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Diagnosing chronic fatigue syndrome

  • Vasudeo P. Paralikar (a1), Mitchell G. Weiss (a2), Mohan Agashe (a3) and Sanjeev Sarmukaddam (a3)
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References

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1 Cho, HJ, Menezes, PR, Hotopf, M, Bhugra, D, Wessely, S. Comparative epidemiology of chronic fatigue syndrome in Brazilian and British primary care: prevalence and recognition. Br J Psychiatry 2009; 194: 117–22.
2 Kleinman, A. Depression, somatization, and the new cross-cultural psychiatry. Soc Sci Med 1977; 11: 310.
3 Paralikar, V, Sarmukaddam, S, Agashe, M, Weiss, MG. Diagnostic concordance of neurasthenia spectrum disorders in Pune, India. Soc Psychiatry Psychiatr Epidemiol 2007; 42: 561–72.
4 Griffith, EE, Gonzalez, CA, Blue, HC. Introduction to cultural psychiatry. In Textbook of Clinical Psychiatry, Fourth Edition (eds Hales, R & Yudofsky, S): 1551–83. American Psychiatric Publishing, 2003.
5 de Fatima Marinho de Souza, M, Messing, K, Menezes, PR, Cho, HJ. Chronic fatigue among bank workers in Brazil. Occup Med (Lond) 2002; 52: 187–94.
6 Karasz, A, McKinley, PS. Cultural differences in conceptual models of everyday fatigue: a vignette study. J Health Psychol 2007; 12: 613–26.

Diagnosing chronic fatigue syndrome

  • Vasudeo P. Paralikar (a1), Mitchell G. Weiss (a2), Mohan Agashe (a3) and Sanjeev Sarmukaddam (a3)

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Diagnosing chronic fatigue syndrome

  • Vasudeo P. Paralikar (a1), Mitchell G. Weiss (a2), Mohan Agashe (a3) and Sanjeev Sarmukaddam (a3)
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eLetters

Ignorance is not bliss

Ellen M Goudsmit, Health Psychologist
22 October 2009

In their thought provoking letter, Paralikar et al claim that chronic fatigue syndrome is not "in the ICD". If they go online and searchthe ICD-10 website, they'll find that it is coded under G93.3 (Diseases ofthe Nervous System) and has been since 1993.

This is not the first time that doctors have argued that the illness doesn't exist in their country and that it is a Western construct; a culturally-influenced label for emotional distress used by gullible individuals unwilling to change their maladaptive lifestyles.

About fifteen years ago, a patient from Peru got in touch with me to discuss treatment options. As far as his doctors were concerned, there wasno such disease and he was left to struggle on his own. Similarly, I heardfrom patients in France where the medical profession was also highly sceptical and those affected often ended up joining support groups in Switserland and Germany. An Indian individual couldn't get anyone to believe him as doctors maintained that it was a disorder not found in tropical lands. And nearer to home, a nun endured years of iatrogenic distress because as everyone pointed out, only Yuppies got 'ME'.

Now I regularly come across studies involving well-defined patients from the very countries where chronic fatigue syndrome doesn't or didn't exist. Did they import their participants from the 'decadent West'?

Perhaps a variable which deserves more attention in this type of research is denial. Moreover, the question we might ask is, who gains fromignoring the literature and the evidence of disease? The fact that the study and letter came from departments of Psychiatry is surely a coincidence?
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Conflict of interest: None Declared

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