RACP Guidelines for CFS

Betrayal of the Severely Ill?
Appendix 4: Letter to the British Journal of Psychiatry
I. Hickie, G. Parker, A. Lloyd, D. Wakefield

British Journal of Psychiatry 1990; 157: 449-450.

Letter from Ian Hickie, Gordon Parker, Andrew Lloyd, Denis Wakefield

"Dr Wessely raises the difficult issue of 'somatisation', a topic that requires clarification. Those with primary depressive disorders often have multiple somatic complaints, but are generally recognised by their psychiatrists as suffering from depression. As discussed, this is clearly not the case with patients with CFS. The proponents of 'somatisation' argue simply that patients with CFS have a type of communication deviance in which they express their pysphoria primarily in a somatic form. This is at best a highly speculative hypothesis. Surprisingly, Dr Wessely takes issue with our use of a well standardised instrument, the Illness Behaviour Questionnaire (IBQ) to evaluate this concept. Lipowsky (1989) has addressed the difficult issue of somatisation within CFS and has warned psychiatrists to avoid simplistic causal hypotheses. Dr Wessely's final statement that the patient's belief in the physical nature of their condition is clinically more important than either concurrent immunological or psychiatric disorder must surely represent his own point of view and one which, like all others, requires empirical evaluation. Whenever patients with non-specific physical complaints fail to demonstrate evidence of a known disorder, psychiatric evaluation is likely to follow. Often this is appropriate. As has been demonstrated in myasthenia gravis (Nicholson et al. 1986), however, such patients are often mislabelled by psychiatrists as 'somatisers' until the actual nature of the disorder is later revealed. To avoid that pitfall, psychiatric diagnoses should be restricted to the identification of 'typical' disorders in patients with positive features of psychological disturbance. More doubtful notions such as 'somatisation' should not be invoked haphazardly to conceal a lack of basic knowledge."

Ian Hickie
Gordon Parker
Division of Psychiatry
Prince Henry Hospital
Sydney 2036 Australia

Andrew Lloyd
Denis Wakefield
School of Pathology
University of New South Wales
Kensington NSW, Australia

Return to the AHMF Letter to the RACP.


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