Threshold Disorders, Auto-Immune: The New Yorker

I recently responded to a most interesting article in the THE NEW YORKER concerning a personal essay by Meghan O’Rourke titled: “What’s Wrong with Me?”  The essay appeared in the August 26, 2013 issue of the New Yorker.  Ms. O’Rourke shared the struggle she had with episodes of symptoms for which she was not able to receive a successful treatment or a clear diagnosis.  One of her physicians thought she might have an AUTO-IMMUNE disorder and that is the diagnosis that she has now accepted as an explanation for her symptoms.

The New Yorker printed my response in the September 9, 2013 issue.  An edited version appeared:

“O’Rourke mentions stress in her description of her search for treatment, but it is not addressed by her physicians. Stress can cause a range of physical symptoms, including fatigue, gastrointestinal upset, fever, and skin reactions. Instead of attacking itself, could her nervous system be responding in a pattern typical of migraine? Migraine appears to occur in those with a hereditarily sensitized nervous system, and could be grouped with other non-organic functional disorders such as fibromyalgia and chronic fatigue, in what might be called “threshold disorders.” In my clinical practice, I find that, when a patient’s nervous-system threshold is lowered, the body might respond with episodes of alarming but non-organic symptoms. Stress would appear to be a major factor in lowering the threshold, as are sleep disorders, hormonal imbalances, and blood-sugar problems. A physician may identify a neurological response, expressed in chemical and tissue changes, call it an autoimmune disorder, and miss the underlying cause.”

My original  response with some editing following my discussion with the nice letter editor and a fact checker at the New Yorker was as follows:

“It interesting that Meghan O’Rourke never emphasizes stress in her description of her valiant search for “What’s Wrong with Me?”, nor apparently did her physicians. The “stress of life”, as that old master Hans Seyle described it, can cause a wide range of physical symptoms including fatigue, gastrointestinal upset, unexplained fever and even skin reactions. In latching onto a diagnosis of “auto-immune disease”, Ms. O’Rourke may be doing a disservice to her most intelligent nervous system. Could it be that instead of “attacking itself” her nervous system was responding in a pattern typical of non-organic, functional “threshold disorders” such as migraine, fibromyalgia and chronic fatigue?

Based on experiences in my clinical practice, I am proposing a clinical model for a group of functional, non-organic disorders to include migraine, fibromyalgia, chronic fatigue, and a group of symptom-clusters that exhibit a wide range of symptoms that with diagnostic testing yield no evidence of an organic cause.  Depression might be considered in this group.  In this model these disorder would be referred to as THRESHOLD DISORDERS

In this model of a THRESHOLD DISORDER, the body has a latent, usually hereditary disposition to a neurological reaction (or ” neurological storm” ). When a patient’s threshold is lowered, the body responds with a particular set of symptoms for which there is no organic cause. Stress lowers the threshold as does sleep disorders, hormonal imbalances, and blood sugar problems. These neurological “storms” are episodic and once initiated take on a life of their own. In evaluating symptoms for which there is no apparent organic cause, a physician or researcher may identify an outcome of a normal neurological response, expressed in chemical and tissue changes, and miss the underlying cause.

No doubt “auto-immune” disorders exist, but most likely they are vastly over-diagnosed.

In Ms. O’Rourke’s case, and in apparently in many others, we have the added phenomena of both the positive and negative effect of the internet age. Processing a large amount of information, often emotional in nature, can help us make informed decisions, but it can also create an atmosphere of fear that initiates a “flight or flight” response in the nervous system further complicating the symptomatic picture. The whole idea of the body attacking itself is not exactly reassuring.

Maybe in many cases such chemical approaches such as “gluten-free” diets help because the patient feels more in control, decreasing the state of neurological fear and therefore helping to alleviate symptoms.”

I am planning to write an essay on the proposed model for THRESHOLD DISORDERS. I am also planning to provide a companion essay, online, that goes through Ms. O’Rourke’s essay as I read it and how parts of the essay caused me to respond with a letter to the editor.

I welcome responses and hope that a fuller essay will make the points I am trying to make clearer.  Email:

Arn Strasser DC

2100 NE Broadway, Portland, OR 97232


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