A Clinician's Guide to Controversial Illnesses: Chronic Fatigue Syndrome, Fibromyalgia, and Multiple Chemical Sensitivities

A Clinician's Guide to Controversial Illnesses: Chronic Fatigue Syndrome, Fibromyalgia, and Multiple Chemical Sensitivities. Rene R. Taylor, Fred Friedberg and Leonard A. Jason. Sarasota, FL: Personal Resource Press (2001) 182 pages, $29.95. Reviewed by Lillian Gross, MD, FAPA, Great Neck, New York.

The authors address three very controversial illnesses. Although published in 2001, this small book remains a valuable reference text. The authors discuss diagnostic criteria and the wide spectrum of treatments that have been prescribed for these ailments, once thought to be merely forms of malingering or minor psychological disturbances. They are now recognized as severe disorders with biological, psychological and social components that severely incapacitate younger people. The book draws extensively on the work of a number of authors with different approaches.

In the first chapter, the definitions of Chronic Fatigue Syndrome, Fibromyalgia and Multiple Chemical Sensitivities are reviewed. The authors discuss prevalence estimates and possible etiologies. They show that the Gulf War Syndrome has many characteristics of these three illnesses. The authors feel that patients are stigmatized when labeled with these illnesses because of the supposed lack of biological markers or diagnostic tests. They point out that many physicians consider them to be psychiatric in origin, a form of malingering or simply nonentities that do not require serious attention.

In Chapter Two the etiology of precipitating factors are described for each illness. The biological findings of a number of investigators who differentiate Chronic Fatigue Syndrome from a purely psychiatric illness are presented. The effect of the immune system on this illness is also reviewed, including the possibility that this represents a hyperimmune response. Multiple explanatory models for Fibromyalgia and of multiple chemical sensitivities are also delineated along with the psycho-social aspects of these three disorders.

Chapters Three and Four examine the diagnostic issues associated with these three illnesses. The Chronic Fatigue Syndrome screening questionnaire is discussed in great detail as well as multiple other assessment instruments. Chapter Four discusses the psychometric and behavioral assessment of these illnesses. The authors feel that the self-report questionnaire alone is not sufficient, and suggest appropriate rating scales

In Chapter Five the pharmacological and alternative treatments of these illnesses are reviewed in detail. The effectiveness of nutritional support, conventional and unconventional medications are elucidated. There is a discussion of alternative medical approaches such as bodywork, massage and nutritional supports. A table featuring patient ratings of the different treatments is also included.

Chapter Six focuses on a cognitive behavioral treatment for these illnesses using an activity pacing theory. In this approach they have the patient stay within the envelope and only use a comfortable range of energy expenditure. The patient is encouraged to avoid both over-activity and under-activity. A case history is presented to demonstrate its application.

Cognitive and relaxation oriented interventions are addressed in Chapter Seven. The authors discuss relaxation training benefits and detail a script with a breathing focus to help the patient relax. They also have a script with pleasant imagery and one with feeling imagery. Hypnosis can easily be added here. There is also a brief discussion of cognitive coping skills based on the principals of rational-emotive behavior therapy. The importance of social support is stressed, and several case examples of treatment are included.

In Chapter Eight, the authors summarize and discuss future directions for these three illnesses. They assert that effective, affordable, comprehensive assessment and treatment programs do not exist today to address both medical and social service needs of individuals with these illnesses. Therefore, they recommend that future planning should combine a thorough and individualized assessment and access to medical services provided by practitioners that are specialized in these areas. Appendices which follow contain valuable questionnaires, scales, and patient resources, including a variety of useful websites.

For such a very small book, the three illnesses are comprehensively covered. The difficulties in dealing with these illnesses are well elucidated. The discussion of three disorders at the same time may be slightly confusing but one can readily see where the many similarities make for a cohesive presentation. For the practitioner seeking a reasonably current review of the state of current knowledge and controversy, this 143 page book is well worth reading.

Copyright American Society of Clinical Hypnosis Apr 2003
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