It's an important topic and the author has done a pretty good job.
But I felt that there were a few 'err, not quite hit the mark moments'.
The biggest problem I think was making sweeping unqualified statements based on the findings from one or two studies, studies that are samples, possibly biased samples, of a particular population in a particular place with a particular culture and healthcare system. Here's an example:
Of those who attempt suicide, 64% visited a healthcare
practitioner in the month before the attempt and 38% visit the
week prior [55]
Then there is the equivocation about whether people are physically sick or suffering from psychogenic illnesses.
Further exacerbating the problem, the vast majority of
people with these chronic invisible illnesses are women [1-4],
who have historically been labeled as hysterical when
presenting with psychogenic symptoms [5]
Presenting with psychogenic symptoms or presenting with symptoms often interpreted as psychogenic?
In POTS, 25% of these typically young, highly educated women are so
disabled that they are unable to work or go to school
What does being highly educated have to do with having POTS? Is the data really strong enough on this point to include it, when its inclusion can suggest that these young women might have been ok if they hadn't been highly educated?
The following statistic is appalling and certainly deserves discussion.
In CFS/ME, the second leading cause of death
is suicide, with approximately 20% of patients dying in this
way [31,32].
However, by not giving us a context of the percentage of people without CFS/ME dying by suicide in the populations evaluated in the quoted studies, we don't have evidence for the later statement that people with chronic invisible illnesses are at a higher risk of suicide than the general population.
There was a lot to like. The author seems to understand that the attitude of health professionals can make difficult situations much much harder to deal with. I liked the understanding that pain is a major factor in creating the hopelessness that can lead to suicidal thoughts. The care that the author proposes (where medical professionals validate the patient's experience and proactively identify and treat pain, sleep problems and secondary psychological issues) is worlds away from what is delivered to most people with chronic invisible illnesses. It's good to state what should be. I hope the author will continue to try to inform health care professionals.
Given that 'thwarted belongingness' and 'loneliness' are identified as significant factors leading to suicide, the author could have mentioned the usefulness of putting people in touch with patient support groups including forums like ours. This paper and a thankfully brief episode of intense physical pain has reminded me how hard things are for so many people in our community and what a difference even small acts of kindness can make.
