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The Lancet, Volume 357, Issue 9271, Page 1889, 9 June 2001
doi:10.1016/S0140-6736(00)05001-7Cite or Link Using DOI

Does myalgic encephalomyelitis exist?

Christopher Bass a
Olivier Mouterde (Feb 17, p 562)1 states that he has never encountered myalgic encaphalomyelitis (ME) in children in France, Belgium, or Switzerland, whereas it is common in the UK. He suggests genetic differences as an explanation, but, in all likelihood, the recognition of the disorder is culturally influenced.
Hacking's work2 has helped us to understand illnesses that find homes in a given place and time. He proposed the idea of an ecological niche, the setting in which a mental illness thrives. For example, in France in the 1880s mad travellers, or fuguers, flourished. These compulsive travellers were, however, confined to France and other countries on the European continent and not in the UK and USA. Many reasons have been suggested, including the lack of conscript armies in the UK and USA, so that no escape was needed; furthermore, fuguers were seen as degenerate in France, but not elsewhere. By 1910, the disorder had died out.
What ecological factors have allowed ME to flourish in the UK in children and adults? The behaviour of doctors and the media have affected the ways in which illnesses become manifest. Shorter's account3 of psychologically induced illness shows how patients throughout the 20th century reported physical symptoms corresponding to the current models of disease espoused by psychiatrists. The most striking example of this was the demise of the florid Charcot-style hysteria after Babinski's attack in 1908.
Most doctors are surprisingly unaware of their potential to influence the course of an individual patient's illness. In one study, of adult patients with severe non-organic disability (some with chronic fatigue syndrome [CFS]), four patients who believed (erroneously) that multiple sclerosis accounted for their symptoms also had difficulties with bladder control, requiring catheterisation.4 Specific and direct questions about urinary function could have affected the development and appearance of the symptoms, presumably because of a suggestion and fear in people willing to embrace the sick role.
Mouterde also makes the valid point that most children have heard about ME before developing it and that they know they can catch it because they can read about it. The media undoubtedly has a role in publicising this illness in children, but what the media cannot explain is the continued prevalence of motor conversion symptoms (hysterical paralyses and sensory abnormalities) in adults. 3 years ago Hacking stated that hysteria does not exist as a possible diagnosis today, but evidence strongly refutes this view.5 Most neurologists see at least one patient a month with conversion hysteria in the outpatient clinic, and continue to do so in the 21st century. How do the medical historians explain the continued existence of this illness, which is invariably concealed from the patient and receives no exposure in the media?


1 Mouterde O. Myalgic encephalomyelitis in children. Lancet 2001; 357: 562. Full Text | PDF(55KB) | CrossRef | PubMed
2 Hacking I. Mad Travellers. London: Free Association Books, 1998.
3 Shorter E. From paralysis to fatigue: a history of psychosomatic illness in the modern era. New York: Free Press, 1992.
4 Davison P, Sharpe M, Wade D, Briss C. Wheelchair patients with non-organic disease: a psychological enquiry. J Psychosom Res 1999; 47: 93-103. CrossRef | PubMed
5 Akagi H, House A. The epidemiology of hysterical conversion. In: Halligan P, Bass C, Marshall J, eds. Contemporary approaches to the study of hysteria. Oxford: Oxford Univerisity Press, 2001: 73-87.
a Department of Psychological Medicine, John Radcliffe Hospital, Oxford OX3 9DU, UK
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