Journal of IiME Volume 2 Issue 2 www.investinme.org P Plluuss ççaa cchhaannggee,, pplluuss cc’’eess tt llaa mmêêmmee cchhoossee ( (ccoonn tt ii nnuueedd )) back on bodily feelings when blood testing is not always available. It is obviously impossible to regulate these patients from afar (external site of control). These patients whether using blood sugar levels or their own internal feelings have to learn to self-regulate, and on a dynamical basis. Of all the potential variables in this complex control system, only 3 are essential- the diet, the dose and timing of insulin, and the exercise must be timed and varied on a frequent basis. The diet raises the blood sugar, depending on its type and amount and the exercise, (again depending on type and amount) and insulin lower it. Osler’s 1914 textbook in internal medicine does not suggest using exercise as a regulator, since it wasn’t yet a crucial control variable, but prescribes “modest exercise” (23). Timing and balancing these variables is an on-line dynamical process. While many other variables can intervene- e.g. rises in the anti-insulin hormones due to stress, infection and anxiety, inability to control due to cognitive problems secondary to hypoglycemia, etc, they are more like external parameters that affect the whole state of the control system than like variables within the system. Emotional problem are common, often during adolescence, when young diabetics during their rebellious adolescent stage will often try to ignore the illness as well as resist such intrusive and bothersome therapy. But it is obvious to all that these emotional disturbances do not cause diabetes, since this is obviously basically a physical kind of dysregulation. They are parametric (22, p71ff) aggravators, quite distinct for the control system itself, and can of either physical or mental kind. Any psychotherapy initiated to get the patient out of her/his adolescent rebellion could certainly improve the diabetic control, and yet not be regarded as a treatment for diabetes. The situation is clear. I would like you to compare this situation with Invest in ME (Charity Nr. 1114035) that of ME/CFS. There is no problem in assigning causal responsibility in diabetics. Why the problem? One is that a complex multicausal regulatory system involved with ME/CFS has proven to be a difficult “entity” to grasp through research. As one does more science, the whole system will undoubtedly become more complex, and we need to guide research towards regions that are likely to be fruitful. Another impediment is that a prominent strategy in current use to guide attitudes and treatment methods regards ME/CFS as a somatoform disorder, i.e. a symptom cluster showing the form of a somatic organic disorder, but without the content. This is actually more of a default position than a diagnosis, but is similar in that it is serving as the termination of a clinical judgment procedure. This has led to disagreement as to whether CFS/ME is a physical or a mental kind of disorder, and within the system which are its constitutive variables that determine its form and which are the parameters that influence it but don’t determine it- with the different kinds of causality that this entails and the different forms of treatment to follow. The result is a mess. We have discussed above how the research definitions have been used not only to guide future research, but also to ignore current research findings until the story has been completely told and “the cause” of CFS/ME is known. If we have not been able to demonstrate the complete causal network with complete scientific certainty, should we continue on the assumption that there is no underlying cause for these symptoms and that they don’t refer to anything except their nominal essence as a name, thus remaining a “somato-form” “nominalist” kind as a default interim position while we search for the underlying cause that fulfills the symptoms’ intention as a “natural kind” ( 21). It is very tempting to slide from the attitude that a symptom’s causal background is uncertain, to the attitude that it is not there, and hence that the illness is all symptom and no reality. From (continued on page 31) Page 30/74

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