Any illness causes magnification of stress. In ME patients this effect is increased and has been confused by some professionals with the idea that stress causes ME. Viruses and other immune insults are usually involved with causing ME through a process of immune shift. eg It is known that some viruses have evolved to interfere with the human immune system and they shift it away from viral defence. Without this effect ME does not happen. So although stress can depress the immune system, and there is a real question about how stress can be an exacerbating factor, it does not cause ME. It is likely though that ME causes unusually high stress levels in patients by effecting the nervous system directly. The effects of ME stress then play a part in a further secondary vicious cycle of illness if the condition is not recognised and treated appropriately, where stress exacerbates ME and ME exacerbates stress. The disease of the CNS in ME explains the disturbing effects of ME on cognition and the emotional lability associated with it.

The disease process of ME typically effects the bowels and autonomic system throughout the body which can be very disturbing to the central nervous system, the brain and therefore the mind. (Like Pavlov's dogs: see below). It has long been recognised that the brain in ME patients is over-active and people with ME (PWME) tend to be hypersensitive to stimuli. Recent research suggests that ME's neurological symptoms may be due to a toxin, (ciguatera epitope) possibly released by the immune system, which directly poisons nerve cells and makes them fire more easily (and leak sodium). The effect of that is to increase nervous system sensitivity in patients to produce hypersensitivity and dysregulation in what might be termed a double-whammy of stress magnification when added to bowel disease and autonomic dysfunction. ME also causes a depletion of protective stress hormones by disturbing the HP axis, making this a treble whammy.

This combination of effects has a major impact on the patient's psychology, in particular on ability to handle stress, far worse than for other diseases. ME patients may also endure life changing events as a result of the illness and this results in a kind of shell shock for many in response to what would normally be considered manageable levels of stress stimulation. This has serious implications for the mental health and necessary care of people with chronic ME, in that they should be spared even mild traumas if at all possible. If ME was not personal enough, stress of this magnitude can effect the most intimate part of a persons life, their own character and beliefs.

The reknowned physiologist and behavioural scientist IP Pavlov studied the effects of stress in dogs and showed that stress is increased in subjects who are suffering from disease. He was not kind to the dogs and I disagree with that, but his science is regarded as a standard which other scientists, both biologists and psychologists, will respect so its worth understanding what he contributed. Specifically he showed how bowel disturbance can effect the conditioning process in dogs. Pavlov found that stress made the dogs' conditioning easier to break or make. He noticed their responses lead through a series of stages of increasing stress to a breakdown where new conditioning was semi-permanently fixed. For example after a flood several of his dogs became conditioned to fear water on the floor of his lab.

The phases he identified lead from an "equivalent" phase where the brain responds equally to different types of stimuli to a "paradoxical" phase where the brain responds more to weak stimuli than to the strong stimuli causing the stress. As the effects of stress increase an "ultra-paradoxical" phase occurs in which previous conditioning including thoughts and beliefs can be suddenly reversed and when sustained this leads on to "transmarginal inhibition" in which the patient feints. After which typically new conditioning has become semi-permanently fixed. Some people use this as a brainwashing technique for both good and ill.

The point is that stress can touch the very deepest parts of what we consider to be ourself and ME patients have to endure profound stress. The vulnerability of ME patients is far greater than most people without it can understand and they deserve the utmost compassion and care in the way they are treated to assist their recovery and minimise psychological damage. This is the reverse of what has been practiced to date in certain quarters advocating that they should be challenged. In my view, the emerging physiological interpretation of ME provides a better basis for treating the ME patient from any perspective, simply because it is a more accurate explanation of the effects of ME. It follows that the secondary disease process of stress effects and cognitive disturbance can be helped by sound and humane psychological intervention eg ensuring a non-stressful environment for the patient and minimising the disturbance due to psychological excitement of any sort and helping with management of difficult times with CBT. It also follows that physiological approaches must be properly applied to reduce the primary disease impact on the nervous system. While we do not yet have a cure for the cause of the disease it is a significant step forward in finding a more correct perspective from which to provide better palliative care.