By Lucy Dechéne, Ph.D.

The Massachusetts CFIDS/ME & FM Winter 2003 UPDATE

In the Summer UPDATE I explained how Dr. Jim Jones was sure that an evil Dr. Svengali had hypnotized each of us into believing that we had ME/CFS. A sure sign, according to him, was that we could roll our eyes heavenward well. As you could tell from my article, I wasn't too convinced.

Well, now we have another entertaining hypothesis. (When you have ME/CFS, you have to find humor wherever you can—even medical journals.)

A recent article by Dr. Ashok Gupta ⁽¹⁾ starts off modestly enough, "Here, a novel hypothesis for chronic fatigue syndrome (CFS) is proposed."  It is certainly novel (although it is loosely related to Dr. Goldstein's limbic hypothesis, which I find believable.)

I will characterize this new hypothesis as the "Bogeyman Hypothesis."  I will give Dr. Gupta credit—he only claims his hypothesis for a "subset" of ME/CFS patients instead of all of us.

I personally suspect his "subset" is what we mathematicians call the "null set" or "empty set." As a Ph.D. student I was told horror stories of Ph.D. candidates in mathematics who went to the defense of their dissertation, where an astute questioner pointed out to them that what they had studied so long was actually a cleverly disguised version of the null set. (Goodbye to your Ph.D.!) (Maybe this will be supposed by Dr. Gupta to be my bogeyman, but I got ME/CFS 21 years before I defended a Ph.D.  In fact I had barely started first grade.) 

Apparently M.D.s aren't subjected to such horror stories. Or at least not M.D.s studying ME/CFS. There is no limit on creativity or credibility for people studying the "psychological" origins of ME/CFS, it seems. The more weird the psychological explanation, the better! If they really don't fit anyone—well, who is to know? How can you disprove "subconscious" explanations?

So what is the "Bogeyman Hypothesis"? Dr. Gupta describes it as, "During a ‘traumatic' neurological event often involving acute psychological stress combined with viral infection or other chemical or physiological stressor, a conditioned network or ‘cell assembly' may be created in amygdala." (The amygdala is the portion of the brain that controls arousal due to emotion, especially fear.)

He continues, "The unconscious amygdala may become conditioned to be chronically sensitized to negative symptoms arising from the body. Negative signals from the viscera or physiological, chemical and dietary stressors, become conditioned stimuli and the conditioned response is a chronic sympathetic outpouring from the amygdala via various pathways including the hypothalamus.

"This cell assembly then produces the CFS vicious circle, where an unconscious negative reaction to symptoms causes immune reactivation/dysfunction, chronic sympathetic stimulation, leading to sympathetic dysfunction, mental and physical exhaustion, and a host of other distressing symptoms and secondary complications. And these are exactly the symptoms that the amygdala and associated limbic structures are trained to monitor and respond to, perpetuating a vicious circle. Recovery from CFS may involve projections from the medial prefrontal cortex to the amygdala, to control the amygdala's expressions." 

Loosely translated, Dr. Gupta said that we had an unconscious "gut" fear reaction to something at the time of a viral infection and that gave us ME/CFS through "fear conditioning." That is, we saw an imaginary "bogeyman" of sorts during a viral illness and the rest is history. At least he credits us with not consciously deciding for all the horror of ME/CFS to happen.

So, how do we recover? Dr. Gupta recognizes that recovery is not easy, but does suggest that sophisticated psychological approaches are needed.

He explains,  "Recovery is likely to involve two distinct processes. First, symptoms resulting from secondary illnesses such as digestive problems need to be addressed initially. Once symptoms have moderated, further recovery may involve the amygdala's expression of danger being regulated by the cortex, in a process called ‘extinction.' It may be particularly difficult to regulate ingrained fear of stimuli which are continually present (i.e., the symptoms of CFS) and patients cannot simply be told to try and not think about or worry about symptoms at a cognitive level, because the cortex is continually arrested and fear processing mainly occurs unconsciously. New therapies may be required which may be distinct to received wisdom in this area and further research is required to test the validity of new therapies resulting from this hypothesis."

So it sounds like he is discounting Cognitive Behavioral Therapy and almost hinting we need a good Dr. Svengali to hypnotize us out of our problems. It is fortunate that Dr. Jones discovered we roll our eyes heavenward well!

Now if we could only find that good anti-ME/CFS hypnotist to banish all traces of the bogeyman (says Dr. Gupta) and those false illness beliefs implanted by physicians into us (says Dr. Jones)!

We'll all be cured forever—or at least until the next bogeyman comes by when we have a virus.

^1. Gupta, "Unconscious amygdalar fear conditioning in a subset of chronic fatigue syndrome patients," Med Hypotheses 59(6) (2002): 727-735.