September/October 1998

Special - Letter to the Editor JAMA, referencing the neuropsychiatric symptoms of Lyme disease.

August 1998


A co-worker said she was having some weird symptoms. Several months later, she complained of numbness, sharp pains, etc. Her doctor diagnosed her with the usual-carpal tunnel, "nerves," etc. Her mental status started going downhill. She had many of the same symptoms I have with Lyme disease. I kept telling her to go back to her doctor. Then headaches started, and they stayed. Another doctor did a CAT scan and an MRI of her head which revealed a tumor. She had a year to live. She never had an objective symptom. I saw alot of things, why couldn't her doctor? Others thought her symptoms were from "stress." They wanted her to see a counsellor. It made me cry. In the end, she could hardly sit up in her chair. She would sit sort of hunched over, like she was falling foreward. I am not an alarmist, but why assume something is stress? Why are so many medical people looking for "objective" signs when so many things obviously do not have objective signs? Why do tumors and Lyme do the same thing?

I also wanted to comment on the treatment of depression with Lyme. I didn't know that your body worked that way. It makes sense now to treat the depression so that your body can work on the disease itself. Could this mean that a person could be depressed first, didn't know it, and that is why their body could not fight the disease, or any other disease for that matter?


This is a sad, but appropiate case to emphasize the subjective/objective issue.

Brain tumors are sometimes a very difficult diagnosis, particularly when they present with cognitive or psychiatric symptoms. In one such case, the presenting symptom was-"I looked at my family doctor and his face changed to something that looked like a combination of Perer Lorrie and Raymond Massey." Eventually a temporal lobe tumor was found.

In another case, the only complaint was that it was taking longer and longer to complete his work. The cause was lung cancer metastasized to the parietal lobe. Another patient with depression, mood swings, subtle cognitive impairment, and decreased judgement had a frontal lobe tumor.

The diagnosis of problems like these require a knowledge of both psychiatry and general medicine, and even then, medicine is still an imperfect science. There has been both panic from over diagnosis, and tragedies from under diagnosis. Sir William Osler, the father of American medicine, once stated-"If you listen long enough, the patient will give you the diagnosis."

A critical point is that subjective symptoms, even when considered bizarre, diffuse, and non-specific should be adequately explained. It is an error to label anything not proven by a test as "psychosomatic"or malingering. Psychosomatic illness is never a diagnosis of exclusion, instead it follows very clear, life long patterns in a person's life.

There is currently a strong pressure in medicine to prove everything with some type of laboratory test. When reliable tests do not exist, we need to resort to the more basic skill of a thorough history, a thorough exam, and sound clinical judgement. In regard to the depression issue, there is alot of interesting research in this area recently. The conclusion is- treating depression significantly improves physical health. Some of the areas studied most include AIDS, gynecological cancers, and cardiac disease. In short, stress pre-empts other bodily functions such as the ability to fight disease.

Robert Bransfield MD


The diagnosis and treatment of any medical and / or psychiatric disorders requires trained medical professionals. The information provided is to be used for educational purposes only. It should not be used as a substitute for seeking professional care for the diagnosis and / or treatment for any medical and / or psychiatric disorder.