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Are emotional reactions a product of
CFIDS or is CFIDS the result of mental instability? That question lies at the heart of the
on-going disagreements between those with CFIDS and the medical establishment and the rest
of society.
MIND-BODY CONNECTION
Despite the plethora of new information and research on the mind-body connection,
modern medicine still clings to a deeply ingrained dichotomy between the physical and the
psychological. We know that negative emotions like depression, resentment, anger,
hostility, grief, fear, panic, guilt, melancholy, sadness and sorrow, have an effect on
everything from colds to cancer. Yet, the very word "psychosomatic" is
practically a code word for "imaginary". Perhaps the heated debate about the
"true" nature of CFIDS underscores our persistent failure to comprehend the
profound and physiologically dynamic connection between mind and body.
CFIDS SUFFERING CAUSES DEPRESSION
The symptoms of CFIDS are not psychosomatic consequences of negative emotions.
Rather, the negative emotions are more often a result of suffering from CFIDS. We
see the same manifestation in patient's with diabetes, kidney failure, cancer, heart
disease and a long list of others. Those negative emotional symptoms are usually treated
concurrently with the primary illness.
BELIEF IN CFIDS?
Most physicians would not even suggest that the diabetes, cancer, or heart disease
was not real. Nevertheless, because CFIDS still has no known cause and no single
laboratory test to confirm the diagnosis, the skepticism continues. It’s easy to say,
"I don’t believe in CFIDS", when the medical community demands more
objective proof that an illness exists. Why this apparent incongruity? Simple; we can
attach numbers to other illnesses---a blood sugar of 484, a serum creatinine of 6.5, a 95%
occlusion of the left anterior descending artery of the heart. The medical profession has
relied on the science of medicine, as seen in the numbers attached to diagnostic
tests. Numbers automatically make anything "real". In addition, the art
of medicine is often seen as ambiguous. Couple that with the variety of symptoms that
CFIDS presents, and it is any wonder we are seen as somaticizing.
VALID STUDIES
When one closely examines the neuropsychological dysfunction, it is apparent that
the illness came before the emotional problems. For instance:
 | Eleanor K. Axe,
Ph.D., from UCLA School of Public Health, Los Angeles, found that most major
emotional problems seen in CFIDS patients had an onset concurrent with their illness. In
addition, she saw numerous neurocognitive impairments (such as motor, visual, language,
attention and memory impairments) as well as emotional in CFIDS patients.
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| A comprehensive study of 1200
patients with CFIDS by Rosamund Vallings, MD from the University of
Auckland, New Zealand, demonstrated that CFIDS might have a
"typical" personality type. She found that most people with CFIDS have the
following personality characteristics:
 | High academic achievers
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| Competitive sports people
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| Obsession with body shape and image
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| Obsession with detail
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| Rigid disciplined lifestyle
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She also found that those with CFIDS, who had the above characteristics, changed their
focus when the illness began. CFIDS often led to loss of control over health and life, so
that other controlling characteristics may emerge, such as obsession with detail over
health, rigid dietary adherence, control of the family with dependency, etc. These
patients often dislike the feelings of loss of control over their own bodies imposed by
medications and the sense of "takeover by medical professionals. They feel
misunderstood and badly treated which leads to a form of "medical paranoia".
They drift from one health professional to another in the endless search for understanding
and are thus often labeled hypochondriacal, somaticizing, or suffering from a psychiatric
disorder, the very label they fear most. The psychiatric label represents to them further
loss of inner control, self esteem, and the constant need to affirm the organic rather
than psychological aspects of the illness.
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Other studies have demonstrated the neuropsychiatric effect of elevated cytokines on the
brain, and the resultant neurochemical abnormalities that often lead to depression and
emotional lability. Specifically, the neurochemical serotonin has been shown abnormally
low in CFIDS. (Nancy Klimas MD, University of Miami School of
Medicine and Janice Kiecolt-Glaser, MD, Ohio State University Medical School, Columbus,
OH)
CAUSES OF NEGATIVE EMOTIONS
| Negative emotions
that seem to accompany most chronic diseases occur more frequently and for a longer
periods. For instance:
| Those with CFIDS can experience
concern when an illness lingers and medical professionals are unable to find the cause of
the problem
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| They can experience fear due to
uncertainty as to the cause or out come of the illness
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| They can experience frustration when
they can no longer do the tasks or the job they were doing before their illness
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| They can experience worthlessness
when they realize that the illness is cheating them of going on with their life
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| They can experience anger—first
at their physician who has told them "it’s all in your head"—then
toward their family and friends who lack understanding or compassion
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| They can experience devastation due
to the financial loss as a result of disability or only being able to work part time, or
spending excessive amounts of money on medical costs
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| They can experience hopelessness when
they realize they must be "taken care of" by others
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| They may mourn the loss of their
former active life.
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CHANGED
PERSPECTIVE
All of these negative emotional reactions can cause stress in the CFIDS
person’s life. This illness tears away at every emotion until it humbles the patient.
However, there is a positive aspect. Patients with CFIDS come to realize that regardless
of the economic or social status, or the life-changing events created by having this
disease, they share certain camaraderie with other CFIDS sufferers. Many patients say if
they get well, they will never be the same. CFIDS gives a new perspective to life with the
realization that we are truly dependent upon our health. It opens our hearts to the
suffering of others, and it opens our minds to the restructuring of our lives when we
recover.
CFIDS CAUSES STRESS
Strong emotions can produce stress. The stress levels that come with several years
of living with a teenager who wants to be a drummer in a rock and roll band (or any
teenager, for that matter) can be equaled or even surpassed by one major argument with a
spouse, a close call in traffic, a registered letter from the IRS or a 3:00 A.M. visit to
the emergency room. Can you imagine what several years of having a chronic illness like
CFIDS would do to one’s stress level?
NEGATIVE EFFECTS OF STRESS
| So far, research has
demonstrated the following negative effects of stress:
| Increased levels of cortisol and
adrenaline. (This is extremely helpful if you are being chased by a grizzly bear, but day
in and day out it is disastrous.)
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| Depressed natural killer cell
activity
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| Decreased interferon levels
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| Increased cytokine production
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| Reduced levels of neurotransmitters
such as serotonin
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| Disrupted normal sleep cycles
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| Reduced numbers of T helper cells
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| Decreased IgA production
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| Muscle tension and spasm
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| Disrupted gastrointestinal function
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It does not’t take a Ph.D. in pathophysiology to figure out that chronic stress can
fuel our disease and make us worse!
While we may not have answered the original chicken or the egg question, when one studies
the research done on CFIDS and emotions, it become clear that most people with this
disease did not have severe emotional problems when they contracted the disease. However,
when they are forced to deal with the complexities and the problems forced upon them
because of having CFIDS, they can certainly experience emotional problems.
DEPRESSION
Depression is a common side effect of having CFIDS. When those with CFIDS are under
stress for a long period with no end in sight, they are at risk for becoming depressed
over the very prospect of living the rest of their life in their condition.
| Depression is said to
be the result of the five D’s:
| Dejection
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| Despondency
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| Discouragement
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| Despair
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| Dismay
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When depressed, we feel an overall sadness, tinged with apathy and exhaustion. Any joy one
once experienced is only a distant memory. Nothing has any value in our eyes. Moreover,
the accompanying fatigue is not really physical (the physical fatigue is caused by CFIDS).
We seem to have the energy, but lack the motivation enough to use what energy we have.
CLINICAL DEPRESSION
Is the sadness we feel just a bad mood, or is it true depression?
| The American
Psychiatric Association says a person who shows at least four of the symptoms below nearly
every day for at least two weeks is clinically depressed and should consider treatment.
| Feelings of worthlessness,
self-reproach, or excessive or inappropriate guilt
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| Indecisiveness or a diminished
ability to think or concentrate.
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| Both poor appetite and significant
weight loss or increased appetite and significant weight gain
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| Either insomnia or significantly
increased sleep.
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| Trouble thinking or moving smoothly
or confidently.
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| Loss of interest or pleasure in usual
activities, or decrease in sexual drive.
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| Fatigue and loss of energy.
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| Recurrent thoughts of death or
suicide, or suicide attempts.
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When one closely examines the symptoms above, it is easy for us to understand why we are
viewed and treated as depressed by our physicians. However, when we look at the usual
symptom list of diagnostic criteria for CFIDS, those are prominent. In addition, research
has demonstrated that the symptoms of CFIDS are organic in origin and not psychological.
TYPES OF DEPRESSION
| There are two basic
types of depression.
| The first, exogenous or reactive
depression, is a reaction to an event
 | The death of a loved one, loss of a
job, divorce, having a chronic or fatal illness, anything that causes profound sadness.
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| The second, endogenous depression is
caused by something inside us, and it’s usually harder to deal with,
| It generally longer lasting and more
severe than reactive depression. Even worse, people who have this second type of
depression don’t know why they’re depressed; they just are.
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To examine depression, one must first understand the mechanical processes of the mind.
Like the rest of the body, the brain is mechanical, with the nerves operating much like
the wires in a computer system. All bodily functions, from the movement of the hands to
the beat of the heart, are regulated by nerves. So are the thoughts and emotions.
The nerves are connected to each other by chemicals known as neurotransmitters. If these
are unbalanced, the functions of the nerves are impaired.
NEUROTRANSMITTERS
Common understanding among the medical profession is that depression is caused by
an imbalance in the levels of neurotransmitters in the brain. This may be genetic, or it
may be induced by external circumstances, such as prolonged stress. Whatever the cause, if
we are depressed we must learn to deal with it, and that might require outside help.
EFFECTS OF DEPRESSION
Depression can do more than just rob our life’s of joy, contentment,
happiness, satisfaction and accomplishment. It can also kill us! Depression can end in
suicide. Suicide is the tenth leading cause of death in America and the number one cause
of death among those with CFIDS.
TREATMENT
| Although most cases
of depression will eventually resolve themselves, there are ways to speed up the process.
| The most common treatment is with
oral antidepressant medications. These medications attempt to correct the neurotransmitter
imbalances. The most common type of antidepressant that is effective in CFIDS patients
seems to be the Serotonin Reuptake Inhibitor’s (SRI’s)
| like Prozac and Zoloft.
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| Psychiatric counseling
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| Reprogramming negative thought
patterns
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| Lifestyle change
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DEPRESSION AND
THE THYROID
According to preliminary findings by Robert Stern, Ph.D.,
assistant professor of psychiatry and neurology at Brown University in Providence, RI,
women who tested just slightly below normal in thyroid function seemed to be more
susceptible to episodes of depression than women whose hormone levels were normal. There
are other intriguing links between thyroid function and depression. "Lab tests reveal
that 5% to 20% of people with depression have a slightly overactive thyroid even though
they show no symptoms", notes Dr. Stern. "And, although we don’t know why,
some depressed patients with normal thyroid function don’t respond to antidepressants
unless they’re also given thyroid hormones."
CHEMICAL SENSITIVITIES
Chemicals can cause emotional reactions. Many people with chemical sensitivities
have reported having emotional reactions, ranging from mild to severe, from being exposed
to a variety of chemicals. 239 people with Multiple Chemical Sensitivities responded to a
survey regarding chemical exposure and emotional reactions that occurred after exposure.
| Reporting from
the survey done by The MCS Exchange from Brunswick, Maine
| The following chemicals caused
reactions:
| Pesticides
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| Perfume
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| Natural gas
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| Foods (with certain
additives/preservatives)
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| Diesel exhaust
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| Tobacco smoke.
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| Reactions that occurred included:
| Irritability
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| Anger
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| Violence
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| Paranoia
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| Depression
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| Anxiety/panic attacks
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| Feelings of suicide.
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The MCS exchange has developed a booklet that focuses on the above situations in more
detail. Cost is $6.00 To order send your request to:
The MCS Exchange
2 Oakland Street, Brunswick, Maine 04011
THE BLUES
Serious depression often requires professional help that might include
antidepressant drugs or counseling. But what about mild or moderate depression? Having
"the blues" is very common.
CLUES TO THE BLUES
There are often activities that one does when they are depressed that indicate the
internal struggle.
| When we have the
blues, we may do the following:
| Isolate ourselves. We tend to want to
be alone, so we can cut ourselves off from the world. We are more likely to skip
activities, work, or appointments
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| Focus on own condition, ignoring the
world around us.
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| Have trouble recognizing the truth
about our situation. Either we exaggerate its severity and complain to anyone who will
listen or, martyr-like, we remain silent about our suffering.
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BLUES BUSTERS
| If you see yourself in the above
quick clues to the blues, here are some ways you can work to shake the grip depression had
on you.
| Get out of the house.
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| Go out to lunch.
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| Go shopping.
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| Take a walk.
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| Pay attention to what’s going on
around you. The longer you focus on yourself and your own depression, the longer you will
remain depressed. Transfer your concerns to something else.
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| Tell the truth. Let people know
what’s going on inside you and how you actually feel—good or bad, happy or
frustrated. Listen, expressing your interest and concern when others tell about how they
feel.
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| Do a reality check.
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| Go ahead pity yourself. If you are
depressed, let yourself wallow in it soulfully and sorrowfully---for only 15 minutes!
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| List your emotional assets. This is
the gratitude list. List at least 10 things for which you are thankful.
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| Eliminate the words
"should" and "Should not" from your vocabulary.
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| Banish the Buts. . "Yeah
buts" and "what ifs" get you nowhere but back into the blues. Stay in the
present. Accept that you can’t change yesterday, and tomorrow has not arrived yet.
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| Treat yourself well.
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| Dare to change. Try something new.
Make new friends, start a new hobby, try an exotic recipe, etc.
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| Open up to the energy and emotions of
others. Do not retreat from human contact. Be honest in your relationships, and use your
ability to communicate your feelings in order to help relationships grow. We need
social, emotional and physical contact with other people. We need affection. Make it a
goal to get-and give-at least three hugs every day.
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| Examine your medicine or liquor
intake. Alcohol and some drugs (legal prescription or over-the-counter) can cause or
aggravate depression. Drugs like sedatives, muscle relaxants, cold remedies, painkillers,
and others make the central nervous system slow and less efficient. Common sense says that
if you load your system with alcohol and drugs that depress the nervous system,
you’re not going to have the energy you need to be productive, creative, or truly
happy.
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| Fake it until you make it. Act as
though you are not depressed. If you fake it long enough soon you will actually feel
happier.
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| Exercise for endorphins. Exercise,
even a little bit, causes the brain to produce endorphins, chemical compounds that occur
naturally in the brain and bring on a natural high.
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| Do a good deed. Helping others is a
great way to help yourself out of the blues. Doing a kindness for others seems to release
those same endorphins that are released during exercise. So, if you can’t get out and
exercise, do something for someone else. It will make you feel warm and fuzzy!
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| Get support from others who have
CFIDS. Go to support group meetings or call someone who has CFIDS. By reaching out to
others, you will find understanding, compassion, and practical tips on how to cope with
your disease.
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| Laugh at life. Laughter, like
exercise and doing a good deed, releases endorphins. Try not to take yourself or your
situation too seriously. Lighten up!
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