Chronic Fatigue Syndrome/Reflections on embodiment and therapeutical approaches
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[edit] Chapter 1: Introducing
[edit] About the authors
I would like to start this new wikibook as part of a interdisciplinary bachelorthesis project. This project consist of making a interdisciplinary thesis by two persons of the Liberal Arts & Sciences Study at the University of Utrecht. I'm doing my project together with Niels van Miltenburg who will approach our subject from the perspective of a philosopher an I, Rik van Velzen, will take a biological approach.
[edit] Content
Although CFS has multiple etiologies and treatmeant differ from a wide range of various drug treatments to behavioral therapies (Cognitive Behavioral Therapy[[1]], Behavioral Interventions[2], Counselling, etc.), cfs seem to have some clear biochemical characteristics. For example Dr. De Meirleir was able to predict with an accuracy of 99% [3] which blood samples where from CFS patients by measuring the 37/80 kDa RNase L ratio.[4]
[edit] Concept Layout of Book
Type of Book: Textbook/Thesis
Difficulty level: Intermediate/advanced level for University student
Disciplines: (neuro)Biology, philosophy, psychology
Aim of the book: Next to creating a book on Chronic Fatigue Syndrom (CFS) and reflecting on medical/therapeutical approaches of psychosomatica (CFS in this specific case) the aim of this book is to support in writing the bachelor thesis for Niels/Rik's project. --rik 17:43, 2 December 2006 (UTC)
[edit] Chapter 2: What is Chronic Fatigue Syndrome
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Chronic Fatigue Syndrome (CFS)[5], which is also known as myalgic encephalomyelitis (ME), post-viral fatigue syndrome (PVFS), and various other names, is a syndrome (or group of syndromes) of unknown and possibly multiple [[6]], affecting the central nervous system (CNS), immune, and many other systems and organs. There is no simple diagnostic test; CFS is a diagnosis of exclusion, although recent research indicates biological hallmarks of the syndrome, and a diagnostic test is predicted soon.
It is important to be aware that the disease Myalgic Encephalomyelitis, which has had a World Health Organisational classification since 1969, is not the same illness as the subsequently-named 'Chronic Fatigue Syndrome' definitions, although they are sometimes treated as similar [7]. In addition, experts such as Dr Byron Hyde [8] have argued that the various 'CFS' definitions have no practical usefulness, as they are so broad that they clearly encompass those suffering from a range of illnesses, and the concept of 'CFS' should thus be abandoned as in practice it functions to divert attention from fully testing and treating patients for whatever they suffer from, in addition to leading to treatment which is possibly harmful for patients as it is not suitable for their particular illness [9].
In contrast to many of the 'CFS' definitions, Myalgic Encephalomyelitis is not a diagnosis of exclusion [10]. Lack of knowledge of this has led both to people being incorrectly diagnosed with the illness, and also to the stigma that sufferers are complaining of an invisible disease, and must hence have a psychosomatic illness.
Adding to the confusion, some research ostensibly done on 'CFS' population samples has in fact been done on sufferers of M.E., and some research ostensibly done on M.E. has in fact been done using test subjects diagnosed with one of the types of CFS which are quite different from M.E. (for instance the Fukuda criteria), or with those who simply have some sort of fatigue, due to the mistaken belief that M.E. is synonymous with 'chronic fatigue'[11][12](nb some definitions of CFS, such as the 1991 Oxford criteria, are quite synonymous with chronic fatigue and others are not, for instance the Australian CFS definition[13]).
It should not necessarily be concluded that those diagnosed with "Chronic Fatigue Syndrome" have, in contrast to those with M.E., a psychosomatic disorder or problems. Part of the problem of the extremely broad criteria of some CFS definitions is that they can incorporate both those whose fatigue is primarily related to depression and emotional stressors in their lives, and those who have fatigue and other physical symptoms which are caused by undiagnosed physical disorders or diseases. Thus the definition CFS is, as Dr Byron Hyde has written, unhelpful to those with M.E., and unhelpful to those who have been diagnosed with 'CFS'. Dr Hyde advocates that the concept of 'CFS' should be abandoned, as in practice it leads to stigmatizing those with physically-caused illnesses as psychosomatic or hypochondriacs, and is often used as an excuse not to conduct proper testing and treatment of the genuinely ill (by doctors who assume the diagnosis of 'CFS' means that there is no point in conducting more than rudimentary physical tests).
[edit] Chapter 3: Therapeutical approaches to Chronic Fatigue Syndrome
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From Highlights from Dr. Kenny De Meirleir's Lecture:
Some psychiatrists advocate that no tests or lab work be done on ME/CFS patients because testing will reinforce delusion of physically illness. Given the wealth of confirmed biochemical abnormalities, such rationale is ludicrous. Dr. De Meirleir stressed that tests must be done in order to eliminate the cause. A "clean-up" of all the consequences of the problem must also be undertaken. Therapies and the orders of treatment vary according to the patient's unique test profile. Treatment includes:
1. Restoring immune competence
2. Removing microorganisms
3. Restoring hormonal balance
4. Restoring intestinal flora
5. Decreasing prostaglandins and protein kinase activity
6. Removing heavy metals and toxic chemicals
[edit] Chapter 4: Biological approaches to Chronic Fatigue Syndrome
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Dr. De Meirleir is a world renowned researcher and professor of Physiology and Internal Medicin at Free University of Brussels in Belgium. In Highlights from Dr Kenny De Meirleir's Lecture[14] Van de Sande states that numerous infectious agents can trigger ME/CFS. Infectious agents that invade cells release RNA (ribonucleic acid) or DNA (deoxyribonucleic acid) when they reproduce. Normally when a virus infects a cell, an enzyme called RNase L (Ribonulease L) is activated and cuts the RNA of the infectious agent so it cannot replicate itself and cuts the RNA of the infected cell, which triggers the cell's death and removal. Then the RNase L molecule "switches off" and remains inactive so that it doesn't damage healthy cells.
Abnormality in RNase L molecule in ME/CFS Patients
The normal weight of the RNase L molecule is 80 kilo Daltons (kDa). In ME/CFS patients the RNase L molecule is being cut and weighs 37 kDa. The low molecular weight (LMW) of the RNase L molecule can discriminate ME/CFS Patients from healthy people and other illnessses such as fibromyalgia, multiple sclerosis, cancer, AIDS and depression. The Center for Disease Control (USA) sent 100 blood samples to Dr. De Meirleir who was able to identify with an accuracy of 99%, using the test for LMW RNase L, which blood samples came from ME/CFS patients. {|- style="color: red" |NEEDS REFERENCE|}
Abnormal RNase L molecule causes chronic dysfunction of the immune system
The damaged RNase L molecule is not able to kill infectious agents and it keeps damaged cells alive. The body is unable to "switch off" these abnormal RNase L fragments and they also continue to cut the RNA of normal cells. Destructive RNase L fragments are six times more active than normal and consume approximately 70% of the cells' energy (ATP). Un-"switched off" Rnase L fragments destroy normal protein synthesis, enzyme production and other vital cellular functions. They inhibit respiratory muscles and cause hyperventilation, metabolic alkalosis, sleep diturbances and fatigue. Furthermore there is sodium retention, low magnesium levels and dramatically low levels of potassium. Natural killer cells, which protect against viruses and intracellular infections, are also being damaged. Thus, the immune system is in a state of chronic dysfunction.
[edit] Chapter [one of the lasts]: Philosophical Reflections on Therapeutical approaches
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Van de Sande points out that these findings confirm an organic origin of ME/CFS and validate diagnosis of ME/CFS.
This idea of there being an organic origin (instead of a mental) suggest a sepparation between mental and physical phenomena which, as we would like to argue in this wikibook, might be a false view and we would like to argue that there is no difference between mental and physical phenomenon. Instead of trying to find treatments on medical or mental bases we should work towards a holistic approach. Problem only is that "mental" phenomenon work as complex non-linear systems for which we can't easily point out which physical constitutions causes which mental phenomenon and vice versa. With reviewing some recent developments in the research on Embodiment we would like to get a better idea how the mental and the physical interact.
[edit] Bibliography
Bibliography:
Cromby, Between constructionism and Neuroscience, the societal Co-constructionism and Neuroscience, Theory and Psychology, Vol 14(6), 2004.
Cromby, Embodied Subjectivity in Chronic Fatigue Syndrome: a phenomenological analysis, (in press).
Hermans, The Dialogical Self as a society of Mind, Theory and psychology, Vol 12(2), 2002.
Lewis, The dialocial brain: Contributions of emotional neurobiology to understanding the dialogical self', Theory and psychology, Vol 12(2), 2002.
Lysaker & Lysaker, Narrative structure in Psychosis: Schizophrenia and Disruptions in the Dialogical Self, Theory and psychology, Vol. 12(2), 2002.
Franssen & Van Geelen, Silence and the dialogical self: Considerations on Polyphony and Authorship, ??, University Utrecht/University Medical Center, 2006.
Varela & Thompson, Radical embodiment: neural dynamics and consciousness, TRENDS in cognitive sciences, Vol. 5 No. 10 October 2001.
--rik 17:15, 2 December 2006 (UTC)
[edit] Footnotes
- ^ Sande, van de, M., Highlights from Dr. Kenny De Meirleir's Lecture, Calgary, Alberta, april 2, 2006.
- ^ Chambers, D, Interventions for the treatment, management and rehabilitation of patients with chronic fatigue syndrome/myalgic encephalomyelitis: an updated systematic review, D Chambers, AM Bagnall, S Hempel and C Forbes is published in the October 2006 issue of the Journal of the Royal Society of Medicine.
- ^ Suhadolnik, R., "Clinical and Biochemical Characteristics Dfiferentiating Chronic Fatigue Syndrome from Major Depression and Healthy Control Populations: Relation to Dysfunction in the RNase L Pathway" in Journal of Chronic Fatigue Syndrome, Vol. 12(1), 2004.
