Environmental Illness

1 What is ""environmental illness""? -- What it is not -- Examples of what it is -- Definitions -- Naming the indefinable -- Idiopathic environmental intolerances -- Clinical ecology and EI advocates -- Prevalence -- Philosophy of science -- Competing theories of EI -- Toxicogenic theory -- History of EI -- Causal agents -- Biological mechanisms and susceptibility -- Explaining psychological symptoms -- Unique principles of toxicology -- Politics -- EI patients -- Symptoms -- Strength of belief in EI -- Personality and behavioral characteristics -- Psychogenic theory -- Belief -- Stress-response -- Psychiatric disorders -- Treatment -- Conclusion -- 2 Toxicogenic theory -- A tale of misguided exploration -- Postulates -- Threshold of onset: total body load -- Long-term effects -- Sensitization -- One-molecule effect -- Heightened sensation: hyperosmia and cacosmia -- Threshold variability -- Sensitivity to multiple environmental agents -- Tune course of a hypersensitivity reaction -- Variability of effects -- Addiction to exposure -- Auxiliary postulates, the protective belt -- Temporal cohesiveness -- Demographic diversity -- Route of exposure -- Dose dependence -- Individual variability, uniqueness -- Rapid onset and cessation of symptoms -- Hypothesized biologic mechanisms -- Limbic kindling -- Tune-dependent sensitization -- Smell and taste -- Conclusion -- 3 Unsubstantiated diagnoses and treatments -- Unsubstantiated diagnostic and treatment practices -- Provocation-neutralization testing -- Sauna depuration -- Imprinted water and EMF -- Inappropriate use of diagnostic methods -- Radiology brain-imaging tests -- Neuropsychological testing -- Self-report of psychological symptoms -- Inappropriate use of treatment methods -- Acupuncture -- Diagnoses incorrectly attributed to EI -- Attention deficit/hyperactivity disorder -- Candida albicans hypersensitivity, the ""yeast connection"" -- Conclusion -- 4 Studies supporting the psychogenic theory -- Demographics and psychiatric/psychological conditions -- Clinical case reports -- Brodsky -- Stewart and Raskin -- Selneretal -- Terr -- Fiedler, Maccia, and Kipen -- Altenkirch, Hopmann, Brockmeier, and Walter -- Witorsch, Ayesu, Balter, and Schwartz -- Black -- Case-control studies -- Pearson, Rix, and Bentley -- Simon, Katon, and Sparks -- Simon, Daniell, Stockbridge, Claypoole, and Rosenstock -- Black, Rathe, and Goldstein -- Staudenmayer, Selner, Buhr, and Selner -- A cohort study of chronic fatigue -- Perplexing questions -- Why middle-age? -- Why female prevalence? -- Symptoms without disease? -- 5 Assessment of the toxicogenic research program -- Critical reports from medical associations -- Junk science excluded from the courtroom -- Testable hypotheses: provocation challenges -- A protocol for provocation chamber challenges -- The challenge chamber -- Methods of blinding the exposure -- Statistical analysis -- The case of a true positive responder -- Controlled challenges with EI patients -- Challenges unanswered -- Conclusion -- 6 Psychogenic theory -- A disorder of belief -- Psychogenic and psychosomatic illnesses -- Psychogenic illness mistaken as asthma -- The sick role -- History of psychogenic illness: neurasthenia -- Primary and secondary gain -- Discussion -- 7 Placebo and somatization -- Definitions -- The placebo effect as nuisance -- Placebo, ritual, and provocation challenges -- Factors contributing to the placebo effect -- Food intolerance: physiology and immunology -- Somatoform disorders -- Hypochondriasis -- Somatization disorder -- Conversion disorder -- An EI case of pseudoseizure -- Conclusion -- 8 Learned sensitivity -- Pavlovian classical conditioning -- Animal conditioning of the immune system -- Conditioning after documented exposure -- Thinking and learning -- Conditioning onset of asthma -- Cognitive learning -- 1886 historical example -- Learning to control allergies -- Fear and anxiety -- Learning and phobia -- The psychodynamics of phobia -- Discussion -- 9 The stress-response -- Hypothalamic-pituitary-adrenal axis -- Psychologic effects of AC1H and corticosteroids -- Stress and aging: the glucocorticoid cascade hypothesis -- Role of psychological factors -- Catecholamine system -- Norepinephrine -- Epinephrine -- Dopamine -- Pupillary reflex -- Autonomic nervous system -- Inhibitory systems -- Serotonin -- GABA -- Opioids and endorphines -- Psychoneuroimmunology -- Effects of the stress-response on cognition -- Conclusion -- 10 Panic attacks and anxiety disorders -- Psychophysiological theories of emotion -- Anxiety -- Panic attack -- Panic disorder -- Trme course -- DSM-IV criteria for PTSD -- Experimental models of PTSD -- Learned helplessness -- Trme-dependent sensitization -- Hyperosmia or cognitive priming? -- Conclusion -- 11 Trauma and post-traumatic stress disorder -- War -- Epidemiology -- Psychophysiology -- Cognitive dysfunction -- Pre-war risk factors -- Childhood trauma and adult sequelae -- Childhood emotional deprivation -- Childhood physical abuse -- Childhood sexual abuse -- A case of sexual abuse and EI -- Neurobiologic effects of childhood sexual abuse -- Conclusion -- 12 The limbic system and trauma -- The limbic system -- Electrical stimulation of emotion -- Emotions activate the limbic system -- Reticular activating system -- Disruptive effects of trauma -- Limbic system symptoms -- PTSD, limbic abnormalities, and trauma -- Hippocampal abnormalities -- EEG abnormalities -- Developmental stage and vulnerability -- Conclusion -- 13 Personality disorders -- Depression as a symptom -- Personality -- Psychological defense mechanisms -- Personality disorders -- DSM-IV Axis II classification -- Self-management of explosive affect -- Self-management of implosive affect -- A case of folie a deux -- Dimensional models of personality -- Limitations of categorical diagnoses -- Dimensional diagnostic approaches -- Discussion -- 14 Iatrogenic illness: exploitation and harm -- A medical cult -- Quacks -- Patient vulnerability -- Devotion to the guru -- Bias and expectation invalidate provocation challenges -- Doctor's expectation and treatment outcome -- Counterphobic rituals and obsessive-compulsiveness -- State revokes license of mercury amalgam guru -- Harmful effects -- The lady in the desert -- Isolation and ineffective rituals -- Munchausen syndrome by proxy -- Where are the bodies? -- Discussion -- 15 Treatment -- The path of psychotherapy -- Difficult patients and resistance -- Transference and countertransference -- Hateful and dangerous patients -- A depth model for selecting an intervention strategy -- Trust, empathy, and rapport -- An exposure event as an organizing concept -- Pitfalls -- The environmental care unit as a sanctuary -- Hope, magic, and the art of healing -- Psychotherapeutic interventions -- Stress management -- Behavior modification: systematic desensitization -- EI case-report involving desensitization -- Cognitive-behavioral therapy -- Cognitive distortions -- Dichotomous thinking -- Selective abstraction -- Arbitrary inference -- Circular logic -- Overgeneralization -- Undergeneralization -- Catastrophizing -- Decatastrophizing -- Misattributed causality -- Rationalization of lies -- Restructuring beliefs -- Psychodynamic psychology -- Treatment of personality disorders -- Psychotropic medications -- Discussion -- 16 Politics -- Victims and a herd of sacred cows -- Blaming social ills -- Reasonable accommodations? -- Victims: a neglected population? -- Politics of intimidation and the law -- Unrealistic product safety regulations -- ""More research"" -- Conspiracy theories -- Media -- Manufacturing industry -- Insurance industry -- Radical politics -- Discussion -- 17 Future directions -- TILT -- Scientific honesty -- The personal factor in disposing of contradiction -- Adversaries -- Paradigm shifts -- Endless rhetoric -- Model for a progressive research program -- Objective measurement and biomarkers -- Predicted outcomes for competing theories -- True positive -- False negative -- True negative -- False positive -- Conclusion -- Appendix A. A methodology of scientific research programs -- Appendix B. Court rulings