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• I read with interest, but also concern, the research paper on counselling people with ME (CPR, June 2008) and the article ‘Living with ME’ (therapy today, June 2008). I take issue with the idea that ME is a disputed condition.
  
  What may be disputed is how many illnesses are currently hidden in the catchall diagnosis of ME/CFS. The World Health Organisation classified ME as a neurological disorder in the International Classification of Diseases (ICD) in 1969. ME Research UK states that ‘ME is a neurological illness with evidence of immunological and toxicological signs, clear disturbances to the neuroendocrine stress axis, impairment of the autonomic nervous system, irregularities in the perfusion to the brain and indeed to the peripheral vascular system confounded by red blood cell abnormalities with recent evidence suggesting a hypercoaguable state – all of these extensively documented findings’ (Dr V A Spence, ME Research UK website, November 2000). Dr Spence says that people with CFS have poor immune activation and poor cellular function, and that it is often a disease with remission-exacerbation cycles.
  
  While I believe that it is likely there are physiological and psychological aspects to all illnesses, to treat either ME or CFS with only CBT and graded exercise is to ignore all biological abnormalities. Stress, for example, may be a contributory factor in some heart attacks and some cancer. However, the first port of call in treatment is to deal with the physical issues, not to ignore these and only offer CBT. The sufferers of these illnesses may feel they could benefit from counselling, but everyone would expect the physical aspects of the illness to be treated. This is, by and large, being denied to sufferers of ME and CFS.
  
  The psychological and medical worlds should learn from history. ME and CFS are not the first illnesses to be claimed to be psychological in the first years of their appearance. In every case, this approach takes away money from research into the potential physical causes of the problem for years. My mother can recall children being beaten and made to stand in the corner after having an epileptic fit because they were seen as being attention seeking. Not much has changed. In more recent years, children suffering from severe ME have been thrown into swimming pools in the belief that this would cause them to start swimming and thereby prove to them that their inability to move had been all in the mind.
  
  CBT is a kinder treatment than that. However, to read the article in CPR where it is quoted that people with ME who are ‘psychologically minded… are more likely to do better with CBT’, is verging on praising/blaming the sufferer for whether or not they recover. At the present time, perhaps we should be investing more money into understanding what ME and CFS actually are before we pass judgement on whether or not the sufferers have got the right attitudes.

• Barbara Jeffries