Psychiatric vs Organic Debate

There is a long-running debate over whether CFS is a psychiatric/ psychological illness, or whether it is organic/physical and caused by some external pathogen or disease mechanism. In the UK the medical profession tends to categorise CFS as psychiatric, whereas in most other countries it is classed as an organic illness. Patients themselves tend to be hostile towards psychological explanations for the illness, probably because most of the proponents of psychological theories have very simplistic explanations along the lines of neurosis or feigned illness.

Part of the problem is the confusing array of symptoms present in the illness. There are certainly many psychiatric symptoms, such as depression and anxiety, which are present in between 50 and 90% of patients. This in itself does not necessarily point towards a psychiatric mechanism for the illness - these symptoms could simply be a reaction to the illness itself (although that is less likely with anxiety than with depression). There are many physiological and physical symptoms, such as abnormal HPA axis activation, low blood volume and problems regulating blood pressure.

CFS is a complex illness which appears to be caused by a breakdown in the systems which are at the boundary of the mind and body - the HPA axis in particular. As such it is dangerous and wrong to pigeon-hole the illness as either psychiatric or physical, as it does not fit into either category in the traditional sense. Both the triggers for the illness and the symptoms themselves are a combination of psychological and physical/physiological.

In summary, understanding this complex illness requires an open mind.

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