I'm a big tent man and I have bitter experience at the depression-CFS/ME interface.
Confusion of terms and the failure to respect the fact that mental illness can co-occur as PART AND PARCEL of neuroinflammatory conditions - ME or otherwise - leads to those with mental symptoms having their physical condition ignored totally, as happened to me. I was told I had personality difficulties and was unable to adjust to adult life. This conclusion would have been far less likely if the medics had appreciated the physical side and such appreciation would have been more likely if the mental aspects of neuroimmune fatigue were accepted. Hostility to those with mental symptoms AND ME/CFS among some ME diagnosees is galling. It also plays into the hands of those who accuse the ME community of being naive about and hostile to concepts of mental illness. Many of us are infact better informed about the overlap between neurology, immunology and psychology than some supposed experts but this gets lost in heated debate (and pseudo-debate).
We have to be very careful re. judging those with depression and an ME consistent condition, esp. on the basis of media reports. We are still in the land where CFS and ME are political as much as medical terms and until we are treated seriously medically, the terms ME/CFS etc will be bandied about with a curious mix of vagueness and dogmatism in the media, among medics and amongst ourselves, with the potential for needless misdiagnosis of depression and other conditions as ME/CFS or vice versa, and alongside this the disparagement of those genuine ME/CFS sufferers who also have a pronounced mental aspect to their illness.
Bitter personal experience prompts me to reiterate what I have said before re. depressive symptomology in organic neuroimmune states, beyond primary depression. If the unfounded dogma is put about even by vague implication that depression is an exclusion diagnosis for CFS/ME, that those with both are dubious cases etc etc, then those who do have both may be treated for depression, but their physical symptoms will be put down to that depression, when the situation is the reverse, leading o the inadequate treatment of both. Please let's not fall into the trap of cheering while those with organic ME consistent fatigue AND depression get poor treatment from docs who insist it is soley depression.
The more we infact see ME and allied unexplained fatigue states as a regular organic illness the less we will need to dismiss any psychiatric inputs/aspects. Though it does not exclude psychological cause, neuropsychiatric does not mean psychological. If anyone doubts the neuropsychiatric aspect of various neuroimmune conditions they can look up Lyme's, post sarcoidosis, lupus etc. etc. Who is to say that Martine's depression was unconnected with the biology of her condition?
Further psychological stress cannot be dismissed as a co-factor in development of physical illness (not somatoform, but organic responding to organic treatment). Parkinson's is worse under stress, psoriasis can be worsened, etc etc.
Anecdotally I know of at least three people with different non-ME/CFS recognised neuroimmune conditions (two ex medical professionals) who all say that overwork and/or emotional issues pushed them towards, if not into, organic illness. Shall we dismiss them as psychologisers? All of them were eventually diagnosed as organically ill and treated appropriately. The more "normal" our conception of ME/CFS, the more ready we will be to concede that psychological aspects can play a role as in these and other recognised organic conditions.
Of course the psychologisers blame "physicalists" for the politicisation and vagueness of the terms around ME and for fear of psychology/psychiatry. I believe we are not so much afraid of psychology as of naive and dogmatic psychologisers of whatever school of "thought" and until NICE gets its act together this situation may continue - but this should not lead us to be suspicious of anyone who refers to mental illness int he context of suspected ME/allied conditions. The key of course is for more medical professionals themselves to see ME/ME consistent conditions as regular illnesses - to acquaint themselves with the biology, to learn, to investigate, to diagnose thoroughly, rather than equating the challenging and unusual with somatisation. Better informed hacks would help too. As it stands some of the best informed are the patients.
As to Martine, what do we really know? Psychological and behavioural inputs may also have been a major precondition of an organic illness in her case. Recognition of lifelong or acute psycho-behavioural inputs does not negate the organic nature of her illness or mean she was "just" mentally ill with primary depression - unless we of all people are willing to follow the worst ideas of the psychologisers whom we generally hold in contempt:-
"You say you're physically ill. Well you were depressed as a teenager, so that's your diagnosis. Have some pills/go to a therapist. Take more exercise Go away"
Is that what we want to support?
Her depression may have been primary or purely reactive to ME/CFS. The latter is sth many of us are familar with. If it is insisted that she "only" had depression, then we would have to agree with the psychologisers that depression can present as ME, unless she was deliberately feigning her physical symptoms. One line of thought plays into the hands of the psychologisers, the other into those of the absolute dismissers.The line of though that depression and other organic symptoms may play a part in one organic whole, is imo a much more reasonable and pragmatic approach, allowing room for the like sof Martine - and myself.
Many immune related conditions can cause depression, as I've said above. Development of depression may be dependent on genetic and epigenetic factors and if you add in for ME/CFS etc. dysautonomia, gut brain axis, sleep disturbance, low mito function, reactive grief, despair and anxiety + the need to cope when it is the very organ of coping - the brain - which is affected and it is hardly surprising if SOME of us have had depression, while being genuinely organically ill beyond anything that can be labelled purely "mental". and consistent with ME diagnoses.
It is utterly illegitimate to exclude a diagnosis of ME on the basis of the co-occurence of depressive symptoms and even worse to disparage such sufferers.
I am sorry to say the following but if those with mental symptoms do not have "real" ME, who has "real"" ME anyway? No one ever gets tested for specific ME. Well hardly anyone. If you have transverse myelitis, you can get a test. Why not ME? Probably again to some degree, we're back to the question of psychologisers and politics - on the one hand you've got the false illness belief fanatics who don't want us tested for anything beyond their latest palette, and on the other hand it might turn out that many of us with real neuroimmune fatigue states/immunological dysautonomias i.e real organic illness, do not actually have specific ME , however sick we may be, which might be hard to take for those who have been told they have "real" ME, - partly as a pragmatic move to defend them from the pychologisers/doubting family/bullying school"friends" etc. Pragmatically ME might be the best diagnosis we can get, but how valid is it in any of us? I have a whole variety of ME/CFS diagnosis consistent markers, but still do not know if I have any myelitis.
CFS sceptical doctors love this muddle, some good doctors are trying to sort it out , Those who refuse to do proper biology point fingers at muddled thinking while maintaining the muddle by their own in/activity/dogmatism. I suppose it's no wonder many of us stick to ME, but ti causes alot of problems imo.