Sunday, March 24, 2013

The Psychological Stress Confussion

NPR interview on the topic of GWI:
DANKOSKY: So Dr. Steele, what do we know about the causes? Because there have been a number that we've heard about over the years. Maybe we can run through a few of them. One of the things that is mentioned sometimes is stress or PTSD, something that we've heard a lot about from these last few wars, Iraq and Afghanistan. How much does stress have to do with it, do you think?

STEELE: That's a really good question. I think for many years after 1991, after the war got over, a lot of folks really didn't know what to make of Gulf War Illness or Gulf War Syndrome. But at this point, now 22 years later, we actually have a lot of students that tell us a lot about what may have caused Gulf War Illness.

Most of the studies early on looked at things like stress and post-traumatic stress disorder, but we now know very definitely that Gulf War Illness, specifically in 1991 Gulf War veterans, is not a stress-induced or trauma-induced kind of disorder. The rates of things like post-traumatic stress disorder are very low in 1991 Gulf War veterans, much lower than we're seeing in current returning veterans from Iraq and Afghanistan.

However, there is a long list of potential causes that different people have looked at over the years, many things like the vaccines that veterans receive, the oil well fires that many of us remember from that time, all kinds of chemical toxicants that they were exposed to.

And just looking over the broad range of studies, at the many epidemiologic studies that have been conducted in this population, we know that several of these risk factors or toxicants have risen to the top in terms of the strength of evidence that suggests that they are connected with Gulf War Illness.

And at this point we can say that the highest risk factors relate to use of prophylactic medication given to veterans to protect them from nerve agents. That pill was called pyridostigmine bromide. In addition, there was extreme overuse of pesticides in some groups of veterans during the 1991 Gulf War. And so those are also linked to higher rates of Gulf War Illness.

And then we also know that some veterans were exposed to very low levels of nerve agents during the Gulf War, and there's also some evidence supporting an association between Gulf War Illness and the nerve agent exposures that happened during and after the war.

Overall, though, the studies consistently show no link between for example serving in combat and higher rates of Gulf War Illness.
Why is it, that if someone postulate that "stress" (or "lack of resilience" or some other "psychological fault" of the patient) is causative for a (hard to grab) disease, that there is so little scepticism? Why are people not challenged more if they spread their "psycho-stress confusion"? And we are not talking here about physical stress, no here supposed psychological stress (combined with some sort of supposed defect of the patient) should be able to cause physical disease like GWI? A disease that is unique to the gulf war veterans?

I'm sure the Theologians of the Wessely School have an explanation for why there are so many gulf war veterans have GWI – this will be an explanation however that does not create clarity, but an explanation that creates confusion instead…


  1. If adrenaline makes the nerve gas pill (pyridostigmine bromide, PB) more toxic, and the people who took the pill were in combat and surely making excess adrenaline ("stress"), how can you say stress is not a potential explanation for the unexpected effects of PB?

    Jim Moss

    Chaney, L.A., Mozingo, J.R., Hume, A.S. & J.I. Moss. 1997. Potentiation of Pyridostigmine Bromide Toxicity in Mice by Selected Adrenergic Agents and Caffeine. Vet. Human Toxicol. 39 (9): 214-219.

  2. So you basically say that without the nerve gas pill, people would *not* have gotten ill, when put in the same stress?

    Then stress is a trigger, and not the cause. The nerve gas pill is the cause.

    (And look at the fact that having been in combat does not make much difference. People who were deployed but not in combat gotten ill at roughly the same rate. Surely people in combat had more stress.)


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