It's Not All In Your Head

[Rene]

It's Not All In Your Head --------------------------------------------------------------------------------
by Lisa Lorden

At the close of FAME 2000--NFA's first-ever international fibromyalgia conference--one of the presenters said: "Given the amount of research that shows physical abnormalities in fibromyalgia, anyone who still believes this illness is 'all in your head' should have their head examined!"

Indeed, despite increasing research distinguishing fibromyalgia (FM) from psychiatric disorders, the role of psychological factors is still being hotly debated. Dr. Muhammed B. Yunus, M.D., is one FM expert who has been researching the clinical characteristics of fibromyalgia for over a decade. Many of his published studies have challenged the notion that the syndrome is nothing more than a problem of stress, anxiety, or depression. He argues that while psychological factors may aggravate symptoms, they also camouflage the real cause of FM, which he believes involves aberrant neurotransmitter mechanisms.


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"It is not the FMS patients who are disturbed, it is the physicians who are psychologically disturbed because they ignore the data..."

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Yet some doctors still cling to the belief that fibromyalgia is psychological in nature. Dr. Yunus calls this "Disturbed Physician Syndrome" (DPS). Says Yunus, "DPS people are trouble because of their preoccupation that FM patients are psychologically disturbed. It is not the FM patients who are disturbed, it is the physicians who are psychologically disturbed because they ignore the data, and whatever data there is, they manipulate it to say what they want it to say."

In fact, psychologist Phyllis Chesler, who suffers from chronic fatigue syndrome herself, points out that the process of struggling for acknowledgment and understanding is, in itself, highly stressful. She writes, "I believe people with poorly understood illnesses are subjected to a level of stress that's more than a healthy person can take." She notes that rheumatoid arthritis and multiple sclerosis were initially seen as manifestations of psychological stress, but are now recognized as bona fide physical diseases.


Research is increasingly showing that fibromyalgia is real, not psychosomatic. Findings such as abnormal levels of brain chemicals have been discovered in people with these illnesses. While many unanswered questions remain, this research may eventually lead to the discovery of an underlying cause (or causes), as well as promising treatments.

Fibromyalgia vs. Depression

Recurrent or persistent pain, especially with an unrecognized or incurable cause, threatens our ability to function and our sense of well-being. Many FM patients have lost their careers, their role in the family, their capacity to think clearly, or the power to control their muscles. It is natural that such debilitation would lead to frustration and depression. In fact, if you're experiencing these things on a daily basis, it would probably be abnormal not to be depressed.

To illustrate the point that the lack of a known organic pathology does not indicate a psychological cause, Dr. Yunus has compared FM to other diseases for which the etiology is known. He points out that cancer is known to be exacerbated by psychological factors such as depression, anxiety, and stress. Yet no one would say that cancer is a psychological disorder. The fact that we don't yet know the cause of FMS does not mean that it doesn't exist, or that it is "all in your head."

Research has indicated that emotional disturbance in patients with chronic pain is more likely to be a consequence than a cause of pain. Dr. Robert Bennett, a well-known FM researcher and clinician, points out that depressed patients who are treated for depression generally respond very well to antidepressant medications. However, patients with fibromyalgia continue to have symptoms such as pain and disordered sleep.

Examining the role of psychological factors in FM is complicated by an inability to separate depression symptoms that may have existed before the onset of FM from symptoms that are a result of chronic illness. But regardless of whether depression precedes or follows the onset of fibromyalgia, these symptoms are separate, and FM symptoms will remain after the psychological symptoms are treated.

Studies have shown that as a group, fibromyalgia patients are no more depressed than other patients with chronic rheumatic diseases such as rheumatoid arthritis. One study compared the responses on a depression rating scale of 45 FM patients, 29 rheumatoid arthritis patients, and 31 healthy controls with no pain. No difference between the two illness groups was found. However, in each group a subgroup of patients appeared to be experiencing significant depressive symptoms.

Another FM expert, Don L. Goldenberg, agrees that although depressive and somatic symptoms are common in FM patients, they are not more prominent than in other chronic conditions. He points out the vast majority of FM patients do not meet the criteria for a psychiatric diagnosis.

Addressing the Depression

While depression is clearly not the cause of fibromyalgia, you should not ignore feelings of stress or
depression. They may be acting as contributing factors, as is the case in most illnesses. The good news is that depression is highly treatable, with a variety of medications that can be tailored to individual needs. Having a network of emotional support is also essential in coping with any illness, particularly one that is so complex and poorly understood.

There is so much about FM that we cannot control. However, depression is one thing that we can do something about. Most people with chronic illness have increased feelings of sadness or hopelessness at some point; this is to be expected. Don't suffer in silence. Reach out to others who can understand and offer help, and consider talking with your doctor about how you can address symptoms of depression together.



From: fmaware.org