28
Jan
2005

Getting the facts straight on EHS and a Book Review: The Psychopathology of Functional Somatic Syndromes

The condition of electrosensitivity has been receiving much attention lately. In October of 2004 the "International Electromagnetic Field Project" held a two day workshop titled: "Electrical Hypersensitivity" in Prague, the Czech Republic. I would have liked to have attended this conference but time and finances made it an impossibility. I was sent the book of abstracts however.

In my opinion far too many of the presentations at the conference have conclusions sure to warm the hearts of the Telcos and power supply guys, such as the conclusions of one presentation:

"After consultations with our psychologists and psychiatrists, we arrived to the conclusion, that the syndrome now called EMF hypersensitivity or environmental intolerance to low level electromagnetic fields has a purely psychomatic origin".

When you come up with those conclusions you are sure to secure further funding!

I also found in the Czech book of abstracts that I apparently said at the Sept Moscow cell phone conference (the only place that I spoke with the fellow) that EMF measurements I have taken in homes and workplaces of EHS people did not differ from "what normally is found".

Funny but I remember saying just the opposite!!!!! I did discuss briefly the CFS/EMF exposure study (residential power frequency) that I was involved with, see:
//www.acnem.org/journal/21-1_april_2002/changes_in_health_status_of_cfs_patients.htm

In that study the exposed group was found to have an average home exposure of 7.1 mG, whereas the non exposed group had an average exposure of 0.67 mG.

Now 7.1 mG is hardly "what normally is found" in homes. Even Sir Richard Doll called 4 mG (0.4 uT) a heavy exposure that is seldom found in the UK. What would he call 7.1?

IN fact, the conclusions of our CFS paper, if referenced properly at the Czech conference, would NOT have supported the presentation he gave. OOPS!

So how did he get it so wrong? The only thing I can suggest is that the Russian Vodka was flowing quite freely while I stick with the water.

The important feature of our CFS /EMF study was that none of the subjects knew anything about electrosensitivity and therefore did not identify with that condition.

We have designed a much larger EMF exposure study specifically targeting that part of the community suffering chronic fatigue syndrome. For if EHS is a real environmental illness it will most likely be found in that population sub-group suffering CFS symptoms. (see below) Unfortunately however, this kind of research does not attract funding.

Though I have not read the book, the following review reads like it is a must for all those interested in electrical hypersensitivity.

Don Maisch



N Engl J Med 2004; 351:2777-2778, Dec 23, 2004. Book Reviews
[Book reviewed by Anthony L. Komaroff, M.D.]

The Psychopathology of Functional Somatic Syndromes
By Peter Manu. 299 pp., illustrated. Binghamton, N.Y., Haworth Medical Press, 2004. $79.95 (cloth); $34.95 (paper). ISBN 0-7890-1259-6 (cloth);
0-7890-1260-X (paper).

This book summarizes many recent studies of illnesses characterized by symptoms that, as yet, have no clear pathophysiology: chronic fatigue syndrome, fibromyalgia, Gulf War illness, irritable bowel syndrome, and premenstrual dysphoria. Although the clinical manifestations of theseillnesses are not identical, they have in common increased sensitivity to pain, sleep disturbance, difficulty with concentration, and labile mood. Indeed, many patients meet criteria for several of the illnesses.

The book cites hundreds of recent publications and will serve as a road map for anyone interested in these common and perplexing illnesses. For each illness, Manu presents a synthesis of the literature regarding clinical manifestations, the prevalence of psychiatric diagnoses, personality profiles, "abnormal" behavior associated with the illness, cognitive testing, and neurobiologic (e.g., neuroimaging, neurotransmitter, and neuroendocrine) studies. Because it involves many different disciplines, pulling together this large and complex body of literature was no small task.

Manu's review is thorough. Although he has previously argued that these syndromes are probably manifestations of a primary affective disorder, in this book he concludes otherwise. In particular, he notes that a substantial portion of patients with these disorders do not have a mood disorder.

Manu cites many studies indicating that patients often believe that they are suffering from an "organic" illness, even though no well-recognized organic illness has been diagnosed, and he suggests that this constitutes "abnormal illness behavior." He also states that the literature supports a connection between the "functional somatic syndromes" and somatization disorder. However, the literature he cites indicates that most patients with these syndromes do not meet the criteria for somatization disorder.

Indeed, if symptoms have an organic basis, then they cannot be said to stem from a somatization disorder, and a patient's belief that his or her suffering is due to an organic illness cannot be called "abnormal behavior." Hence, the central question: Do these functional disorders have an organic basis? What is the evidence? Manu summarizes many neurobiologic studies that have found objective, biologic abnormalities in patients with these syndromes (e.g., abnormal patterns on magnetic resonance imaging and on single-photon-emission computed tomography; abnormal responses on the testing of several hypothalamicpituitary axes), in contrast to matched, healthy subjects and patients with psychiatric disorders, particularly major depression.

Perhaps the most interesting question raised by this book is this: What are "functional somatic syndromes"? The question is never explicitly addressed or answered. For many physicians, the word "functional" implies an illness that probably has no biologic cause, with symptoms that reflect a weakness of character or outright malingering. The literature summarized in this book argues that such inferences are unfounded. Indeed, in my view, the continued use of the term "functional" by mental health professionals perpetuates an archaic notion of mindbody dualism. The symptoms of these "functional" illnesses probably have biologic underpinnings, even though the articulation of a patient's suffering clearly is influenced by personal experiences and cultural values. Although we are a long way from identifying the precise pathophysiology of these illnesses, there is considerable evidence that they have an underlying biologic basis.


Anthony L. Komaroff, M.D.
Harvard Medical School
Boston, MA 02115
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