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Balanced view on fibromyalgia is essential

Sir - As a medical practitioner specialising in the treatment of fibromyalgia I feel duty bound, as well as entitled, to respond to the Patricia Redlich interview with Dr Michael Kelly (Sunday Independent, 21/11/04).

Over time, I have patiently listened to Dr Kelly on radio, noted his comments on television, attended a lecture and read his book. His view being at variance with my own is acceptable, but the persistent absence of professional counterbalance is not.
With each global, generalising statement of personality issues and perfectionism, I have witnessed many sufferers feeling angry, frustrated, embarrassed and upset - and no, it is not part of the disorder, it is a justifiable response to a misrepresentation of the range and complexity of the disorder.

Dr Kelly has correctly identified a feature of fibromyalgia - personality. But personality is merely a description of the way people utilise their energy. Sufferers tend to have a feature of giving their energy and concern away in spades, displacing themselves excessively for the sake of others and, in the case of perfectionism, repeatedly transgressing their energetic limits in order to complete a task.

And yet, there are any number of subtle background issues preceding even this. In reality, far from being on the spectrum of having a personality disorder or having mental problems, they are entirely normal but big-spirited, industrious people who have drained 'the battery' of life and have difficulty fully recharging again. They therefore have an increased vulnerability to cumulative stressors such as infection, chemicals, injuries, etc.

In representing this disorder as emotional stress- or personality-related, there is a great danger that family, friends, employers, insurance companies and health practitioners, may perceive that simply de-stressing and thinking happy thoughts will reverse the problem. In most cases, it will not. Even in the theoretical case that emotional stress was the only cause (it almost never is), changes have occurred in the body which are not easily reversed. (Hard cement will not revert to wet cement simply because you wish it would.)
Any health practitioner will find changes in the density and tension of the tissues should they take the trouble to examine them.

Another great danger is that by erroneously focusing on personality as the lone agent of disruption, one tends to lose sight of the deepening disorder which is gradually creeping into an individual's physiology, ultimately leading to ever-decreasing circles of functionality and ever-increasing waves of distress and pain.
It must be absolutely clear to the public, families, insurance companies and the health service, that this is a very serious disorder in terms of the loss of life quality. Very few of us could withstand all-over body pain, extreme exhaustion, sleepless nights, nausea, clogged thinking, flattened mood and abdominal upsets, etc, with enthusiasm.
Research into fibromyalgia is proceeding at a pace. The general consensus from the World Congress of Fibromyalgia and Myofascial pain in July was that its origins were distinctly neurological.

Much progress has been made with understanding the processing of pain within the spinal cord. Yet, somewhere between the highly cellular view of biochemical research scientists and Dr Kelly's generalising statements regarding emotional stress and personality - lies the truth. Unfortunately, physiological truth and reality are far more intricate and multifaceted than we have heretofore recognised.
Dr Veronica Downes,
Douglas, Cork

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