Comment by cpncrunch | Hacker News Reader

Comment by cpncrunch | Hacker News Reader

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Having recovered from CFS myself and researched it for about 15 years, it seems highly likely it is psychosomatic rather than organic. The literature seems to point in this direction -- that it is a condition caused by chronic stress. (Interestingly the biomarker found in this study is also found in PTSD and in abused women).

I think you've hit the nub of the problem with your statement that you're "more than 99% sure CFS is a physical condition". The majority of people (including many doctors) simply don't understand certain basic facts about how the body works (such as the fact that cortisol is a stress hormone, but also one of the main modulators of the immune system). Most people still have a Cartesian/Victorian view of the human body, and believe that the mind and body are completely separate.

Telling someone to "get a new hair cut to cheer you up" won't be much use for major depression or PTSD either. Comments like this just perpetuate the misconception/prejudice that psychiatric conditions aren't real illnesses. I think it's a combination of this prejudice, combined with a misunderstanding of how the body works, that has caused most of the problems relating to understanding CFS.

Interesting thoughts and it's always good to hear from those who've recovered, hopefully yours was full?

I'm always open to differing views, so would be interested in any recent papers pointing to a psychosomatic cause, especially as this seems to be an area active research is moving away from.

I completely agree the mind/body need to be treated more as a single entity, but the researchers and clinicians I've been engaged with are most certainly looking at this in a non Cartesian way. Nb these are not general practice doctors.

Again, I'm comp sci rather than medical, so my experiences are anecdotal but a good many of the CFS patients I've known have not been under chronic stress with the often exception of CFS seemingly being triggered by a viral infection such as glandular fever. I can't comment on whether cortisol levels remain high.

Fundamentally there is so much we don't understand about what may in fact be a group of illnesses, hence why people's personal stories seem to fall into two or three conflicting camps.

We need more data to go on, which is why I've a side project looking to address this which will hopefully lead to more areas of research.

Yes, my recovery was full. I haven't had any symptoms in about 15 years, so I think that is a fair assumption to make.

Studies do show that the majority of CFS patients report more stressful life events preceding their illness than controls (e.g. Salit 1997, Hatcher et al. 2003, Theorell et al. 1999). Also, from speaking to patients, you do very often find that they lived stressful lives prior to developing CFS.

Also bear in mind that it may be burnout more than stress that is important in triggering the illness, and it appears to be possible to have burnout even in the absence of stress (see for example Pruessner et al., 1999).

Infections also activate the HPA axis in a similar way to psychogolical stress, and it may be a combination of stress and infection that causes CFS. (Some studies show that gulf war syndrome is more likely if vaccinations occur during the stress of combat). Alternatively the viral infection at onset might simply be due to suppression of the immune system due to stress.

If you're interested, here is my theory of CFS:

https://peerj.com/preprints/860/

Feel free to email me or leave a comment there if you have any comments. If you're interested in this area, I'd recommend reading the full-text of the studies in my references -- let me know if you want the full-text of any of them. Like you I'm compsci rather than medical, but IMO a lot of the medical people aren't really doing a good job at figuring out this illness.

I've followed through on your links and suggested reading and to be honest a lot of your conclusions are based on theory from a decade or more ago. Obviously there are still some proponents of this being psychosomatic but it's widely and rightly disregarded now.

I saw in one place that your your understanding of the illness was described as "6 months of disabling fatigue, depression, sleep disturbances, and/or GI problems"

If that's the case then I'm afraid I don't think you are really an authority to talk about CFS from the perspective of a former patient. That does sound like a stress related breakdown which happens to share many of the symptoms associated with CFS.

Is there even a difference between 'psychosomatic' and 'organic'? As far as I know we've acknowledged that the brain has significant power over the functioning of the body, being able to modify blood pressure as an example. Why wouldn't environmental factors be able to influence mental chemistry and functioning, which in turn influences physical fitness?

Maybe I misunderstood but it seemed as though you were drawing a line between mental and physical origins of the disease and I just don't see how this is so "highly likely" or even a useful distinction.

That said I think it is highly likely that we simply don't understand enough about the brain or body to say one way or another what could be causing diseases like CFS.

The difference between psychosomatic and organic is the etiology of the illness -- whether it is mainly caused/perpetuated by stress/emotions or similar.

Certainly, it's possible for the brain and body to influence each other. Any severe infection will induce "sickness behaviour" for example, causing symptoms like fatigue and depression -- very similar to CFS in fact. However there is quite significant evidence that is caused by a dysregulation of the stress system, and not really much if any evidence showing an infectious etiology. Pretty much all the pathophysiology is consistent with a stress related illness, including this interferon-gamma biomarker.

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