and embrace that situation and give it a positive spin.

I taught myself this skill. For example, I took the idea "I am so tired today. I don't think I will ever feel energetic again" and reframed it as "I am tired today. But from my past experience with fatigue, I know that I will feel good again, after giving my body the rest it needs." The thought, "My pain is awful and it's never going to get better" became "Yes, the pain is strong today, but the last time it was this bad, it did get better."...

Benefits of Acceptance

I have learned that there are many benefits of acceptance of my FMS. I take better care of myself. My health is a top priority. When I feel better, everything in my life works better. My life becomes more predictable, less of a roller coaster ride. With proper exercise, rest, and activity pacing, I am giving my body the gift of healing. My body relaxes when I'm not fighting with it, and I feel better.

I also have more confidence in myself and in dealing with people. By accepting my illness, I feel less of a need to explain, rationalize, and fret over what others think.

http://www.cfidsselfhelp.org/library/how-i-created-a-good-life-with-fibromyalgia

From: “The Mystery of Fibromyalgia and How Cognitive-Behavioral Therapy Can Help”:

Cognitive-behavioral therapy can assist the fibromyalgia patient to identify stressful triggers that exacerbate pain. This may involve examining family struggles, exploring inner-conflict, and working with core, self-defeating assumptions that affect thinking and behavior. Teaching the patient mindfulness meditation as a way of relaxing the sympathetic nervous system is beneficial...

...There is a tendency for fibromyalgia patients to distort reality by focusing on negative perceptions to the exclusion of the positive. Helping the patient and family to accept physical limitations is a necessary component to successful treatment.

Fibromyalgia patients can easily get enmeshed in a cycle of pain and associated emotional symptoms. It is the goal of cognitive-behavioral therapy to assist the patient in coming to terms with his disorder and making plans to manage it. This is accomplished through acceptance and teaching the patient positive ways of thinking about his condition and multiple ways of treating it.

http://leavingthebubble.blogspot.com/2009/01/mystery-of-fibromyalgia-and-how.html

Daily Strength's Fibromyalgia forum- thread “acceptance, do we ever truly accept?” webpage:

http://www.dailystrength.org/c/Fibromyalgia/forum/3422237-acceptance-do-we-ever-truly

From the Fibromyalgia Facts and Symptoms- “Coping With Fibromyalgia” webpage:

When faced with a chronic condition especially one that involves a lot of pain it is inevitable that your emotions will run amok. Taking control of your emotional life involves learning emotional coping techniques. You will more than likely go through the stages of grief when faced with a condition such as fibromyalgia. You will grieve the relatively carefree life of "before the diagnosis". You may feel anger, despair, and even depression over the prospect of what your life will be like now that you have the diagnosis of fibromyalgia.

The stages are just like those one goes through dealing with death. You will go through a refusal or denial of the condition, anger or feeling like it is unfair that you have been dealt these cards, and then you will decide that bargaining or promising that you will be a better human being if only the condition will go away only to discover that the condition is here to stay and then the depression sets in and you may decide to just give up, and eventually you will come to the place called acceptance. Once you have navigated your way through the stages you will reach a place where you can start to come to terms with your diagnosis. Seeking the help of a professional counselor may help you to deal with the stages and face your emotions. Sometimes medications can help to ease the discomfort and pain, as well as the depression that may encompass you. Support groups are wonderful tools for being able to cope with your emotions.

http://chronicfibromyalgiatreatmenttips.com/coping-with-fibromyalgia.php

“Fibromyalgia Attitude Adjustments” tips, from the Fibromyalgia Life Tips website:

http://fibromyalgia.lifetips.com/cat/58409/fibromyalgia-attitude-adjustments/

“Accepting Fibromyalgia and Moving Past It: Patients Share Their Coping Strategies” webpage from Health.com:

http://www.health.com/health/condition-article/0,,20188802,00.html

Selected quotes from the book “Fibromyalgia & Chronic Fatigue Syndrome: 7 Proven Steps to Less Pain & More Energy” by Fred Friedberg Ph.D, a practicing clinical psychologist and CFS patient, who uses Cognitive Behavioral Therapy techniques to treat the symptoms associated with Fibromyalgia and Chronic Fatigue Syndrome:

When you do actually assert yourself, give yourself both the right to your feelings and the right to personal time. You may experience mixed feelings during these assertive exercises- possibly at every step of the way- because this level of forwardness may seem to conflict with the person that you wish to be. But remember, that person, who strives to be all things to all people, is also an overstressed, overburdened, and- at the core- unhappy person. (p. 98)

People suffering from CFS or FM may experience a variety of jarring negative emotions-including anger, grief, discouragement, worry and guilt. Coping with the emotions...can not only help improve your day-to-day well-being, it can also aid your overall improvement-particularly when these coping skills are well-learned. And without the burden of these negative emotions, you'll have a greater chance to enjoy positive feelings. (p. 101)

You probably experienced large doses of guilt even before you became ill. If you hold yourself to perfectionistic high standards- standards that rarely can be reached- the guilt of not doing enough may be a persistent theme in your emotional life. And if your sense of self-worth comes from helping family, friends, and others, not helping- or not being able to help- can produce intense feelings of guilt. (p. 106)

...Any bad relationship that is a major part of your life- whether it be with a spouse, significant other, sibling, or parent- can be detrimental to your healing. Dysfunctional relationships create an array of negative emotions, including anger, hurt, anxiety, guilt, and depression. These emotions will stress your fragile physical being and worsen your symptoms (p. 116)

Excerpts from the November 2004 article “A holistic approach that turned up trumps” by Patricia Redlich, which appeared in the Irish newspaper- the Independent:

MICHAEL Kelly is an old-fashioned clinician. The way doctors used to be. He reads his patients...

When he talks about the mind in the matter of fibromyalgia, then, he is not holding up an accusing finger, but merely dealing in the obvious. The mind and body are one, in sickness and in health, and healing. So why should it be surprising that the cause of the condition should lie in the head or heart or personality, rather than in the muscles, or connective tissue, where the often excruciating pain of fibromyalgia resides?

...Michael Kelly has a deep respect for the human spirit. He knows it doesn't confine itself to mere emotional expressions of distress. The body can suffer too, quite terribly, when the heart is disturbed...

...Theirs is a disorder, and Michael believes its origins lie in a spiritual deficit - my words, not his, for he fears it sounds too metaphysical.

He talks instead of a driven personality, different from male workaholics, to do with women who effectively prostrate themselves in the service of their chosen task.

Dr Kelly describes women "cocooned in a state of constant misery" and believes the misery was always with them, and only manifest now that they can no longer put in the relentless effort. He's trying not to sound like a pop psychologist, he explains, and goes on: "These are women who don't seem to have any real sense of self. Their chosen path of attempted perfection, be it career or domestic goddess, is their only persona. They feel good only from doing good, never from just being. And you can feel their agitation, an internal distress which drove them always, and now threatens to annihilate them."

I tell him it's the brownie-point syndrome, the endless hope that if we earn enough, by trying hard enough, we'll be liked, loved, appreciated, accepted, allowed exist, breathe even. Which is why he is right that this isn't just workaholic behaviour, even though these young women are high career achievers. Workaholics settle for career success, job acknowledgment, status. The women are seeking the right to be alive, are driven by the terror of personal disintegration if they can no longer perform. Many of us have been that soldier. We know.

“...There's no external solution, it's an inside job. My patients have to undergo psychological change, in terms of their attitudes to themselves and to others," Michael continues.

All he can do by way of helping is tell them the truth. Which is why he's brought out a second edition of his book Fibromyalgia, Fatigue and You. In it, amongst other things, he's attempted to spell out some paths to that much-needed personality change. I don't argue with him about that, but ask instead how a driven personality can end up with terrible physical pain. The exhaustion I can understand. Alcohol addiction I could expect. But how does the pain come about? Dr Kelly has an explanation.

"Women who end up with fibromyalgia operate on the basis of unrelenting internal distress, chronic worry, all-pervasive anxiety, and suffer as a result from lack of restorative sleep, that sleep phase most necessary for refreshing the body, and mind. They're exhausted, but keep going, pushing themselves, and create a vicious circle as sleep further deteriorates. Their pain threshold then sinks, and sensory messages from the muscles travelling back to the brain register as pain. Lack of physical fitness, specifically aerobic fitness, adds to the problem, presumably because more muscles become involved in sending pain signals, sleep worsens, the brain doesn't get to produce the happy hormones, or endorphins, it creates during exercise, and the body becomes even more sensitised."

Is there hope, I ask?

"My patients feel like freaks. That's so sad, because the suffering in fibromyalgia is so real. It helps a lot for them to hear the story, to see it written down. They feel better, and heartened about taking some tentative steps towards change.

"And it's great to see the metamorphosis, to witness a woman blooming, as she leaves fear behind." http://www.independent.ie/national-news/a-holistic-approach-that-turned-up-trumps-486456.html

From the Psychology Today article “Is It All in My Head? With diseases like chronic fatigue syndrome and fibromyalgia, what you believe about your illness influences how sick you become.” by Melissa Schorr:

Wayne Katon, whose research focuses on depression, anxiety and somatoform disorders, makes the case that stress and anxiety play a primary role. In his view, personality doesn't just create a hospitable environment—it's an integral part of the diseases. He believes that the initial injury or illness is almost irrelevant. What really matters is the interpretation and emotional reaction. Patients develop what he calls "catastrophic cognitions": beliefs that if they start to get back to their activity, they will damage themselves further.

According to Katon's clinical observations, patients with chronic fatigue or fibromyalgia tend to be highly driven overachievers unaccustomed to feeling any loss of control. When injured or sickened, those who decide that the pain or illness has overwhelmingly and permanently damaged their bodies come to feel victimized and unable to cope. Learned helplessness sets in, and patients can find themselves perpetually depressed and inactive. "They have trouble getting back to that old lifestyle, and what sets in is depression, " Katon suggests. "In our modern society, for proplr who have driven themselves, fatigue becomes a palatable way out of a difficult existence."...

Fear of further damage and disability may keep patients from trying to get back to an active life. "Whatever caused this impairment is probably not what's keeping it going," Katon says. "What's keeping it going to a large extent are the misbeliefs about getting back to an active lifestyle."

http://www.psychologytoday.com/articles/index.php?term=20050503-000002&page=1

 From the “Fibromyalgia in Children” webpage:

Therapy can also help the fibromyalgic child cope with tension and/or stress in more healthy ways. Many children with this condition don’t know how to manage their stress and are often high-achievers who try to do too much. They are also hard on themselves and may be prone to other self-esteem related problems too. Some studies have shown that therapy, specifically of the cognitive-behavioral type, can help improve fibromyalgia symptoms in some children. Therapy can also help to alleviate the anxiety and depression symptoms which often accompany this disease....

What Causes Fibromyalgia?

Fibromyalgia syndrome (FMS) is generally an elusive disease. I know from personal experience that not many people seem to understand much about it. I include many medical professionals in that group. There are several theories on the causes of FMS. First, there seems to be a prevailing belief that a trauma such as a car accident triggers the disease. Other traumatic events that may lead one to develop this disease include sexual or physical abuse and alcoholism.... http://health.learninginfo.org/fibromyalgia-children.htm

Quotes from the book, Recovering from Chronic Fatigue Syndrome: A Guide to Self-Empowerment (Chapter 12: "Using Your Illness as a Teacher")” by William Collinge, Ph.D.:

People with Chronic Fatigue Syndrome (CFS) often find that the syndrome directly challenges all that their lives have stood for. Many have found that to make it through this existential crisis, they have had to find a way to fit this illness into the overall fabric of a meaningful life...

Psychologists have long been interested in what they call the secondary gains, or benefits, of illness. There are two ways in which illness can be beneficial. One is when it serves to rescue or remove us from unacceptable or unwanted circumstances. The other is when it brings us unexpected insights or discoveries which enrich our lives and advance our growth....

It is certainly worthwhile to examine whether the illness is bringing relief from some otherwise unacceptable circumstance. If this is the case, then you may not be pursuing your recovery program with full commitment.

Our focus here, however, is on the other kind of benefit-one which, for many patients, has been totally unexpected yet greatly appreciated. CFS has served as a teacher and an opportunity for personal growth. As you have no doubt found, this disease can force you to re-evaluate your values, purposes, and whole way of life. Various people have described this illness as a wake-up call or a two-by-four over the head. Perhaps a more sophisticated term is to call it a "pattern-interrupt." This is a term used by hypnotherapists to describe something that interrupts or changes old, unconscious patterns of living or acting, and makes room for something new and better to happen....

CFS forces you to change your relationship with yourself. One of the most common discoveries is that we can actually pay attention and listen to ourselves much more deeply than ever before. Some experience this as listening to inner guidance. Others describe it as listening to the body, as trusting yourself, or as accepting yourself. Consider Tina's story:

"Getting sick was the best thing that ever happened to me. It was what it took for me to really. . . make major changes. I don't think I would have done it otherwise. My body just had to stop me. I wasn't paying enough attention to my life, my stress, my job, and my unhappiness to do anything about it, until I got so sick that I literally could not do anything and had to stop. After that, everything changed...

A similar experience is reported by Christy, who states: "I am actually grateful that I got sick, for what I have learned has been that valuable to me. It taught me to slow down and listen to myself. It also taught me that I will never work for money again, only for something I like to do. Money will come, but my job will never run my life again. I will do things that bring me joy."...

Another aspect of this transformation is the obvious shift in attitudes toward self-care. A high degree of vigilance needs to be developed which involves paying attention to your needs on a moment-to-moment basis. Maintaining your sense of balance or integrity becomes a real priority in daily living...

Tremendous strides in self-acceptance are very common for people who have been through CFS. The syndrome forces people to acknowledge and accept their vulnerability and their limitations. In the process of doing so, there very often is an overall shift toward greater self-acceptance....

Self-acceptance also involves acceptance of aspects of your self that were previously denied or discounted, such as your wants and needs. Debbie had previously taken an attitude of self-denial, self-sacrifice, always putting others' wants and needs before hers. This would happen not only in family life but with friends as well. Her belief now is that "My wants and needs are valid, and I say what they are. I may not always get it right now, but I no longer wait for someone else to give me permission or encouragement to have what I want or need."...

One of the ways that we add to our suffering is in our nonacceptance of what is true now. Our denial of the truth of our circumstances postpones our acceptance of, and our working with, the present. Energy is consumed by our struggle to hold on to the past, which is impossible and prevents us from living fully now.

One consequence of this for many people with CFS is depression. I refer here to the depression that can arise as a result of our appraisal of our circumstances, not as a result of the chemical changes from the disease process. The antidote to this kind of depression is acceptance of what is true now, and letting go of our fixed ideas from the past about how things should be.

http://www.prohealth.com/library/showarticle.cfm?id=4187&t=CFIDS_FM

 

Quotes From: The Psychological impact of Fibromyalgia and Chronic Fatigue Syndrome: Coping strategies" an article by Dr. Mark J. Shaw, the author of “Beat Fibromyalgia and Chronic Fatigue Syndrome”. Dr. Shaw portrays the emotional aspects of a Fibromyalgia and CFS diagnosis as rather bleak- a life of social isolation, filled with fear, anger and resentment, with ostracism and rejection by loved ones, and a complete lack of understanding by those who don't suffer from these conditions:

I will say from the outset that I believe this is one of the worst afflictions that can strike any person, at any age and at anytime....

...At a time when you need the most support in your life, often, people are turning their backs and walking away or muttering under their breath. It is a frightful condition.

There is no point disguising the reality which is, I'm afraid to say, that you will lose a lot of friends and colleagues along the way to the monster that is Fibromyalgia and CFS.

It is NOT possible to explain this condition to people who have no experience of it either by having suffered, or through having a particular medical interest in the area. They WILL NOT understand what, or to what extent, you are suffering. Again, I'm afraid this is the norm. Accept it as such and you will not then be personally offended by acts of prejudice....

If you had no knowledge about Fibromyalgia and CFS what would your reaction be to someone else developing these symptoms?............ You see? Its human nature, it's cruel isn't it?...

Concentrate on yourself and try not to dwell morbidly over the people that you have lost already. Those that do not stand by you, and there will be some, are what we term fair-weather friends...

Fibromyalgia and CFS will create emotional havoc for you and for your loved ones. This is normal.

Becoming chronically ill is very much like a bereavement. The losses and emotions involved are very similar. Giving up works means not only that you lose income but you also lose status, friendship and a purposeful role in life....

Fibromyalgia and Chronic Fatigue Syndrome can create a fear of rejection by others even when there is no evidence of this happening. I mean, who wants to be around someone who is like this, we say to ourselves.

....our self esteem is based on what others think of us, and usually that is based on what we "do" or "how we play" , or "what we say", generally how we interact with other people. As we take to "doing less", "playing" less and generally interacting "saying" less, then our self esteem plummets along with our health.

We are worried about the future; the dark shadow of uncertainty is round every corner....

I do advocate counseling and support groups. You will need to find someone who has specific knowledge about the emotional effects of Fibromyalgia and Chronic Fatigue, again a good doctor should be able to put you on the right path, there are also Fibromyalgia and CFS support groups based in most cities and towns across the US.

Once you have found a good support group you will also find good counseling. http://www.submityourarticle.com/articles/Mark-Shaw-1444/fibromyalgia-9108.php

Anyone who is diagnosed with a life-altering medical condition is naturally going to experience periods of adjustment which can come in many forms. Of course educating friends, family and colleagues may be a necessary aspect of this adjustment for any illness which is new to the members that patient's familial, social and career circles. The concept of fair weather friends and others who are too self-absorbed and can't be bothered caring about other people when they're experiencing hardships in their lives is nothing new either. Everyone in their course of their lives has to deal with such individuals whether they are family members, friends, acquaintances, co-workers, classmates, or neighbors. Dr. Shaw's hyperbole filled piece could unnecessarily frighten newly diagnosed patients into believing they're about to be abandoned by just about everyone in their lives, and that none of their family, friends, and colleagues will be capable of understanding them. Considering Fibromyalgia and CFS have symptoms in common with various illnesses, including Lupus, Multiple Sclerosis, Lyme Disease, Vitamin and Mineral Deficiencies, and AIDS, it's bizarre that Fibromyalgia and CFS are painted as completely “unique” illnesses symptom-wise and are supposedly not understandable to everyone who doesn't have either or both of these conditions.

Time to shake things up a bit

Tripod Blogs is being a bit glitchy at the moment while they transition us from one form of software to another, so I've been forced to re-enter several entries beginning with "Beware the Fibromyalgia Diagnosis Part Fourteen" which of course alters their posting dates- changing them from June to July.  Sorry for any confusion this may cause. Otherwise... 

My research into the 'great imitator' illnesses has reached the point where it makes sense to start posting blog entries discussing the other great imitators alongside the “Beware the Fibromyalgia Diagnosis” entires, as I've reached the part of the “Beware...” series where information regarding the what's and whys behind Fibromyalgia and Chronic Fatigue Syndrome will begin to overlap with information related to the other great imitators, as I begin to delve more into the the hard science-the biologic, environmental and genetic questions and answers (where there are answers), although I'm still not finished with the social science aspects. This series has actually spawned a major research and writing project as well which I am still in the process of finishing up- to be published in some form at a currently unknown time.

In addition, I'm simply getting myself into a sort of rut by only focusing on posting about Fibromyalgia/CFS-ME and am ignoring other topics related to chronic illness/disability, healthcare, related public policy issues and the like.

Beware the Fibromyalgia Diagnosis Part Thirteen
Topic: Medical Care

How Abuse Trauma and Personality Type Theories Play Out in the Fibromyalgia and CFS Online Support Groups and Message Boards

Considering fibromyalgia patients are very strongly encouraged by the medical and psychosocial support communities to join fibromyalgia support groups and forums and to network, bond with and commiserate with fellow fibromyalgics, where does peer pressure and peer acceptance fit into the equation?

From “Treating Fibromyalgia” by Paul J. Millea, M.D., M.S., and Richard L. Holloway, PH.D; from American Family Physician:

Support Groups and Online Chat Rooms. Many patients benefit from discussing their day-to-day lives with others who are also affected by fibromyalgia. Support groups may be located through a local chapter of the Arthritis Foundation (AF). The AF address is 1330 W. Peachtree St., Atlanta, GA 30309. Information on local chapters can be found on the AF Web site at http://www.arthritis.org.

http://www.aafp.org/afp/20001001/1575.html

From the “Fibromyalgia Resource Information” website answering the question of why Fibromyalgia patients may need therapy:

Fibromyalgia patients may need added emotional support and help with coming to terms with living with the chronic pain and physical and mental limitations associated with this disease. Counseling sessions with a trained professional may help improve communication and understanding about the illness and help to build healthier relationships within the patient's family. Becoming actively involved in a support group can help those with fibromyalgia ease feelings of isolation and low self-esteem.

http://www.fibrofactpage.com/questionsii16.html

The link between Fibromyalgia/CFS and Post Traumatic Stress Disorder through emotional trauma from domestic violence victimization, or by supposedly 'freaking out' from being in a car accident, only garners a mention in just some of the Fibromyalgia/CFS books which are written for patients and their families. The concept of Fibromyalgia and CFS being somatoform/biopsychosocial illnesses caused by parents and other family caregivers neglecting, beating and/or molesting their children, which leads to fibromyalgia in adulthood for these child abuse victims, is much more commonly found and is discussed in far greater detail within the written literature which is geared towards physicians, psychologists, social workers, and others in the medical and social services support fields; although these subjects occasionally become minor news in the media for a very short time the findings from a new psychosocial new research study are released. But the somatoform theories of Fibromyalgia being caused by the emotional aspects of domestic abuse and/or accident trauma have definitely made it to the internet-based formal and informal Fibromyalgia support and advocacy groups and organizations, as well as to various patient online support groups, forums, message boards, and illness/awareness blogs for dissemination to the patient community as a whole. Discussions of studies linking fibromyalgia to certain mental illnesses appear in these forums, on occasion.

Oddly enough, some Fibromyalgia patients from the cyber-based fibromyalgia advocacy websites and online patient support groups and blogging community seem to readily embrace the abuse-trauma connection without question, and these fibromyalgia patients also very willingly embrace the Type A Overachiever-People Pleaser Fibromyalgic Personality label and the Fibromyalgia/Mental Illness co-conditions labels. Obviously everyone who has been diagnosed with fibromyalgia isn't an abuse victim, doesn't have PTSD, nor are they all Type A overachievers and people-pleasers with low self esteem issues, nor do they all have mental illnesses, such as Bipolar Disorder. So what is going on here? Abuse and neglect victims develop a wide variety of medical conditions, illnesses and diseases like everyone else, so naturally some of them will be labeled with fibromyalgia and CFS; and in all likelihood there are significant socioeconomic reasons behind this. Does everyone in the fibromyalgia patient support community who vocally goes along with the abuse-trauma and mental illness premises really have these problems?

The Dangers of “Me Too!” Syndrome

Any chronic illness patient pool will include members who are less knowledgeable, not as well educated, easily impressionable and easily persuadable, who will go along with something just to go along and to fit in with their peers; or they are so desperate for answers if not an outright cure they become all too willing to buy into any theory that comes along that attempts to explain the cause of their illness. Some of these desperate, impressionable patients who buy into the childhood abuse theories may start to go looking for so-called “proof” that fit into this premise by exaggerating or even inventing trouble that isn't really there. If an impressionable patient spends time socializing with fellow support group members who all talk about their childhood abuse problems and blame the abuse for causing their fibromyalgia or CFS, what's to say the impressionable patient won't begin to develop a distorted view regarding her/his upbringing and seek out childhood based “problems” in order to fit into the mold and fit in with her peers? Examples: Suddenly her parents' rules regarding childhood curfews, not being allowed to watch television on school nights until all homework was finished, and rules on teenage dating, wearing make-up, etc. which were a bit stricter than the rules imposed by the parents of some of her childhood friends could suddenly be misread and misinterpreted into indicating that her parents emotionally “abused” her while she was growing up. Or the emotional “abuse” could be: As a teenager she was forbidden to date a boy she had a serious crush on who had several runs-ins with law and was frequently truant from school.

Unfortunately the same “Me too!” philosophy holds true when links between fibromyalgia and particular mental illnesses are brought up for discussion as well.

From the abstract for “Are support groups beneficial for fibromyalgia patients? The negative effects of social comparison for those who want it most”:

Peer support plays an important role in coping with many chronic health problems. Peer support may, however, contain a risk. Research has indicated that people with high social comparison orientation (SCO) are, on the one hand, more interested in contact with peers, but may, on the other hand, be negatively affected when they are confronted with peers who are worse-off....The results supported our hypothesis. Despite the many beneficial effects of peer support, the present study showed that as fibromyalgia patients have a higher need to compare themselves with others, they are more negatively affected by social comparison with peers who are worse-off, because they tend to identify themselves with worse-off others. http://dspace.ou.nl/handle/1820/1206

In a discussion thread, on the 'connection' between fibromyalgia and child abuse trauma (at www.mdjunction.com's fibromyalgia forum), one poster wrote:

 

"I have heard the same thing and I was diagnosed with fibro and also had an abusive childhood. I have heard others with fibro say they had suffered some trauma also. The percentage is really high, like 80 to 90% or something. I really believe when people abuse children they ruin lives"

http://www.mdjunction.com/forums/fibromyalgia-discussions/general-support/59274-fibromyalgia-and-childhood-abuse

When rumors such as this fly around the online and real world fibromyalgia communities- misconceptions like this poster's false belief that as many as 80% to 90% of those diagnosed with a particular chronic physical medical condition, in this case Fibromyalgia, were child abuse victims and the abuse caused them to develop this medical condition as adults- what sort of social, psychological and medical repercussions are there for this? For every fibromyalgia patient who posted to this thread essentially saying "Me too!" to being abused as a child, how many hundreds, if not thousands of other patients are out there who would have written "Not me!" to a history of childhood abuse, or "I doubt it's true that most FM patients were childhood abuse victims" or "That's not an accurate figure at all, it's not 80% to 90%" if they were posting to that discussion thread? But they didn't post to this thread and apparently they aren't really posting to enough of the child-abuse-causes-fibromyalgia threads in the other fibromyalgia patient forums, groups, and message boards either, so their divergent voices certainly aren't heard as often as they should be.

When it comes to the issue of Type A personailty being a caustive factor of Fibromyalgia and CFS, this discussion page features more "Me too!" responses than responses in which posters don't buy into this cause-effect theory.

"The Type-A Personality in Fibromyalgia & Chronic Fatigue Syndrome":

http://chronicfatigue.about.com/b/2008/02/26/the-type-a-personality-in-fibromyalgia-chronic-fatigue-syndrome.htm

The same holds true with links made between Fibromyalgia and Bipolar Disorder. This blog entry, on Bipolar Fibromyalgia discusses a study which links the two conditions, and is followed by responses from Fibromyalgia patients. While one patient dismisses the theory outright, pointing out that the two conditions have very different symptoms; the other respondants jump on the "Me too!" bandwagon. Some have informally diagnosed themselves with Bipolar Disorder and state they feel the link made between the two illnesses is valid:

 

"Bipolar Fibromyalgia" from the Bipolarity website:

http://bipolarity1.blogspot.com/2007/10/bipolar-fibromyalgia.html

If you have this illness, you must be an abuse-trauma victim too, just like the rest of us. Or, if you have this illness, your brain is malfunctioning and you have bipolar fibromyalgia which explains your aches and pains, your short attention span, and why you rack up credit card debt... This "Me too!" philosophy can be a very damaging mindset for patients to adopt.

Of course, not every patient buys into the various theories which come down the pike that link Fibromyalgia and CFS with psychological problems:

“Did You Know You Have a Functional Somatic Syndrome?”:

http://chronicfatigue.about.com/b/2008/05/15/did-you-know-you-have-a-functional-somatic-syndrome.htm

Beware the Fibromyalgia Diagnosis Part Twelve
Topic: Medical Care

From: “A Look at Questions Surrounding Fibromyalgia”:

MIND OVER MATTER? Patients diagnosed with fibromyalgia are more likely to have a history of mental illness, be overweight and economically disadvantaged. Some doctors say their suffering may stem from difficult circumstances rather than disease. http://abcnews.go.com/Business/wirestory?id=6831204

Quote from “Primary Care for Women”, Second Edition by Jeffrey F. Peipert:

Factors associated with fibromyalgia in the general population include female sex, divorce, failure to complete high school, low household income, decreased pain threshold, subjective joint swelling, parenthesis, irritable bowel syndrome, moderate or sever impairment demonstrated by the health assessment questionnaire, increased pain, fair or poor self-reported health status, and moderate dissatisfaction with health. (pp. 590-591)

 

From “A Review of Fibromyalgia” by Devi E. Nampiaparampil, MD; and Robert H. Shmerling, MD:

Disability secondary to chronic pain appears to result from a combination of patients’ past experiences, self-esteem, motivation, psychological distress, fatigue, ethnocultural background, education, income, and potential financial compensation... Disability in chronic pain does not appear to be related to the severity of the pain. (pp798-799 The American Journal of Managed Care November 2004 ) http://www.hcplive.com/_micro/ajmc/_picture/folder_12/AJMCnovNampiaparampil794.pdf.

Some Sociological/Sociodemographic Questions:

What is the average household income for someone who has been diagnosed with fibromyalgia? How many or how few people with household incomes over $100,000 are diagnosed with this condition? How many have incomes over $60,000? Are lower income people- the working poor and the public assistance-dependent more likely to be given this diagnosis? What about health insurance coverage and policies? Is it a case of: “the better health insurance coverage you have, the less likely you'll be diagnosed with fibromyalgia?” Are the underinsured more likely to be told they have fibromyalgia versus those with more comprehensive health coverage? Are uninsured clinic patients, those reliant on Medicaid or Charity Care, given this diagnosis at much higher rates then those with health insurance coverage? What about education levels and fields of employment, or lack thereof? Are high school drop-outs and those with just a high school diploma more likely to be diagnosed with fibromyalgia than someone with multiple or advanced college degrees? Are people who work in low-income jobs, the unemployed, and housewives more likely to be diagnosed with fibromyalgia than people with higher paying white collar jobs, financially successful business owners, or people who have good civilian jobs working for State Government, or the Federal government?

If a doctor thinks a patient is stupid, or whiny or flaky or neurotic or a pest does that make her a more likely candidate for receiving the fibromyalgia diagnosis? Are patients judged by their appearance? Are patients who appears to be lesser educated and lower income through their mannerisms, speech, and physical appearance (such as the quality of clothing and accessories they wear) more likely to be viewed with less credibility and have their symptoms taken less seriously versus patients who comes across as better educated and more affluent? Can such distinctions lead some doctors to casually slap the Fibromyalgia diagnosis label on patients from lower educational and financially modest backgrounds? Is a female patient who is either shy, timid and hesitant to speak; or who comes across as nervous, anxious, and easily excitable; or who uses a lot of emotion-laden words to describe her physical symptoms more likely to have her ailments diagnosed as fibromyalgia than a female patient who comes across as calm, cool, and collected? Are women who are overweight more likely to be hastily given the fibromyalgia diagnosis versus women who aren't overweight?

If a doctor knows the patient has, or did at one time suffer from depression or anxiety, does this increase the likelihood the patient will be automatically told her (or his) symptoms are caused by fibromyalgia, with little or no diagnostic testing done to rule out other medical conditions with similar symptoms? Does the same hold true if the patient responds with a “yes” when questioned about whether or not she was ever in a car accident, or ever had surgery, or was abused as child, or had beaten by a boyfriend or husband, or if she was ever raped, or if her parents ever consumed alcohol during her childhood, or if she smokes, drinks or had ever used illegal drugs?

From “Bone health in patients with fibromyalgia” by A. W. Al-Allaf, P. A. Mole, C. R. Paterson and T. Pullar1:

Patients with FMS were more likely to be smokers compared with controls (52.5 and 18.9% respectively,P¼0.006). Patients were found to have a higher BMI compared with controls (28.9 and 25.8 respectively, P¼0.016). FMS patients were found to be more likely to have had previous steroid therapy compared with controls (42.5 and 8.1% respectively, P¼0.001). However, FMS patients were significantly less likely to take alcohol on a regular basis (27.5 and 78.4% respectively, P<0.001). www.fibromynet.nl/pdf/voedingssupplementen-vitamined.pdf

 

From Rx AlterativeMedicine.com “Fibromyalgia Syndrome, Chronic Fatigue Immunodeficiency Syndrome FMS”:

The causal factors that most frequently contribute to FMS/CFIDS are addressed in an online Comprehensive Health Assessment found on the link listed below. The assessment, all easily accomplished from the convenience of your computer, will give you good insight into whether you are experiencing any of the common causes of FMS/CFIDS. Those factors include:

Candidiasis , a common yeast problem frequently associated with FMS/CFS.

Food allergy is usually associated with Candidiasis and undetected in most cases, especially the delayed onset type.

Gastrointestinal disorders including the "leaky gut" and microbial parasites, among others, are often a factor.

Toxic metals including lead, mercury, cadmium and aluminum are unsuspected culprits and should be considered in persons who have been exposed to them.

Hormonal imbalances including thyroid, adrenal and progesterone insufficiencies as well as others may be a problem.

Poor diet, junk food, smoking, obesity, and alcohol should always be considered.

In our clinic, every FMS/CFS patient completes the Comprehensive Health Assessment mentioned above. We consider it to be a required part of every patient's program. It is very easy to complete in spite of being extensive and global in its evaluation of your potential for these FMS/CFIDS causal factors. It is done at your convenience and time table, all online.

The Contributing Factors to Fibromyalgia and Chronic Fatigue Syndrome

As you have read above, FMS/CFIDS are caused by a variety of different conditions which on the surface would seem to be unrelated to fibromyalgia. There is a tremendous amount of literature available on FMS/CFIDS and your challenge is to sort through it all to see what applies to you. http://www.rxalternativemedicine.com/articles/fibromyalgia.html

 

Quote from the abstract for Characteristics of patients with fibromyalgia syndrome assisted in a hospital of Salvador, BA, Brazil. COSTA, Sergio Ricardo Matos Rodrigues da et al.:

We found a significant association of low family income, sleeping disturbances and smoking habit with a larger amount of tender points. http://www.scielo.br/scielo.php?pid=S0482-50042005000200004&script=sci_abstract

 

Quote from the abstract “Quality of life, functional disability and lifestyle among subgroups of fibromyalgia patients : The significance of anxiety and depression”:

Anxiety and depression interacted to yield relatively high consumption of coffee and cigarettes among the anxious and depressed subgroup, and this effect emerged only after the elimination of confounding effects of age and duration of the fibromyalgia disease.

http://cat.inist.fr/?aModele=afficheN&cpsidt=1216145

 

Has Fibromyalgia become a diagnostic label which is largely based upon behavioral stereotypes both here in the United States and abroad?

The Double-Edged Sword of Alcohol Use

Some doctors ask their fibromyalgia patients about their personal backgrounds and childhood and this can potentially include the loaded question: “Did your parents drink when you were a child?” Alcohol use has different connotations when related to socioeconomic factors, race and ethnicity. Obviously both non-abuse related alcohol consumption and alcoholism exists across the socioeconomic spectrum, and in all racial and ethnic groups. But, when it comes to social class, social standing, education, career and income, race and ethnicity there are societal-based stereotypes which can effect how a “yes” answer to the above question will be perceived.

In our society, for middle and upper income adults, (particularly for white middle and upper income adults) with higher levels of education and well paying white collar jobs, alcohol consumption, especially in social or romantic settings, bears far less of a negative perception. Drinking quality wines with meals; or choosing champaign for special occasions; drinking liqueurs, mixed drinks and microbrewery beers; being knowledgeable about wine; attending wine tastings; going on 'wine country tours' and the like is considered sophisticated and chic. But when it comes to societal perceptions regarding alcohol consumption, even just occasional consumption in social settings, by lower-income workers, and the poor, by anyone who has recently developed a chronic health problem, as well as by members of racial and ethnic minority groups, negative societal stereotyping can come into play.

If a white, middle class or wealthy patient is asked whether or not her parents consumed alcohol during her childhood, and she answers “yes”, the likelihood her questioner may or will automatically assume the alcohol consumption equated with alcoholism and domestic violence can differ somewhat than if that question is posed to a low-income white, or low or middle income black, Hispanic or American Indian patient. The same socioeconomic and racial/ethnic based stereotypes may very well influence how the medical or social support caregiver views the patient if the patient answered “yes” when asked if she or he ever consumes alcohol. With efforts being made to blame many medical problems on “bad personal behaviors” like consuming alcohol, even when that behavior have nothing to do with the development of the patient's medical condition, negative and erroneous assumptions can still be made about any patient who isn't a teetotaler. With efforts made to blame various illnesses and diseases in adults, including musculoskeletal and autoimmune diseases on childhood domestic abuse at the hands of parents and other caregivers, the question of “Did your parents drink when you were a child” becomes a loaded question particularly in light of societal biases and stereotypes against lower income whites and those from racial and ethnic minority group, and this factor needs to be considered.

Can a lower income/poor white, or non-white patient with minimal or no health insurance coverage who presents with chronic fatigue and pain, who answers “yes” to parental alcohol consumption have that “yes” used in part by her medical caregiver to reach a hasty diagnosis of fibromyalgia, based upon the stereotypes, biases and perceptions that exist in our society?

Is Fibromyalgia Partly a Socioeconomic and Social Stereotype Based Diagnosis?

A wide variety illnesses, diseases and medical conditions have symptoms that are similar to fibromyalgia, yet Fibromyalgia is currently a popular “fad” diagnosis for all that ails many people, particularly women; so what roles do socioeconomics, medical care coverage or lack thereof, and social class, gender, racial and ethnic stereotypes play within the medical community which effects physician diagnostic decision making? How do these factors help determine which patients will quickly receive the Fibromyalgia label with little or no medical testing to rule out other conditions, and which patients' doctors will look elsewhere for an answer through thorough diagnostic testing?

On average, how many medical tests are run on a patient with good to excellent health insurance coverage before her doctor even considers the fibromyalgia diagnosis? How many medical tests are run on an underinsured or uninsured patient before her doctor ever considers the fibromyalgia diagnosis?

It would be interesting to see studies run by Sociologists (academic Sociologists, not social workers) which strictly focused on socioeconomic and educational backgrounds, racial and ethnic factors, and levels of health insurance coverage or non-coverage regarding who is more likely to receive the Fibromyalgia diagnosis, particularly in situations where either few or no laboratory or hospital-based medical tests are performed to first rule out other medical conditions with similar symptoms.

It would also be interesting to read some Criminolgists' opinions on linking Fibromyalgia and CFS to child beating and child molestation, as an emotional symptom of suffering physical or sexual abuse. Have those criminologists who've interviewed the offspring of violent criminals (whose victims included family members) ever noticed any tendencies in these offspring to suffer from fibromyalgic and chronic fatigue-like medical problems?

Fibromyalgia and Gender, Race , Ethnicity and Occupation

From the “Fibromyalgia Pain in African Americans” webapge:

An estimated three to six million people suffer from fibromaylgia in the United States...African-American women account for a good portion of those diagnosed. Studies have shown that African-American women with fibromyalgia suffer more widespread severe pain than Caucasian women.. Treatment for fibromyalgia pain has varied for African-Americans.. A study published in 2003 discussed the lack of referrals for specialized pain management for African-Americans.

Fast Facts:

• A study revealed that African-Americans have a higher severity of chronic pain and an increased sensitivity to pain..

• Until recently, there were few studies on African-Americans and fibromyalgia..

• Trials are being conducted to study fibromyalgia pain in African-Americans. http://organizedwisdom.com/Fibromyalgia_Pain_in_African_Americans

Excerpts from “Patients of Color” by Sabrina Dudley Johnson:

Why is it important to discuss race and fibromyalgia?

Many minority fibromyalgia patients have recounted incidents with physicians who believed, “Since there are no minorities discussed in fibromyalgia research, they must not have it.”

Members of FACES (Fibromyalgia Association Created for Education and Self-help), including African American, Latina, and white people, males and females, civilians and law enforcement officers, drove three hours to a seminar. During the Q&A session, one member asked, "When are researchers going to do studies on people of color, and police officers with fibromyalgia?" The researcher replied "Never! They don't exist!"..

Marcellus Walker, MD, and Kenneth Singleton, MD, address race and healthcare, stating: “In the current climate of ‘political correctness,’ many people consider it inappropriate to separate people on the basis of race, but, when it comes to health, race really does matter. African Americans . . . will soon experience an epidemic of cancer, fibromyalgia, chronic fatigue, and other degenerative diseases.”..

A University of Alabama study revealed that African Americans have a higher severity of chronic pain, an increased sensitivity to pain, and a lower pain tolerance threshold than their white counterparts. The study went on to relate that coping styles, cultural responses to stress, and biases towards/from healthcare providers may be contributing factors.

Patrick*; an African American law enforcement officer with fibromyalgia, was given a referral for massage therapy. The physician called the therapist and asked if she had an opening for a male patient. She replied yes. The officer was ushered into a treatment room. The therapist entered and, upon seeing her new patient, ran from the room. "He didn't tell me you were black!" she snapped...

FACES was founded by people of color and public safety workers with fibromyalgia. We wanted to ensure that the diversity of people affected by this condition receive equal recognition in research and awareness projects. We also realize that the special issues of pain management disparities and cultural competency must be addressed on multiple fronts. Therefore, FACES concentrates on partnerships with other fibromyalgia organizations, government agencies, members of academia, disability organizations, members of law enforcement, and various community-based organizations... http://www.fmaware.org/site/News2?page=NewsArticle&id=6282

Unfortunately FACES was forced to shut down because its founder Sabrina Dudley Johnson has been struggling with worsening health issues. You can read more about Sabrina Johnson and FACES here: http://fmsglobalnews.wordpress.com/2008/01/06/the-demise-of-fibromyalgia%E2%80%99s-faces-inc/

Beyond medical discriminatory issues faced by members of racial and ethnic minority groups; when it comes to the fibromyalgia diagnosis, the fact that men too are diagnosed with fibromyalgia is often ignored in favor of painting it as a “woman's illness”. Also occupation seems to play a role for some patients. First responders of both genders- police, firefighters and EMTs- along with members of the healthcare profession- nurses, and even some doctors- are being diagnosed with fibromyalgia and CFS. Musculoskeletal and autoimmune illnesses are on the rise among first responders in general. First responders and healthcare providers come into contact with a lot of people as part of their profession- a lot of injured and ill people- so they are frequently exposed to various bacteria and viruses. Also with first responders, particularly firefighters, they are exposed to hazardous materials, toxic fumes/toxic smoke and such as part of their everyday jobs. But, unfortunately “job stress” has become the convenient medical excuse for the rise in such illnesses in healthcare workers and first responders. Several doctors who are involved with Fibromyalgia and CFS research and advocacy suffer from these conditions themselves. They are: Drs. Mark Pellegrino, Daniel Dantini, and Devin Starlanyl.

Beware the Fibromyalgia Diagnosis Part Eleven
Topic: Medical Care

Fibromyalgia and CFS As Psychosomatic Trauma Illnesses- Part Four:

Questioning This Flawed Premise- Part Two

The Role of Gender Differences in the Use of Language

Somatoform/Biopsychosocial researchers and other so-called Fibromyalgia experts often push the concepts of the Fibromyalgic personality: suffering from low self-esteemed based people-pleasing and being the typical Type A workaholic overachiever who doesn't know how or when to rest and relax.

When it comes to people pleasing, and burning the candle at both ends, women are viewed in our society as nurturers and care-takers, and many are struggling to balance work and family responsibilities. Feeling burned out, overworked and under-appreciated by both their employers and family members is not a new concept, and these sentiments are felt by members of both sexes. This concept really has nothing to do with whether or not someone has been diagnosed with either fibromyalgia, or CFS, or has been abused as a child. Employees are working harder, for longer hours each week than in decades past, and many aren't receiving the salaries they deserve for all their efforts. Higher levels of education, job training, and frequent educational/career skill updating is required in various career fields. Two-income households are often a necessity in order for families to make ends meet. Beyond that are the additional responsibilities of home and family, which may include raising children while also taking care of aging and ill relatives. But the medical language of Fibromyalgia (and CFS) has been completely enmeshed in psychotherapy-speak, and abuse and dysfunction concepts and buzzwords. These buzzwords and dysfunction concepts are most often pushed and touted by male medical researchers who are using these terms to analyze and psychologically profile female patients. Female fibromyalgia patients who use emotion-based words, who express feelings of under-appreciation or say they feel burned out by their work and family responsibilities are simply deemed as 'damaged' and 'dysfunctional'. It is a well known and well researched fact that gender differences exist between the way men and women use language. Some women simply tend to use more emotion-based words when speaking casually and informally than men. Any female patient who uses emotion-based expressive words to describe herself, her feelings and personal life can easily have these sentiments misconstrued by male somatoform/biopsychosocial researchers as indicating she suffers from low self-esteem and emotional dysfunction issues, and has been taken advantage of and is being beaten down emotionally by her loved ones.

Military Versus Civilian Life- An Awkward Comparison

From the article “Neurotherapy Treatment of Fibromyalgia Using EEG-Based Stimulation”:

Yudenfreunc-Sujka found that 90% of the Orlando VA Healthcare Center's female patients with chronic headaches and fibromyalgia have a sexual assault/abuse history.²² Patients presented with several diagnoses overlapping with the symptoms of fibromyalgia and post-traumatic stress disorder. "It is the author’s opinion that the sexual assault/abuse that the patients had been subjected to resulted in psychological problems that contributed to the development of headaches and muscle aches and pains which were then labeled fibromyalgia." He concludes that "...rape and any type of sexual assault can be a precipitating cause of post-traumatic stress disorder."²³ Highly charged emotional events create a chemical cascade in the CNS that leaves its imprint on functioning. What is not mentioned in most of this research is the effect of physical trauma on the central nervous system from blunt forces, or internal forces generated by acceleration/deceleration trauma. Many sexual abuse incidents involve head trauma as a result of accompanying physical assault. Highly charged emotional events create a chemical cascade in the CNS that leaves its imprint on functioning in addition to whatever physical trauma may have occurred during the abuse. http://www.fmpartnership.org/Files/Website2005/Learn%20About%20Fibromyalgia/Articles/Neurotherapy%20Treatment%20of%20Fibromyalgia.htm

One interesting point not made about the above statement regarding sexual abuse and trauma with these female patients is the significance that they are female veterans who are patients at a VA hospital which offers mental health services for veterans dealing with various issues including Military Sexual Trauma. Hence this is VA hospital, serving the veterans of central Florida, which offers counseling services for former military members who were raped while they were serving their country. News stories about the how the military often does a poor job when it comes to serving the needs of female soldiers, sailors and airman who were raped- both from the legal standpoint of prosecuting the rapist and the emotional standpoint of providing counseling services for the victim have made these deficiencies and flaws public knowledge to our society-at-large.

The Orlando VA Medical Center's Mental Health Program includes treatment for: Post Traumatic Stress Disorder, Alcohol and Drug Abuse, Traumatic Brain Injury, Military Sexual Trauma, and has a Domiciliary. http://www.orlando.va.gov/services/index.asp

A Domiciliary is an in-patient rehabilitation and treatment program which:

...Provides clinical care to patients who suffer from a wide range of problems, illnesses, or areas of dysfunction, which can be medical, psychiatric, vocational, educational, or social.

...Provides clinical care which emphasizes a positive therapeutic milieu, functional independence, and patient mutual support,specifically utilizing the Therapeutic Community model. As used here, this implies the use of the "community as method."The peer community is used in a conscious, purposeful manner to facilitate social, psychological, and behavioral change in individuals. Multiple therapeutic and rehabilitative activities are used, all being designed to produce therapeutic and educational changes, and all participants (patients and staff) are considered mediators of these changes.

...Provides care by Domiciliary interdisciplinary clinical teams which develop, integrate, and coordinate comprehensive and individualized plans of treatment, rehabilitation, or health maintenance which include all resources involved in the patient's care, both within and outside the Domiciliary.

...Offers the potential for treatment or rehabilitation of patients with relatively narrowly defined problems if the general definition of Domiciliary Rehabilitation and Treatment is met, in each instance attending to whether a different type of care or treatment program would be more appropriate.

http://www1.va.gov/domiciliary/

The female fibromyalgia patients from the Yudenfreunc-Sujka study belong to a rather unique subgroup. They are women with a military service history which may have lead to bodily injury or injuries which increased their vulnerability to developing chronic health problems, who were also unfortunate enough to become the victims of rape while serving their country. These female veterans' lives and personal experiences don't exactly correspond to the life-experiences of female civilians who've been diagnosed with fibromyalgia, so it's an awkward comparison.

Everybody Into the (Fibromyalgia Patient) Pool!

Quotes from the abstract for “Psychiatric Disorders and Functional Disability in Patients with Fibromyalgia”:

The objective of this study was to describe the prevalence of current psychiatricdisorders and functional disability among a sample of patients attending a fibromyalgia group clinic in the Rheumatology Department at Kaiser Permanente Colorado...

A sample of 184 patients, 92% of whom were women, were given questionnaires at the beginning of the group clinic. Questionnaires included items on demographics, work disability, and history of trauma and abuse. Also included were the following instruments: the Illness Intrusiveness Scale, the Fibromyalgia Impact Questionnaire, and the Quick Psychodiagnostics Panel...

Most patients reported a history of trauma (74.7%) or abuse (53.5%). Major depression (34.2%), anxiety (29.9%), and panic disorders (17.4%) were prevalent in this sample. Symptoms of bipolar disorder were present in 59.2% of patients. In addition, a high level of psychiatric comorbidity was evident: 64.1% of the patients met DSM-IV criteria for two or more diagnoses. These patients also reported clinically significant functional impairment (especially in thelife domains of active recreation, health, and work) and were most negatively affected by fatigue, lack of restfulness at waking, and stiffness.

This study seems like it's pretty straightforward, but is it really?

The study itself reads:

Most patients diagnosed with fibromyalgia by their primary care physician at Kaiser Permanente (KP) in Colorado are referred to a rheumatologist. Because of the volume of fibromyalgia patients seen there—fibromyalgia is the second most prevalent condition seen at the KP Colorado Rheumatology Department—and because of the difficulties in providing care to these patients within the traditionaloffice-visit model, the rheumatologists developed a fibromyalgia group clinic that was implemented in1998. The group clinic consists of one four-hour session that includes education about fibromyalgia and its diagnosis; behavioral guidelines for restorative sleep, relaxation, and exercise; and treatment such as medications and physical therapy. Because the course of the condition is greatly affected by the presence of psychiatric disorders and by the patient’s initial level of functional impairment, assessment of these two domains among patients attending the group clinic became a primary goal for the rheumatology providers

What exactly has been going on at Kaiser Permanent Hospital since the late 1990's which results in their primary care physicians diagnosing so many patients with fibromyalgia that it's become the second most prevalent rheumatological condition at that hospital, and the sheer volume of fibromyalgia patients requires a special clinic set-up to accommodate them all?

Their study sample uses 184 patients, but how many patients make up their entire Fibromyalgia patient pool?

We were particularly interested in screening for psychiatric disorders, because the rheumatology clinical staff expressed their belief (and the medical literature about fibromyalgia suggests) that psychiatric disorders are common among patients with fibromyalgia and greatly affect these patients’ ability to manage their condition and to achieve successful treatment outcomes.

Since this hospital and its staff already works under the assumption of a link between psychiatric disorders and fibromyalgia, does this mean any of these Kaiser Permanente patients who were labeled with Fibromyalgia to explain their medical ailments received the fibromyalgia diagnosis label because their physicians already knew they had some sort of mental health issues- anxiety disorders, depression or whatnot- so the fibromyalgia diagnosis became the 'easy answer' for these particular patients? Or, because of the assumption of a link between the two factors, are their fibromyalgia patients automatically viewed, assessed and labeled as suffering with mental health issues just because they have the fibromyalgia diagnosis, i.e.- does the fibromyalgia diagnosis “taint” these patients in any way?

Think this study was conducted fairly and honestly? Well, think again.

Study Subjects and Data Collection

The data for this study were obtained from a variety of validated self-report measures administered to 184 patients attending the fibromyalgia group clinic between November 1998 and August 1999. Patients had been referred to a rheumatologist by their primary care physician, who made the initial diagnosis of fibromyalgia; the rheumatologist scheduled the patient for the group clinic after confirming the diagnosis.

In other words, they carefully cherry-picked 184 patient self-reports taken from the entire pool of incoming clinic patients who were seen over a nine month period, which fit into their preconceived ideas regarding links between fibromyalgia and psychiatric problems. This was an intentionally loaded study which was conducted in such a way to“confirm” their hypothesis and personal viewpoints, and there is nothing 'random' or straightforward about how this study was conducted.

Another interesting thing to note is the inclusion of one patient's self-report, and the clinical assessment made regarding her answers and interview. The common symptoms of fibromyalgia this patient experienced, which included: dizziness, shortness of breath, heart palpitations, muscle tension, and sleep disturbances were clinically assessed as “Anxiety Symptoms”. Weight gain, insomnia, poor concentration, and fatigue- other common fibromyalgia symptoms- were placed under the “Depressive Symptoms” list. Hence the common symptoms of the condition itself are automatically classified as mental health issues. Listing the common symptoms of a particular medical condition as psychiatric in nature automatically categorizes and classifies its entire patient pool as 'mentally ill'.

The entire study can be downloaded here: http://xnet.kp.org/permanentejournal/sum00pj/fibro.pdf

A Question of Neuropsychiatric Lyme in Colorado

Kaiser Permanente Hospital had an unusually large pool of patients who have been diagnosed with Fibromyalgia, beginning back in the late 1990s. And their staff strongly believes in links between fibromyalgia and psychiatric disorders. Did any of these doctors ever think to evaluate their patients with chronic pain and fatigue, and psychological problems for Neuropsychiatric Lyme/Lyme Encephalopathy? There is a subset of Lyme patients for whom the physical symptoms take something of a back-seat because the Lyme Borrelia spirochetes attack the brain, resulting in encephalopathy- an inflammation of the brain and spinal cord. Lyme Encephalopathy can cause symptoms that mimic psychiatric illnesses, including: bi-polar disorder, obsessive compulsive disorder, anxiety disorders and depression. Neuropsychiatric Lyme is medicinally treated the same as Lyme in general- with antibiotics.

Medical researchers, doctors, nurses and psychosocial-support workers who claim that some/many/most of the fibromyalgia patients they deal with tend to have psychological problems may be in fact dealing with misdiagnosed patients who really belong to the Neuropsychiatric Lyme patient subgroup.

...Virginia Sherr, a psychiatrist from Holland, Pennsylvania, meanwhile, says the prevalence of tick-borne disease has transformed the face of her practice- and not because Lyme Disease patients sought her out. “I find that many patients walking in off the street are infected, but unaware,” Sherr states. “They don't know what has happened to cause their depression, confusion, obsession, anxiety, tendency to lose things, or other complaints.” When Sherr suspects Lyme or a coinfection, she has no compunction about sending blood out for laboratory tests. “When tick-borne disease is the cause, it's only with antibiotic therapy that psychiatric symptoms resolve.”

...“Doctors can destroy patients by telling them that a true, physical disease is all in the head,” Sherr says, “and suicide is a possible result.” In the hyperendemic area of Bucks County, she sees a new case of Lyme encephalopathy every week and, sometimes, almost every day. “I am a psychiatrist. These are not people who are referred to me because they have Lyme disease- they are sent because they have panic attacks, hallucinations, obsessive compulsive disorder, depression. They are in agony- not only neuropsychiatric pain, but physical pain as well. They have never been hypochondriacal in their lives, but that is how they have been labeled before they come to me. They are encephalopathic, but they have been told they are not by physicians who wouldn't know a case of encephalopathy if they fell over it.” (pp 152-153, “Cure Unknown: Inside The Lyme Epidemic” by Pamela Weintraub)

The “NEURO-COGNITIVE LYME DISEASE” webpage is filled with links to numerous educational and informative articles on Neuropsychiatric Lyme: http://www.lymeinfo.net/neuropsych.html

Beware the Fibromyalgia Diagnosis Part Ten
Topic: Medical Care

Fibromyalgia and CFS As Psychosomatic Trauma Illnesses- Part Three:

Questioning This Flawed Premise- Part One

Quote from the abstract for “Physical symptoms in sexually abused women: somatization or undetected injury?”by Sarah Nelson:

Medically unexplained physical symptoms and disorders in women sexually abused in childhood are widely interpreted as somatization-the expression of emotional pain and stress through bodily symptoms. However, the somatization theory is not based on detailed knowledge of the abusive incidents, and may underestimate the direct effects of violence and injury, repeated over years, to children's developing bodies.

http://www3.interscience.wiley.com/journal/91016052/abstract?CRETRY=1&SRETRY=0

Under the somatoform/biopsychosocial model- physical injuries which cause soft tissue damage, nerve damage, broken bones, etc. whether from domestic violence, automobile accidents, workplace related injuries or from do-it-yourself home maintenance/repair mishaps which involve falls from ladders, or roofs and such, etc., which result in permanent pain or injury have suddenly been reduced to the bodily injury not counting at all in favor “diagnosing” the patient with Post Traumatic Stress. The same holds true for physical damage caused by serious and persistent viral and bacterial infections, other environmental based health problems, autoimmune diseases, and genetically-based health conditions. Any so-called “trauma” or hardship one faces throughout the course of his or her lifetime can be scapegoated as a “stressor” which triggers illness. If the patient wasn't in a car accident and wasn't the victim of domestic violence or sexual assault; any difficulty, loss or hardship in life can be substituted, whether is was a job loss, a divorce, the death of a loved one, undergoing surgery, etc. The way this belief system is headed, soon the “childhood emotional traumas” people experienced such as having their pet hamster die when they were ten years old, or not making the cheerleading squad in ninth grade, or not belonging to a popular clique in high school, or not attending one's prom with her or his 'dream date' will be blamed for the illnesses they later develop in adulthood. The same may hold true with adults who will be labeled as “psychologically traumatized” because they didn't get that promotion they wanted at work, or because they couldn't afford to buy their pricey dream house, and instead had to choose a much more modest home which fell within an affordable price range; and these set-backs may be seen as the so-called 'emotional causes' behind their physical pain and permanent health problems following that serious car accident in which they nearly died, or if they develop cancer or an autoimmune disease.

It's typical for some (many?) patients diagnosed with fibromyalgia to have a medical history which can include a combination of bodily injuries from various sources, genetic-based health problems, multiple infections and sometimes other chronic progressive conditions such as rheumatoid arthritis. So there is this one of school of thought (of growing influence within our healthcare system) which places just about all the “blame” for illnesses, particularly ones which involve chronic pain and impose limitations on physical activity and stamina, on the patients themselves for having weak psyches and flawed, dysfunctional personalities due to being repeatedly beaten down emotionally by the people in their lives and by various life-events. This trauma-induced stress damages their HPA Axis (HPA- Hypothalamus, Pituitary and Adrenal glands) leading them to develop an “adrenal fatigue” type illness. Adrenal fatigue being yet another fad diagnostic buzzword which is related to people's bodies burning out via the HPA Axis due to the stresses of our fast-paced modern world. A subset within this school of thought blames these emotionally traumatized and family dysfunction-damaged patients for destroying their own health through the negative personal behaviors of smoking, alcohol abuse, using illegal drugs, eating a fatty food/junk food filled diet, and not exercising.

Stress and poor personal life choices are the current scapegoats for a growing number of diseases and other medical conditions. Forget about permanent bodily injuries, chronic and persistent bacterial and viral infections, and other harmful environmental agents, and of course there's genetics which can leave some people much more vulnerable to illness via their either lacking certain good protective genes or possessing other not-so-great genes which increase their chances of developing certain kinds of health problems- these factors have all become irrelevant. Equally irrelevant are the facts that many people who develop chronic illnesses don't come from abusive or dysfunctional families, don't smoke, don't drink in excess (or imbibe at all), don't use illegal drugs, and don't eat any less healthy or exercise any less than many other ordinary, average people who don't develop chronic health problems. On the other hand, there are plenty of people who come from abusive or dysfunctional backgrounds, and who make poor life choices who don't develop life-altering chronic health conditions.

Our healthcare system is run by managed care health insurance companies and the major pharmaceutical companies Over fifty million Americans lack health insurance coverage and that number continues to grow as jobs continue to be outsourced overseas, and our economy is now furthered weakened by a deep, global recession which is triggering even more job layoffs, on a daily basis. About an equal number of people are underinsured, and are carrying policies which cover only very rudimentary healthcare services. Some of the uninsured are relying on state Medicaid programs which are drastically underfunded, and it's the same story with state Charity Care programs. How convenient that there are these catch-all illness pigeonhole labels involving the HPA-Axis and so-called emotional-trauma related physical ailments to dump patients into with little or no diagnostic testing required, which is a real money saver for those insurers who are footing these patients' healthcare bills. Being able to blame the patients for their illnesses by claiming they must have been abused as children, or they were traumatized by some incident that happened to them sometime during their lives, along with negatively stereotyping them regarding their lifestyle choices is a money saver as well for cost-conscious insurers, and it also provides them with convenient 'excuses' for cutting back on the quality and duration of the medical care their patients can receive. And of course this means it's okay to cut back on certain types of medical research regarding the true biological, environmental, and genetic causes behind those diseases and health conditions which are on the rise, as “stress”, “psychological trauma” and “bad personal behaviors” have become the cheap and easy answers. Under this mindset, the easy answer to why illness happens is becoming- someone in your life did something bad to you which screwed you up emotionally and/or you're doing bad things to yourself, which has damaged your body and destroyed your health. The primary course of medical treatment for these conditions will likely include prescribing one or more of the popular antidepressants which are heavily advertised on television and in all the top selling weekly and monthly magazines, along with sending these patients to cognitive behavioral therapy and patient support groups.

Analyzing the Abuse Related Studies- It's about Socioeconomics and Stacking the Deck

The abuse related trauma studies of fibromyalgia and CFS patients typically involve very small numbers of people, and they tend to be hospital clinic patients. When you're dealing with clinic patients, particularly here in the US, you're often hitting upon very specific socioeconomic demographic backgrounds. Typically clinic patients in the US are uninsured or underinsured. They tend to have lower incomes and are often members of the working poor; or they are on fixed incomes via Social Security, modest pensions, Disability, or Welfare. With some of these patients, they are under/uninsured and low or fixed income because they are chronically ill and/or permanently injured and this has severely impacted their income-earning potential and their overall ability to be in the workforce. These patients originally came from a broad range of socio-economic backgrounds, and have varying levels of education and job skills. They include those who came from stable working class and middle class backgrounds, including those with higher education. These are patients whose lives have been upended by their current medical situations.

On the other end of the clinic patient demographics scale are the life-long disadvantaged poor. These patients' medical histories involve a much more complex interaction of the problems typically faced by the life-long poor. Some of these patients grew up in heavily trafficked and/or heavily industrial areas where breathing in smog and other toxic fumes was the norm, where local waterways were heavily polluted by industrial run-off, and soil contamination from local industry was common. Some grew up in households where there wasn't always enough food to eat. Some grew up in substandard housing where peeling lead-based paint and mold growing inside the walls, floors or ceilings was the norm. Unfortunately higher crime rates (including rape), domestic violence, child abuse and neglect, are much more prevalent in economically depressed urban neighborhoods and rural communities where you find higher levels of unemployment and underemployment, a greater dependency on welfare, poorer quality schools, and high school drop-out rates which greatly exceed the state's and national averages.

Poor choices in personal behaviors- heavy smoking and drinking, illegal drug use, and domestic violence far too often walk hand-in-hand with a socioeconomically disadvantaged lifestyle. Eating a diet entirely composed of cheap fast food, tv dinners and other heavily processed foods, caffeinated and carbonated beverages, and high calorie sugary snacks is much more common in families who have extremely tight food budgets and live in neighborhoods where fast food restaurants, small corner groceries and convenience marts are much more common fixtures than regular supermarkets, higher end whole foods/organic foods stores, and farmers markets. When somatoform/biopsychosocial studies are done on clinic patients (particularly here in the US), the lifelong socioeconomic demographic backgrounds of these research subject patients are crucial factors regarding how much or how little their personal life-experiences truly reflects the greater so-called 'typical patient life-experience'. The socioeconomic demographics data should be disclosed when these studies are published. When researchers release a study claiming a link between lifestyle and personal history factors and the development of chronic illnesses and diseases, when these factors can be directly linked to patients' socioeconomic status there needs to be more transparency regarding whether or not such factors are being linked to patients from all socioeconomic backgrounds, or just patients from certain specific socioeconomic backgrounds.

Sociological/socioeconomic factors which should be assessed for Fibromyalgia and CFS clinic patients who are participating in lifestyle assessment, and personal, familial and lifelong medical history research studies, includes: Socioeconomic demographics and the general crime rate for each patient's current place of residence. Current household income. Highest levels of education attained by the patient, spouse or romantic partner, siblings, and parents or childhood legal guardians.

All research study patients should be asked: Did you grow up in public housing and/or other substandard housing? Are you currently living in public or substandard housing? Did your family ever rely on welfare, WIC and/or food stamps when you were a child? Are you currently on public assistance and/or are receiving food stamps? Were you ever forced to skip meals or go to bed hungry during childhood because there wasn't enough food in the house? Are you forced to skip meals now for financial reasons? Were you ever diagnosed with vitamin or mineral deficiencies? Were you ever small or underweight for your age during childhood? During your childhood, were your parents ever married to each other and did you all reside in the same household? Did you grow up in a high crime area? During your childhood, did you live in an industrial area where contaminated air, water or soil triggered various illnesses in local residents- such as asthma and certain forms of cancer? Do you live in such a place now? Did you have steady access to healthcare as a child? During your childhood, did your family have private health insurance coverage and family physicians, or were you mostly or completely dependent upon Medicaid or Charity Care funded clinic care or Emergency Room visits for your access to medical care?

Why Are Most Male Patients Typically Kept Out Of Fibromyalgia and CFS Patient Studies?

Another flaw with these fibromyalgia and CFS clinic patient studies is the test subjects are typically adult females. Girls and adult women who are socioeconomically disadvantaged and are from economically depressed urban neighborhoods and rural communities are at much higher risk for becoming the victims of both stranger-based violent crime and domestic abuse than girls and women who are from stable financial backgrounds and reside in safer middle class neighborhoods. Poor, undereducated women are more likely to stay in abusive relationships than middle class women with educations and marketable job skills. Children from low income and public assistance-dependent families are more likely to be abused and neglected. And girls are more likely to be sexually abused than boys. In economically depressed areas where the crime rates are higher, there is a higher risk potential for being sexually assaulted in one's own neighborhood or community- while walking to and from school, while taking the elevator or walking up or down flights of stairs alone in one's housing project or low-income apartment building, while walking to a local grocery store, while walking to friend's or relative's home, or while waiting alone at a bus stop in an isolated and quiet area when it's dark outside, etc. Smoking, excessive drinking, illegal drug use, and frequent heavy junk food binging are all more likely to serve as escapist comfort activities for people from lower-income and disadvantaged backgrounds.

These Fibromyalgia and CFS clinic patient studies which may very well skew towards studying and assessing the lives of lower-income, socioeconomically disadvantaged women simply aren't going to reflect the personal lives, family backgrounds, the likelihood of sexual assault victimization, and lifelong health histories of women from stable working class and middle class lifestyles and backgrounds who reside in safer neighborhoods.

Men are also diagnosed with Fibromyalgia and CFS, yet their socioeconomic-educational backgrounds, personal and familial life histories, and lifelong medical backgrounds are kept out of these childhood abuse trauma and adult domestic violence and rape victimization studies by somatoform and biopsychosocial medical researchers. Why are male Fibromyalgia and CFS patients typically kept out of the picture when it comes to these researchers developing the so-called psychosocial life history and personality profile for the 'typical' fibromyalgia and CFS patient; except on those occasions when male patients appear in car crash caused pain studies, or military combat-caused PTSD pain studies, where male patients are studied in regards to their experiencing chronic aches and pains? The answer to that is pretty simple and straightforward- you don't see and likely won't see studies conducted where male Fibromyalgia and CFS patients are asked if they were physically and/or sexually abused as children, or if they have been abused by a spouse or romantic partner, or have been sexually assaulted in adulthood. Adding more men into the equation- especially men from stable middle class familial, socioeconomic and educational backgrounds- by adding male patients to these somatoform/biopsychosocial studies which attempt to equate Fibromyalgia and CFS to childhood abuse, and adult domestic violence and rape victimization would likely unravel the theories that these illnesses are trauma-based somatoform disorders mainly caused by being the victim of childhood physical and/or sexual abuse, or spousal/partner abuse and adult rape.