The biopsychosocial bomb? (or the importance of disclosure)

How do you feel about the proposition:

The symptoms of chronic brucellosis are, when all traces of infection have disappeared, perpetuated by the psychosocial characteristics and vulnerabilities of the patient?

Let me run that by you again.

How do you feel about that same proposition knowing that one of the authors of the series of papers establishing this worked at Fort Detrick on the biological warfare program? The viruses and bacteria selected for the program were in part chosen for their debilitating rather than lethal effects. One of the bacteria weaponised was Brucella, the pathogen causing brucellosis.
www.genomenewsnetwork.org/articles/09_02/weaponized.shtml
Anomalous isn't it? Why develop a bomb which is dependent for its effect on the psychological and social vulnerabilities of the intended victims? Has such a concept ever been contemplated?

The papers by Imboden et al were an essential part of the BPS library in the period 1988-1993 and were quoted by, inter alia, Wessely, Sharpe, Goldberg, Eisenberg, Abbey and Chalder. I stopped looking at that point. You will be able to find many more examples. I have no doubts that Wessely, Sharpe and Chalder approached these papers entirely in good faith, having no suspicions as to their provenance, though I am less sanguine about Eisenberg and Goldberg. Without the Imboden papers it would have been difficult for the BPS approach to gain a secure hold.

The papers are general referred to as by Imboden. So far as I can tell he was a psychiatrist working at Sinai Hospital, Baltimore but I have found little about him. It is a co-author who is of interest. Leighton E (Lee) Cluff, for it is he, appears to have been a leading expert on infectious diseases working in the Osler centre at John Hopkins University, Baltimore, becoming professor in 1964
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1473151/

The critical part of his obituary is:

While at Hopkins, Lee was co-editor of the 17th (new) edition of the Osler Textbook of Medicine. He also volunteered as an officer in the U.S. Public Health Service, assigned to Ft. Detrick, MD and was able to continue his activities at Hopkins while serving as a consultant at Ft. Detrick in the Biological Warfare Program. He carried out a series of investigations on laboratory and occupationally acquired infections, adverse effects of intensive immunization and the psychological determinants of delayed convalescence from acute and chronic infections. At Hopkins he did extensive studies on the pathogenesis, epidemiology and clinical manifestations of staphylococcal infections as well as infections in the newborn nursery, studies on fever and endotoxins and the pathogenesis of fatal pneumococcal infections. Following this he began a series of studies, which would continue over the next fifteen years on drug utilization and the epidemiology of adverse drug reactions. Several dozen research
fellows were recruited by Lee during this period, many of whom went on to distinguished academic careers.

Perhaps I have read too many of the wrong sort of books, but this all looks dreadfully like a cover story. Is one of the country's leading experts on infectious diseases spending his time in Frederick studying psychological determinants of convalescence whilst those around him are designing bombs and dispersal methods. Perhaps it was the monkeys that were in charge. That's why they had to die.

The Imboden papers seem to give protection on two fronts. They give a pretext for the work that was being done by Cluff, and perhaps the others. In case of any accidental contamination they provide a get-out-of jail-free card-blame the victim.

My suggestion, which I may have to come back to, having reached thee end of my tether, is that The BPS approach may be founded on deliberate disinformation intended to cover aspects of the biological warfare program.

You will be pleased to know that the CDC even gets a walk on part. In the 1980's they licensed the export of biological agents, including Brucella, to Iraq where they were used in their weapons program. Of course, they were friends then.

Schedule:

Brucellosis. III. Psychologic Aspects of Delayed Convalescence.


Author(s) : TREVER, R. W. ; CLUFF, L. E. ; IMBODEN, J. B. ; CANTER, A.

Journal article : Archives of Internal Medicine 1959 Vol.103 No.3 pp.406-14 ref.24

Abstract : III. The third paper deals with the psychological aspects of the illness in the 24 subjects of the previous study. The analysis of the data revealed emotional disturbance, especially depression, in the chronically ill and that the emotional disturbance was more related to the pre-illness personality structure than to the stress of the illness.
[These useful studies on " chronic brucellosis " indicate that the name as defined by the authors is probably a misnomer for psychological illness precipitated by brucellosis. The danger of an incorrect diagnosis of a psychological illness being made when the symptoms are due to active and demonstrable brucellosis still remains. The early appearance of agglutinins in acute brucellosis and the variable response, if any, of their titre to skin testing are other valuable findings. The observations are limited to Br. melitensis and Br. suis infections.] Frederick J. Wright.
ISSN : 0003-9926

DOI : 10.1001/archinte.1959.00270030037004

 

Fort Detrick, home of the 8 Ball, at one time likely the worlds largest microbe sphere? The same Ft Detrick that at times acted as the de facto wateringhole for importees of Operation Paperclip, just downstream from Plum Island?

I do not find it surprising that there might be a psych component folded into these efforts. It would be surprising if it were not.

It's disconcerting nevertheless.

So you have Bethesda, Md and Frederick, Md...What else is down in that neighborhood? Oh yeah, the NIH.

Johns Hopkins is a short drive north. You could bike it.

The psych contingent conceivably might fit in when planning for an infectious agent that was deliberately NOT lethal, that was being designed to debilitate. These bio-weapons evidently were being harvested to incapacitate communities for extended periods of time - with infectious agents that would boast little in the way of etiology. They would not be easy to identify.

The ramifications to the sick who cannot prove they are sick, we know.

 

See my other recent post that fantastic claims (be they about radiation poisoning, vaccines, 'chemicals' or now biological warfare experiments) need fantastic evidence.

Personally, Occam's razor applies. Which is more likely? That the above is true? Or that psychiatrists - in the vein of 'if all you have is a hammer, everything looks like a nail' - hypothesised that an otherwise unexplained illness was psychological in nature, used flawed experimental techniques also seen elsewhere in psychiatry and wider science (a.k.a. the replication crisis) and then, because they were so invested in their hypothesis, loudly explained any criticisms were due to delusional patients unwilling to see the 'truth' that they are mentally unwell?

It's entirely explicable without the need for a government conspiracy.

'ME/CFS patients are the inadvertent victims of a psychological misinformation campaign used to hide the development of biological weapons' is likely to lead to the average person on the street suggesting a soft room and a suit that ties at the back. And frankly the ME/CFS community faces enough of that already.

 

You mean the same way psychiatrists believed that Soviet political dissidents were not against Stalin but were actually beset by an otherwise unexplained illness that was psychological in nature, and helped send those dissidents to the gulag?

 

@Londinium The only problem with that is that it does not explain why the US government spent,presumably, hundreds of millions of dollars in developing a weapon system which they knew to be effective only at a psychosocial level.

It is all very well being contemptuous of evidence. Occam's razor may not provide complete answers.

 

As time has passed previously secret projects have seen the light of day. The Church committee investigation into the CIA brought all sorts of weird things to the surface.

The MKultra project was only discovered because papers marked "destroy after read" were found in a CIA office. It was not denied when it became public. It involved the use of LSD and other strange psychological things.

We now know that airborne bacteria were released into areas to watch their spread; prisoners were left with untreated diseases to follow their progress and projects were run where people were injected with radioactive particles to induce cancer and other chemicals to induce heart attacks.

I am not saying that any of our diseases, especially ME, is dogged by conspiracy but these things do happen. To dismiss everything as "conspiracy theory" has been used to take the teeth from legitimate enquiry.

In my 60s, I have stopped being shocked by seeing things shown as true that were meant to be massive conspiracy delusions at the time. The miner's union, was attacked by the government and Harold Wilson was investigated by the spy services for instance.

 

Indeed. Corrupt governments tend to preach democracy and freedom but tend to contradict themselves in any way possible. And when caught, they shift the attention through international affairs to make the people forget.

 

The biological weapons program was a dangerous place to work. Frank Olson, who "specialised in developing bacteria for use in aerosol delivery systems" was "defenestrated" from the 10th floor of a New York hotel in suspicious circumstances.

A question arises about this whole program of psychosocial research. There were the three Brucellosis papers in 1959, one on flu in 1961 conducted on military personnel in Rockville (handy for calling in to supervise if travelling between DC and Frederick) and a further one on flu in 1966. Who provides funding for such a scheme of work, and why?

There is another interesting wrinkle to this story. Imboden was apparently aware by 1972 of the distinction between chronic brucellosis and "chronic brucellosis". the latter being considered by some akin to neurasthenia. The findings of these papers related to "chronic brucellosis". The timing is convenient. The biological weapons program was closed in 1969, at least supposedly. One might reasonably expect that the leading experts on the condition might have drawn that conclusion in 1959, if they were going to draw it at all.

 

I am now going to do something almost unheard of. I am going to admit to a mistake, correct it, explain it and apologise. Who knows? It might set a precedent.

In a post above I said that the Influenza paper of 1961 was conducted on military personnel in Rockville. That was a mistake, although I am sure I have read it. I apologise for the error-there was a time when I would not have made it. Until this week I also thought the test was conducted on civil servants. I also read that, and know that Eisenberg stated that in 1988. The tests were in fact conducted on 600 employees at Fort Detrick (although Eisenberg strangely states 480). That seems to be a relevant fact which has not exactly been trumpeted by those relying upon the paper. Of the 600, 26 developed flu, of who 14 were asymptomatic within 14 days, and in twelve symptoms persisted beyond three weeks. Here is the full paper.

Convalescence from Influenza A Study of the Psychological and Clinical Determinants
JOHN B. IMBODEN, M.D.; ARTHUR CANTER, Ph.D.; LEIGHTON, E. CLUFF, M.D.
Arch Intern Med. 1961;108(3):393-399. doi:10.1001/archinte.1961.03620090065008

sci-hub.se/10.1001/archinte.1961.03620090065008

In a recent study 1 of convalescence from acute brucellosis the findings strongly supported the view that delay or failure in symptomatic recovery from that disorder is critically dependent upon the emotional state or attitude of the person. While no objective clinical or laboratory findings differentiated those persons who recovered quickly and completely from those who retained symptoms for a long period of time (chronic brucellosis), there were striking differences between these two groups in terms of psychological adjustment and life situation concurrent with the acute phase of the infection. The evidence pointed to the importance of depression particularly in retarding symptomatic recovery from the illness......

It seems likely that the Brucellosis cases also appeared amongst Fort Detrick staff. I will follow up on this point

The work was "supported by contract with the Army Chemical Corps". Had it been supported by the general medical services no eyebrows would have needed to be raised. But the Army Chemical Corps? This paper needs to be looked at and analysed.

There appears to be significant difficulty in applying any findings of this paper to ME, not least because the follow up period seems to be three weeks.

The importance of these points is in the poisonous use made of it by Eisenberg in 1988:
https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0033291700001823

Psychological Medicine, 1988, 18, 1-9

EDITORIAL
The social construction of mental illness1


... As an intern, I 'saw' patients with chronic brucellosis, a disease diagnosed on the basis of weakness, fatigue, migratory aches and pains and low grade fever; a history compatible with exposure to Brucella; and a positive agglutinin titre. It was considered rather a coup to have made the diagnosis; the patient tended to be grateful, despite the absence of effective treatment, having previously been dismissed as a hypochondriac or a malingerer. Yet, thirty years later, it is reasonably clear that chronic brucellosis is a spurious disease construct which legitimizes and thereby perpetuates chronic illness behaviour.

Comparisons of fully recovered patients with those complaining of persistent symptoms after bacteriologically confirmed acute brucellosis reveals no difference on physical examination or laboratory tests (Cluff et al. 1959). However, on mental status examination, the symptomatic patients display signs of depression. Are the symptoms somatized depression or are patients depressed for having a chronic bacterial disease?

To discriminate between the two possibilities, Imboden and his colleages (Imboden et al. 1961) assessed 480 male civil service workers by the Minnesota Multiphasic Personality Index shortly before an expected epidemic of influenza. During the 'flu season, the rate of infection (as determined by serological surveillance of all subjects) was no greater in persons identified as 'psychologically vulnerable' by their test scores, but they made clinic visits five times more often. Almost all the patients who exhibited prolonged convalescence from 'flu were in the vulnerable group. The chronic aftermath of acute infection represents a pattern of persistent illness behaviour precipitated by a disease episode in psychologically vulnerable individuals. Once sanctioned by a physician, the symptoms are more likely to persist; the persistence of the symptoms is mistaken for confirmation of the diagnosis.

Chronic brucellosis no longer has much cachet as a diagnosis, but candidates for the succession are very much in evidence. Currently, considerable attention is being devoted to 'chronic mononucleosis', also known as 'chronic active Epstein-Barr virus (EBV) infection'. The syndrome is characterized by chronic fatigue, fever, myalgia, pharyngitis, headache, depression and cognitive change (Buchwald et al. 1987; Holmes et al. 1987). Antibody titres against EB virus are somewhat higher in patients with these symptoms than they are in the general population, but exposure to EBV is so ubiquitous that there are no cut-off levels which reliably distinguish patients from controls. Whatever the cause of this symptom pattern, EBV infection is an unlikely bet. If some cases indeed prove to be due to an as yet to be discovered virus, many more, in my estimation, represent the somatization of personal distress, legitimized by a newly fashionable diagnosis.

This might be reasonably be taken as the commencement of the new attitude towards ME. It would be interesting to know whether he spoke in these terms at the CIBA conference in 1988, about which we know very little. It seems that after this speech all the BPS brigade were suddenly quoting Imboden.

This is the reason for the interest in the facts surrounding chronic brucellosis and Fort Detrick. Why would the Chemical Corps fund such research, and are the findings valid.

 

A doctor giving a talk for millions missing spoke about herpes viruses (EBV is one). He expresses amazement that doctors quite willingly accept that chicken pox can live on in the body to emerge as shingles 60 or more years later but are dismissive over claims any of the others can.

 

The first of the Brucellosis papers, which is rarely, if ever, referred to gives vial background information

TREVER, R. W. (1959). Brucellosis. A.M.A. Archives of Internal Medicine, 103(3), 381. doi:10.1001/archinte.1959.00270030037004
https://sci-hub.se/10.1001/archinte.1959.00270030037004

It is unusual to have an opportunity for specific clinical evaluation of patients with infectious disease prior to onset of illness, except in volunteer studies. From 1945 to 1957 sixty cases of acute brucellosis occurred among personnel of a bacteriology laboratory engaged in studies of Brucella melitensis and Brucella suis. These patients had been followed regularly by clinical examination and serological tests before infection occurred. Their known occupational exposure facilitated early diagnosis, hospitalization, and treatment. Many of the infections followed documented laboratory accidents. Most of the patients were observed frequently for one or more years after onset of the acute illness. Analysis of these cases of brucellosis brings out several interesting features of the disease and has made possible appraisal of the incubation period, diagnostic procedures, clinical manifestations, efficacy of chemotherapy, and development of chronic persistent symptoms ("chronic brucellosis")…….

The research clearly arose out of cases of accidental infection in a biological warfare laboratory. There is a clear conflict of interests in the research being funded by the employer. One might perhaps have considered the possibility of claims under employers' duty of care, running an unsafe system of work etc. So much simpler to blame the psychosocial fragility of those whose condition became chronic.

The influenza research which followed people for (EDIT between three and six weeks) is clearly wholly inadequate. The claims made for this line of research do not seem to hold up.

 

Willy Burgdorfer discovered the causative agent behind Lyme. He was recruited to investigate an outbreak of something in CT because of his world-wide acclaim when it came to the study of spirochetal and ricketsial diseases, among other vector-borne diseases. He identified the new species and he related back to what had already been known from Europe in the first half of the 20th century. He claimed that Lyme could reside dormant in humans, latent and asymptomatic for years, then roar into the lives of its hosts.

That's not what the text books teach.

 

Oh dear, oh, dear, oh dear.

Leon Eisenberg was at John Hopkins University from 1952 to 1967. Small world, isn't it. So, a colleague, albeit in different departments, of Cluff.

EDIT it would be interesting to know if he was in the same department as Imboden at any time.

This report in the Baltimore Sun of his death might say more but is inaccessible in Europe, at least to technology incompetents like I.
https://www.baltimoresun.com/news/bs-xpm-2008-02-08-0802080269-story.html

EDIT there is a paper on the internet which appears to state that Imboden was an Associate professor of Psychiatry at John Hopkins and Psychiatrist-in-Chief Sinai Hospital Baltimore. This might explain Eisenberg's enthusiasm and proselytising for the work.