The concept of ‘illness without disease’ impedes understanding of chronic fatigue syndrome: a response to Sharpe and Greco, by Steven Lubet, David Tuller in BMJ Medical Humanities. Published Online First: 01 June 2020. [doi: 10.1136/medhum-2019-011807]
In a recent article in Medical Humanities, Sharpe and Greco characterise myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS) as an ‘illness without disease’, citing the absence of identified diagnostic markers.
They attribute patients’ rejection of psychological and behavioural interventions, such as cognitive–behavioural therapy (CBT) and graded exercise therapy (GET), to a ‘paradox’ resulting from a supposed failure to acknowledge that ‘there is no good objective evidence of bodily disease’.
In response, we explain that understandings about the causes of and treatments for medical complaints have shifted across centuries, and that conditions once thought to be ‘psychosomatic’ have later been determined to have physiological causes.
We also note that Sharpe and Greco do not disclose that leading scientists and physicians believe that ME/CFS is a biomedical disease, and that numerous experts, not just patients, have rejected the research underlying the CBT/GET treatment approach.
In conclusion, we remind investigators that medical classifications are always subject to revision based on subsequent research, and we therefore call for more humility before declaring categorically that patients are experiencing ‘illness without disease’.
Read summary of article by Steven Lubet: Is ME/CFS an “Illness without Disease”?
No. No it is not. No matter what certain psychiatrists have opined..
…Given psychiatry’s long history of mistaken theories of disease
causation, there is an almost wondrous grandiosity to Sharpe and
Greco’s proposed solution to the supposed “paradox” that troubles
them. Rather than conceding that CBT and GET may be failed therapies
for ME/CFS, and that biomedical research may ultimately hold the key,
they instead call for “a major long-term change in thinking” on the
part of patients, clinicians and scientists who do not share their
particular views regarding the “moral connotations of illness and
The illness-without-disease concept can be a useful tool in
exploring interactions between patients and health care systems, but
only if it is recognized as highly contingent and subject to the
admitted limitations of current knowledge. Contra Sharpe and Greco,
patients would be better served by greater humility accompanied by an
understanding that medical categories are always provisional and
therefore subject to change with advances in research.