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Margaret Williams 21st July 2012
The British Army is about to be
truncated: not only are thousands of servicemen/women to be made redundant
and more reliance placed on Territorial Army (TA) recruits in times of need,
but those seriously injured in, for instance, Afghanistan, who have been
blown up by an IED (improvised explosive device) and have lost limbs are
apparently to be denied disability benefits on the grounds that once they
have been fitted with prostheses, they are no longer disabled.
The British Army appears to have an
unenviable track record when it comes to looking after its sick personnel
who suffer from either Gulf War Syndrome or ME/CFS, perhaps due to the
prominent role played by Professor Simon Wessely in both disorders and his
well-known views that neither disorder actually exists except as a
dysfunctional “belief”.
In 1994, an Editorial in The Journal
of the Royal Army Medical Corps (Chronic Fatigue Syndrome in Army General
Practice: June 1994:140:2:59-60) by Lt Col JH Johnson set out the British
Army’s position in relation to ME/CFS:
| “A recent Editorial in the BMJ has
cogently and succinctly stated what is currently known about Chronic Fatigue
Syndrome (sometimes given the unhappy acronym ‘ME’, with its double
implication of serious pathology in the nervous system ‘Myalgic
Encephalomyelitis’ and of the suffering ego ‘Me!’). |
| “Many with this complaint have a
recognisable psychiatric condition….Some may have had an infection, usually
viral, but the relevance of this is uncertain and studies purporting to show
an important pathogenetic role for chronic viral infection have
been…unconvincing. |
| “No tests other than history are
needed to make the diagnosis…no special training is needed to make the
diagnosis and no investigations are required other than…to exclude other
diseases. |
| “Some patients…especially those who
have made their own diagnosis and joined a ‘self-help’ group, seem to enjoy
the status of ‘ME Victims’; usually they have a devoted spouse who helps
them to record their many symptoms….many do not get better but devote their
life to their disease. |
| “Chronic Fatigue Syndrome…is not
new. ‘Neurasthenia’ was a popular disorder in the last century but went out
of fashion when the physical explanation…ceased to be valid. During the
First World War… ‘Effort Syndrome’ became a common diagnosis. This disease
was characterised by chronic fatigue and a long list of other ‘functional’
symptoms….So many men were affected that the War Effort was put in danger.
Special Rehabilitation Hospitals were therefore set up and sufferers were
made to undergo staged physical training under medical
supervision….Preparations were afoot for a similar epidemic during the
Second World War. |
| “We in the Army Medical Service
still…have at our disposal the treatment modality set up by our predecessors
in 1915. |
| “Army General Practitioners should
be able to look after their patients with Chronic Fatigue Syndrome…(who)
indeed may be better served with historically attested treatment facilities
than their counterparts in civilian practice”. |
As with other recruits, a TA applicant
must fill in a comprehensive medical questionnaire (British Army Health
Questionnaire) and the RG Form 8 (Revised July 2004) in the section headed
“Psychiatric or mental health disorders” lists “Chronic Fatigue
Syndrome or ‘ME’” along with “Behavioural problems”.
The British Army Form RG 8 that was
revised in June 2008 equally lists “Chronic Fatigue Syndrome or ‘ME’ ” at
section 6.25, that section (6.20) being “Mental health problems”.
Despite the now extensive database of
biomedical abnormalities found in ME/CFS, has anything changed in the
British Army’s outdated categorisation of ME/CFS in the intervening four
years?
Whilst it is clearly imperative that
Army recruits must be of “a robust constitution and free from disease or
pre-existing injury to undertake the physically and mentally demanding
challenges of training and future service”, should soldiers be
unfortunate enough to succumb to ME/CFS whilst serving their country, it is
not acceptable for them to continue to be labelled as suffering from a
psychiatric or mental health disorder or to be compelled to undergo
“rehabilitation” in the form of graded exercise therapy, particularly as it
is known that such patients exhibit profound abnormality in their response
to exercise intervention and will not benefit from it (Loss of capacity to
recover from acidosis on repeat exercise in chronic fatigue syndrome: a
case-control study. David EJ Jones, Julia L Newton et al. European Journal
of Clinical Investigation, February 2012:42:2:186-194).
Why is the Ministry of Defence, headed
by the Secretary of State for Defence, allowed to diverge from adherence to
the WHO ICD-10 classification of ME as a neurological disease when other
Departments of State including the Department of Health are mandated to
observe the WHO classification?
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