Description
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
