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Chronic Fatigue Syndromes: The Limbic Hypothesis
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Jay A. Goldstein. 259 pages. New York: Haworth Medical Press; 1993. $89.95, hardcover; $49.95, softcover.
The author of this book "has seen over 3000 CFS (chronic fatigue syndrome) patients". This would have been a good opportunity for him to present a wealth of important basic information. Some simple tables describing characteristics of his patients with the syndrome, which are identified by the inventories on pages 6 to 10 and 235 to 238, would have been relatively easy to do and illuminating and would have provided a solid foundation for generating hypotheses. Instead, the author has largely relied on his own anecdotal material. Throughout the book he makes statements that cry out for some indication of the statistical reality of his vast clinical experience. For example, he indicates that ovarian carcinoma is disproportionately prevalent among patients with the syndrome. Where are the data? Tantalizing statements such as these are hard to swallow without some kind of substantiation.
A book on limbic connections to disease should be strong in psychiatric background. Considerable epidemiologic data have accumulated on the relation between psychiatric disorders and the chronic fatigue syndrome, which the author has largely overlooked. His limbic hypothesis lacks integration of psychiatric elements. For example, how does he come to terms with the well-documented high comorbidity rates of psychiatric disorders in patients with the syndrome? What does he make of his own finding that many of these patients report that they were abused children? Although he notes that the National Institutes of Health recommendations include standardized diagnostic evaluations for psychiatric disorders in all patients with the syndrome, he has largely ignored this in preference to ferreting out brain mechanisms of cause that apparently exist in a diagnostic vacuum. He has devoted only six pages of the entire book to psychiatric disorders, with few supporting statistics.
These vital flaws do not generate confidence in the hypothesis of the book, a serious problem in a book whose purpose is a hypothesis.
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