COMMENTARY

Morgellons: Real Disease or Imaginary Malady?

Andrew Scull, PhD

Disclosures

June 18, 2015

In This Article

Making Sense of Morgellons

Morgellons disease has no characteristic laboratory abnormalities, suggesting that it is a form of psychiatric disorder. No obvious and uncontested biochemical or metabolic abnormalities correspond to patients' subjective symptoms. Nor does this condition correspond to any known neurologic disorder. Sufferers complain of muscle pain, persistent headaches, unrefreshing sleep, sore joints and throats, impaired memory and generalized malaise, not to mention impaired ability to think and to concentrate—and even this extensive list fails to include the full panoply of symptoms some patients experience.

What are we to make of it all? It is clear what those complaining of this syndrome want. Bitterly, the fatigued denounce their critics, the worst-placed rattling their wheelchairs in lieu of shaking their fists, accusing doctors of being "lamentably ignorant of the most basic facts of the disease." Proudly they rededicate themselves to what one of the targets of their ire, the British psychiatrist Sir Simon Wessely, has suggested that they consider: "the long uphill battle against ignorance and inertia."

Pesticides, hormones, chemicals, bacteria, viruses: Something must surely be responsible for these patients' suffering, and if modern medicine pronounces itself unable to oblige with a physical account of their troubles and proposes to ship them off to the tender mercies of the psychiatric profession, then they are off elsewhere. Off to self-help or to holistic practitioners, who are happy to display more sympathy and faith in the physical reality of their disorder, and to link it to the perils of civilization, only this time in the guise of a poisoned modern environment. Off to online support groups, where they can multiply their tales of woe and sense of grievance.

The verbally and sometimes (ironic as that would be) almost physically violent response of many of these patients to the suggestion that their symptoms are psychosomatic, or "all in their heads," is impossible to miss. Those who question their insistence that their disease is "real"—that is, rooted in the body—are deluged with abuse.

Wessely, for example, who was last year's president of Britain's Royal College of Psychiatrists, once worked extensively on chronic fatigue syndrome. Although he was willing to consider the hypothesis that viral or other unknown infections might initially trigger the disease, he proclaimed that psychological and social factors were far more important in perpetuating it, and that it largely resulted from dysfunctional illness beliefs and coping behaviors. His reward was to be inundated with abuse and personal attacks, even threats on his life. His mail has had to be X-rayed, and at times he has had police protection. Not entirely surprisingly, he has ceased further research on the subject.

Dubbed by the tabloids "the most hated man in Britain," Wessely's experiences are testimony to how desperately many of the afflicted want a neurologic diagnosis. That diagnosis will validate the reality of their disorder, and legitimize their suffering. But the neurologists who have grown to professional maturity in the post-Charcot world evince little or no interest in their troubles. Pausing only long enough, in the most plausible of cases, to subject them to batteries of tests and scans before pronouncing them physically normal, they suggest these nuisances go to see a shrink. That, as we have seen, is the last thing these patients want.

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