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Friday, June 19, 2009

Lyme disease and female hysteria

I offer this piece after reading only the abstract of a recently published article. There may be inaccuracies because I have not read the entire piece. Feel free to post corrections.

A syllogism is a form of logical thinking which I learned about in college. Syllogisms are frequently twisted into false logic causing spurious or misleading conclusions. To say( 1) more women have Lyme disease(which is vague) then (2)more women also have depression(which is also vague) THEREFORE women who have Lyme disease likely have depression- is like saying: fire hydrants are red: you are red: therefore you are likely a fire hydrant. This is the sort of logic evinced in a recent article published by prominent anti-Lyme IDSA figures in the Journal of Women's Health. I can understand why women take umbrage with these remarks.

Not only is the logic false, but the implications are insulting to many health care professionals and professional health care organizations. If "Chronic Lyme disease" is a vaguely defined term that has been applied to patients with prolonged subjective symptoms..." The same cannot be said for fibromyalgia, chronic fatigue or depression.

Fibromyalgia is not vague. It is a syndrome which has been clearly described by the American Association of Rheumatology. It is defined by very specific symptoms combined with very specific physical findings. Chronic fatigue syndrome is not vague. It has been very clearly defined. This definition can be viewed in CDC published literature. Depression is certainly not vague. The psychiatric community has meticulously defined this disorder, and its subtypes, in a book called the DMS4.

There are clear cultural differences between men and women. Men are infrequent users of the health care system. Men are less likely to complain of symptoms. Culturally men are taught to be stoic, to not complain and ignore symptoms until they are very advanced.

Their are indeed biological differences between men and women as well. Women are twice as like to suffer with autoimmune diseases as men. Most physicians who treat chronic Lyme disease are well aware of the strong autoimmune component of Lyme disease. Women also live longer than men and are less likely to succumb to severe infectious illnesses. These differences are real.

Are diseases like depression really more common amongst women? We know that women are more likely to seek professional help for depression. MEN ARE FOUR TIMES MORE LIKELY TO SUCCESSFULLY COMMIT SUICIDE. Which gender is more depressed? Men are more likely to suffer with alcoholism, drug addiction and commit acts of violence. These are well known surrogates of depression and other mental illnesses.

The word "hysteria" is derived from an ancient Greek medical concept. It was a female disease related to a disturbance of the uterus. Hysteria has become synonymous with the terms "psychosomatic" and "psychogenic." Sadly, many physicians today are still influenced by this ancient, unwarranted prejudice.

One might conclude that the authors have lumped together these so called female predominant disorders because the underlying beliefs of the authors, like many others in the medical community, is that these "new age" illness are a phony-psychosomatic- manifestation of hysteria- as described by the ancient Greeks.

Why conclude that so called chronic Lyme patients have been misdiagnosed and really have these other syndromes? What evidence is there to back up this conclusion? Perhaps it is the other way around. Typically, chronic Lyme patients do not neatly fit into the syndromes of fibromyalgia or chronic fatigue syndrome. Unfortunately may cynical physicians, who fail to accept the reality of these illness, have used these clinical disorders as a "waste basket" for Lyme patients when in fact no clear diagnosis has been established--at least according to their paradigm.

This sort of thinking seems dismissive and anachronistic with regard to the suffering of so many chronic Lyme sufferers. And as stated at the outset, the logical argument marshaled here is questionable at the very least.

One has to question the motives of the authors: Are they trying to promote a scientific understanding of a disease or are they publishing pabulum in an effort to promote their pre-existing, crumbling paradigm?

I think its time for a change. Don't you?


Isabel80208 said...

It's amazing to me that these guys who wrote the article you are speaking of are still writing these things. We can only hope the IDSA review hearing July 30th will put a muzzle on them and their so-called findings. I have doubts though considering the review panel they have selected.

They have sent their posse out in CT as well. The following links to editorials posted in the New London Day and the Hartford Courant in the last few days show that they are getting nervous and trying to counter the Under Our Skin publicity.,0,5257058.story

You have a lot of followers, and I hope everyone goes online and adds their two cents to the comments section under these editorials. It's scary that the newspapers actually printed these.

It is time for a change. We need it!

Bird Blog said...
This comment has been removed by the author.
monkey girl said...

I agree with you, it's time for a change.

However, when I was diagnosed with fibromyalgia in early 2008, it really felt like a non-diagnosis (kinda like IBS) to me because the doctor still couldn't explain all my other symptoms, so he ignored them and just said, 'Oh, you have fibro, here take an anti-depressant', pat me on the back, end of story.

That didn't sit well with me.

Three months later my ND tested me for lyme...which came up glaringly positive (with 2 co-infections).

I guess what I'm saying, rather inarticulately, is when there is a diagnosis of a syndrome that has the unfortunate reputation of happening to mostly women, and the doctors only and/or usual solution is to prescribe an anti-depressant...well, like I said, it doesn't sit well with me. It's too convenient to just prescribe anti-depressant as if it was the 'cure-all' for every woman problem.

I find it insulting.

monkey girl said...

After re-reading your post, I do have one question, did the article you mentioned, actually say (or imply) that chronic Lyme is being fueled by female hysteria?

Everything about your post played out exactly how my Lyme diagnosis came about, because I wouldn't accept their diagnosis that I was just depressed and suffered from fibro and chronic fatigue. ( frankly, I was depressed because they weren't listening to me)

I can't explain to you how insulting the whole process was, and it took years before I got my Lyme diagnosis.

Just reading your post about this 'article' infuriated me to no end, however, I truly appreciate that you wrote it and are disturbed by it as well.

LYMEMJ said...

Sounds like when I went to see this Doctor I have even worked for as a medical interpreter; and I gave him my interminable list of symptoms, and showed him a "lyme test check list" I got in the internet, and told him: Doctor I think I have Lyme Disease. (I also told him he was my "last resort" after seeing other six Doctors before). So, after he checked my list he said: "Naaa, I think you just have an allergy; you know, you WOMEN present strong symptoms when you get allergies..." but when he saw my face, and I was still pointing at the paper, begging him to please believe me, he said: "Well, if I'm wrong, I'm wrong". And I had to pay and leave with my tail between my legs.
Was he wrong? yes. Did his consideration of us WOMEN helped? Nope! Was he sexist and dismissive and avoiding medical responsibility based on my sex and, forgot, age? Yep!
So, here I beg to IDSA,to please do not make Lyme a sexist or "agist" situation. I've seen videos of this 12 year old girl, or this 28 years old man, all depressed because of precisely, this absurd guidelines, based in wrong paradigmatic non sense conclusions. We women, you men, them gay, us human are in serious need of a real honest, professional profound and especially, ethic change!
Oh, and I was wrong too, that Doctor was not my "last resource at all", God was there and gave me the opportunity to go bother this Montgomery County doctor and yes, me women, it was Lyme and Babesia, daaa!

Unknown said...

I am so grateful that you took the time to write this post.

Anonymous said...

Thank you for this particular post!

I get so infuriated with the ignorance within the medical system Lyme sufferers come up against repeatedly! It has taken me 5 years, 17 doctors later to finally get my Lyme diagnosis…yet even with my Western Blot results in hand a recent visit to a new neurologist ended as soon as it started! The physician was intent on labeling me “depressed” even though repeatedly I told her I was not. She even offered depression meds more than once during my visit. Then lab work and other tests she insisted on ordering had a diagnosis code of ICD-9-CM of 300.16 “factitious disorder with predominantly psychological signs and symptoms”.

It is so sad that Lyme sufferers have to put up with such blatant ignorance!

I am hopeful that in my lifetime I will live to see a shift in attitudes of physicians we come in contact with!

Hopefully these physicians will start seeing the damage they are inflicting on truly ill patients!

LYMEMJ said...

And, forgot to say... I am a female with Lyme disease and every time I get a little bit better I feel sooo happy! And I've heard other WOMEN in similar circumstances as mine feel this way too when they have some recovery; so, I wonder if the guidelines IDSA is going to review to treat Lyme disease this time are more reasonable and the treatments proposed might really help improve and recover the health of the Lyme Disease sufferers, well, does this means that WOMEN with Lyme Disease are going to be happier than all the other WOMEN? I bet, the paradigm works for me!!!!!

bobcat said... I get it! Because I'm a woman....I am more likely to have depression.

So I wonder what people (men and women) with Lyme-specific antibodies are more likely to have?


Lyme report: Montgomery County, MD said...

The authors did not say that women are more likely to suffer from hysteria. These are my conclusions
based on the tone of the article.
This sort of thinking is sexist, antiquated and should be permanently expunged from the collective psyche of practicing physicians everywhere.

In case you are wondering, my gender is male. I have been a physician since 1983.

As far back as medical school, internship and residency I have had the distinct impression that medicine has had a misogynistic bias.

Medicine has also had the bias that when patients with multiple,confusing symptoms have hypochondria: they are "crocks." There is much more that we do not know than we do know. Doctors need to stop blaming their own deficiencies on patients and take patients at their word. In my experience no one really wants to walk into my office unless something is wrong.

One of the first things I learned in medical school, is just as true now as it always was: the hallmark of a good physician is that he(she) knows what he(she) knows---and, he knows what he(she) does not know!

I treating many sick men with Lyme disease and many sick women.
What the piece is really trying to say is that chronic Lyme disease is an invented myth--it simply does not exist. The gender issue is just a smoke screen for the larger point.


monkey girl said...

Thank you for being a doctor true to it's meaning. We definitely need more of them here in Washington state.

DocJen said...

THANK YOU for this! For far too long, being a woman has been a diagnosis in itself. This of course, as I'm sure you know, isn't just limited to lyme disease and how women present. This misogyny has been a fixture in medicine for almost as long as there has been medicine.

As you mentioned, women suffered from "hysteria" and were given drugs like laudanum to quiet the "spasms" (and make them addicts). All manner of illnesses like chronic headaches, pelvic pain, endometriosis (the "career woman's disease"), and fibromyalgia were dismissed as hypochondria.

If the House of Medicine wants to continue to make women a diagnosis, then just do away with the facade and give us an ICD code already.

notchoronic said...

I live in NYC and am being treated for Lyme and Bartonella after 5 years of being misdiagnosed. It is such a pleasure to have a doctor acknowledge the link between this illness and misogyny.Thank you. It gives a lot of people to know there are smart caring doctors out there!

Minnie55 said...

I was talking with another lyme sufferer today and we both noted that it seems that men do not suffer as badly as women when they have lyme disease. My husband got it, took doxycycline and was fine. I got it, and have had severe joint pain all over from before the date of diagnosis and although it has lessened in severity quite a bit, I still have joint pain four months later. My friend observed that the women she's talked to have suffered more than men with this. The doctors don't seem to believe we are in this much pain and they don't want to help us. I remember crying the day after the doctor stopped the doxycycline because I felt so much better just being off of that. I was then put on Ceftin for a month. I still had a lot of joint pain, but nowhere near as crippling as it was with the doxycycline. Maybe my body doesn't respond to doxyclycline the way a man's body does? I don't know but it seems the women get the worst of this disease.