An excerpt from Chapter 1.5 of . . . . .

The Metabolic Treatment
of Fibromyalgia

"Debunking an Unscientific Hypothesis:
Fibromyalgia is Not a Somatoform Disorder"

by Dr. John C. Lowe

Delusional (Paranoid) Disorder. Some physicians believe fervidly that syndromes such as fibromyalgia are caused purely by psychological processes. And some of these physicians irresistibly promote this psychogenic hypothesis. The behavior of some of the physicians may constitute "delusional (paranoid) disorder." The authors of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-III-R) describe the disorder and provide a diagnostic code for it, 297.10. According to them, the essential feature of delusional disorder is the persistent expression of a non-bizarre delusion that is not due to any other mental disorder. Aside from the delusion, the person's behavior is not otherwise odd or bizarre.

There are several reasons to suspect that the belief of some of these physicians in the psychogenesis of physical illnesses is delusional. First, they deny that conditions such as fibromyalgia and myofascial pain syndromes exist. While doing so, they ignore the published documentation of such conditions, and they decline other clinicians' and researchers' offers to demonstrate for them that the conditions do in fact exist. Second, the physicians are apparently unable to recognize the thorough absence of credible evidence for an hysterical basis for physical illnesses. They also appear unable to acknowledge the available scientific evidence that some illnesses they diagnosis as somatoform are clearly organic. Their irrational behavior is similar to that of a spouse with delusional jealousy (classified by the DSM-III-R as jealous type delusional disorder). The jealous spouse appears unable to recognize the complete absence of evidence for the other spouse's presumed infidelity, and the jealous spouse also ignores overwhelming evidence of the other spouse's complete loyalty. Third, despite the presumably high intelligence levels of the physicians, they ignore DSM criteria for differentiating various somatoform disorders, jumbling and mixing the criteria as needed to support their arguments that fibromyalgia (or other syndromes) is psychogenic.

In the grandiose type of delusional disorder, the person believes he possesses some extremely important insight that others do not recognize. He usually takes the insight to various government agencies, such as the FBI or the U.S. Patent Office. The physician whose delusion consists of a belief in hysteria-based somatoform disorders may confidently express that belief to other official bodies: to medical audiences through lectures and published papers, and to insurance companies and the courts through written reports and expert testimony.

People with grandiose delusions of a spiritual nature often become leaders of religious cults. In a similar pattern, those with delusions of a psycho-medical nature may become medical "authorities." In their role as "authority," they proselytize other physicians to accept the false belief of hysteria-based physical illnesses and to use somatoform diagnoses. In DSM-III, delusional disorder was termed "delusional paranoid disorder." The authors changed the name of the disorder in the
subsequent DSM-III-R because a delusion is the primary

 

 

symptom of the disorder and the term paranoid has multiple meanings. Some members of the small cadre of physicians I refer to here, however, do exhibit paranoia. Their paranoia consists of an obstinate belief that the patients whom they designate as having hysteria-based complaints are faking their symptoms and conniving to get undeserved money from third party payers. These physicians will debate at length that most patients who report chronic symptoms and litigate for settlements or other benefits are faking. The physicians almost always include in the putative profit-making plot clinicians who treat and testify on behalf of litigating patients. The physicians steadfastly stand by their paranoid accusations despite overwhelming contradictory evidence. The very boldness of their paranoid assertions can convince readers or listeners. But careful logical analysis usually shows that their assertions consist of multiple logical fallacies fluidly woven together to convince others of the truth of the paranoid assertions.

The major problem in applying the diagnosis of delusional paranoid disorder is the same as applying somatoform diagnoses to fibromyalgia patients: The authors of the DSM specify that the diagnosis of delusional disorder should be used only when it cannot be shown that the disturbance is the product of an organic mechanism. As a student of applied logic, this qualification makes the diagnosis abhorrent to me. But if we are to apply labels for social purposes, we would do better to apply that of delusional disorder to these physicians rather than somatoform disorders to fibromyalgia patients--for it is the physicians' behavior and not the patients' that is problematic. The physicians' problematic behavior may or may not have an organic basis. Regardless, labeling their behavior can serve as a starting point for rectifying the public health problems this type of behavior tends to generate. If labeling the physicians' behavior safeguards patients and their relationships with their treating clinicians, then the labeling is a humane and worthwhile practice.

The judiciary can contribute to rectifying the public health.consequences of the physicians' neurotic behavior. One way is to require the physicians, in their testimony in written reports and as expert witnesses, to conform to at least minimal standards of rational, scientific thinking. Not to require this leaves these physicians free to mislead judges and juries.

The problem would perhaps best be studied by a combination of sociologists, psychologists, social workers, public health
professionals, and judicial officials. An investigation could begin
with an appeal to the descendants of Sigmund Freud (the
fountainhead of the notions underlying somatoform diagnoses) to permit examination of some of his potentially telling written communications. In the 1890s, Freud underwent an extreme personality change that appears to have resulted from a cocaine addiction. Eysenck wrote, "Until the change, his scientific contributions had been lucid, concise, and conformed to the state of knowledge as it existed at the time, but now his style became extraordinarily speculative and theoretical, strained, and contrived." There is evidence that Freud suffered nose and brain damage from long-term cocaine use. As Eysenck indicated, the brain damage apparently accounts for the progressively bizarre quality of Freud's theories. The irrationality inherent in modern physicians' use of fantastical
psychoanalytically-based interpretations of fibromyalgia is a fitting legacy from the cocaine-addicted Freud. Regardless, a hundred years of adversity for patients from such irrationality is simply too much. It is time that we recognize these physicians' delusions for what they are and take all necessary steps to end the doctors' pernicious impact on patients.