ABOUT THE SPEAKER
Jennifer Brea - Filmmaker
Jennifer Brea was a PhD student at Harvard when, one night, she found she couldn't write her own name.

Why you should listen

Over the following months, while doctors insisted her condition was psychosomatic, Brea became bedridden. She started filming herself and the community that she discovered online, collecting the first footage of what would become a feature documentary about myalgic encephalomyelitis (ME), often referred to as chronic fatigue syndrome. The film, Unrest, which will premiere at the 2017 Sundance Film Festival, tells Jen's story as well as the stories of four other patients living with ME.

Brea is also the founder of #MEAction, an online organizing platform for ME patients around the world, many of whom cannot leave their homes.

More profile about the speaker
Jennifer Brea | Speaker | TED.com
TEDSummit

Jennifer Brea: What happens when you have a disease doctors can't diagnose

Filmed:
2,042,782 views

Five years ago, TED Fellow Jennifer Brea became progressively ill with myalgic encephalomyelitis, commonly known as chronic fatigue syndrome, a debilitating illness that severely impairs normal activities and on bad days makes even the rustling of bed sheets unbearable. In this poignant talk, Brea describes the obstacles she's encountered in seeking treatment for her condition, whose root causes and physical effects we don't fully understand, as well as her mission to document through film the lives of patients that medicine struggles to treat.
- Filmmaker
Jennifer Brea was a PhD student at Harvard when, one night, she found she couldn't write her own name. Full bio

Double-click the English transcript below to play the video.

00:17
Hi.
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Thank you.
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[Jennifer Brea is sound-sensitive.
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The live audience was asked
to applaud ASL-style, in silence.]
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So, five years ago, this was me.
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I was a PhD student at Harvard,
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and I loved to travel.
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I had just gotten engaged
to marry the love of my life.
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I was 28, and like so many of us
when we are in good health,
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I felt like I was invincible.
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Then one day I had
a fever of 104.7 degrees.
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I probably should have gone to the doctor,
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but I'd never really been sick in my life,
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and I knew that usually,
if you have a virus,
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you stay home and you make
some chicken soup,
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01:00
and in a few days,
everything will be fine.
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But this time it wasn't fine.
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After the fever broke,
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for three weeks I was so dizzy,
I couldn't leave my house.
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I would walk straight into door frames.
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I had to hug the walls
just to make it to the bathroom.
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That spring I got infection
after infection,
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and every time I went to the doctor,
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he said there was absolutely
nothing wrong.
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He had his laboratory tests,
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which always came back normal.
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All I had were my symptoms,
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which I could describe,
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but no one else can see.
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I know it sounds silly,
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but you have to find a way
to explain things like this to yourself,
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and so I thought maybe I was just aging.
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Maybe this is what it's like
to be on the other side of 25.
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(Laughter)
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Then the neurological symptoms started.
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Sometimes I would find that I couldn't
draw the right side of a circle.
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Other times I wouldn't be able
to speak or move at all.
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I saw every kind of specialist:
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infectious disease doctors,
dermatologists, endocrinologists,
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cardiologists.
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I even saw a psychiatrist.
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My psychiatrist said,
"It's clear you're really sick,
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but not with anything psychiatric.
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I hope they can find out
what's wrong with you."
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The next day, my neurologist
diagnosed me with conversion disorder.
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He told me that everything --
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the fevers, the sore throats,
the sinus infection,
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all of the gastrointestinal,
neurological and cardiac symptoms --
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were being caused
by some distant emotional trauma
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that I could not remember.
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The symptoms were real, he said,
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but they had no biological cause.
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I was training to be a social scientist.
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I had studied statistics,
probability theory,
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mathematical modeling,
experimental design.
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I felt like I couldn't just reject
my neurologist's diagnosis.
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It didn't feel true,
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but I knew from my training
that the truth is often counterintuitive,
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so easily obscured
by what we want to believe.
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So I had to consider the possibility
that he was right.
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That day, I ran a small experiment.
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I walked back the two miles
from my neurologist's office to my house,
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my legs wrapped in this strange,
almost electric kind of pain.
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I meditated on that pain,
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contemplating how my mind
could have possibly generated all this.
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As soon as I walked through the door,
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I collapsed.
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My brain and my spinal cord were burning.
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My neck was so stiff
I couldn't touch my chin to my chest,
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and the slightest sound --
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the rustling of the sheets,
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my husband walking barefoot
in the next room --
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could cause excruciating pain.
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I would spend most
of the next two years in bed.
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How could my doctor
have gotten it so wrong?
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I thought I had a rare disease,
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something doctors had never seen.
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And then I went online
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and found thousands of people
all over the world
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living with the same symptoms,
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similarly isolated,
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similarly disbelieved.
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Some could still work,
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but had to spend their evenings
and weekends in bed,
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just so they could show up
the next Monday.
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On the other end of the spectrum,
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some were so sick
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they had to live in complete darkness,
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unable to tolerate
the sound of a human voice
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or the touch of a loved one.
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I was diagnosed
with myalgic encephalomyelitis.
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You've probably heard it called
"chronic fatigue syndrome."
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For decades, that's a name
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that's meant that this
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has been the dominant image
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of a disease that can be
as serious as this.
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The key symptom we all share
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is that whenever we exert ourselves --
physically, mentally --
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we pay and we pay hard.
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If my husband goes for a run,
he might be sore for a couple of days.
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If I try to walk half a block,
I might be bedridden for a week.
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It is a perfect custom prison.
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I know ballet dancers who can't dance,
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accountants who can't add,
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medical students who never became doctors.
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It doesn't matter what you once were;
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you can't do it anymore.
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It's been four years,
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and I've still never been as well as I was
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the minute before I walked home
from my neurologist's office.
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It's estimated that about 15 to 30 million
people around the world
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have this disease.
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In the US, where I'm from,
it's about one million people.
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That makes it roughly twice as common
as multiple sclerosis.
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Patients can live for decades
with the physical function
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of someone with congestive heart failure.
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Twenty-five percent of us
are homebound or bedridden,
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and 75 to 85 percent of us
can't even work part-time.
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Yet doctors do not treat us
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and science does not study us.
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How could a disease this common
and this devastating
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have been forgotten by medicine?
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When my doctor diagnosed me
with conversion disorder,
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he was invoking a lineage
of ideas about women's bodies
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that are over 2,500 years old.
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The Roman physician Galen thought
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that hysteria was caused
by sexual deprivation
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in particularly passionate women.
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The Greeks thought the uterus
would literally dry up
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and wander around the body
in search of moisture,
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pressing on internal organs --
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yes --
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causing symptoms from extreme emotions
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to dizziness and paralysis.
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The cure was marriage and motherhood.
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These ideas went largely unchanged
for several millennia until the 1880s,
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when neurologists tried to modernize
the theory of hysteria.
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Sigmund Freud developed a theory
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that the unconscious mind
could produce physical symptoms
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when dealing with memories or emotions
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too painful for the conscious
mind to handle.
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It converted these emotions
into physical symptoms.
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This meant that men
could now get hysteria,
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but of course women were still
the most susceptible.
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When I began investigating
the history of my own disease,
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I was amazed to find how deep
these ideas still run.
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In 1934,
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198 doctors, nurses and staff
at the Los Angeles County General Hospital
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became seriously ill.
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They had muscle weakness, stiffness
in the neck and back, fevers --
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all of the same symptoms
I had when I first got diagnosed.
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Doctors thought
it was a new form of polio.
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Since then, there have been more
than 70 outbreaks documented
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around the world,
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of a strikingly similar
post-infectious disease.
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All of these outbreaks have tended
to disproportionately affect women,
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and in time, when doctors failed to find
the one cause of the disease,
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they thought that these outbreaks
were mass hysteria.
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Why has this idea had such staying power?
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I do think it has to do with sexism,
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but I also think that fundamentally,
doctors want to help.
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They want to know the answer,
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and this category allows doctors to treat
what would otherwise be untreatable,
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to explain illnesses
that have no explanation.
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The problem is that this
can cause real harm.
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In the 1950s, a psychiatrist
named Eliot Slater
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studied a cohort of 85 patients
who had been diagnosed with hysteria.
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Nine years later, 12 of them were dead
and 30 had become disabled.
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Many had undiagnosed conditions
like multiple sclerosis,
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epilepsy, brain tumors.
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In 1980, hysteria was officially
renamed "conversion disorder."
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When my neurologist gave me
that diagnosis in 2012,
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he was echoing Freud's words verbatim,
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and even today,
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women are 2 to 10 times more likely
to receive that diagnosis.
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The problem with the theory of hysteria
or psychogenic illness
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is that it can never be proven.
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It is by definition
the absence of evidence,
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and in the case of ME,
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psychological explanations
have held back biological research.
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All around the world, ME is one
of the least funded diseases.
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In the US, we spend each year
roughly 2,500 dollars per AIDS patient,
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250 dollars per MS patient
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and just 5 dollars per year
per ME patient.
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This was not just lightning.
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I was not just unlucky.
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The ignorance surrounding my disease
has been a choice,
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a choice made by the institutions
that were supposed to protect us.
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We don't know why ME
sometimes runs in families,
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why you can get it
after almost any infection,
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from enteroviruses
to Epstein-Barr virus to Q fever,
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or why it affects women
at two to three times the rate of men.
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This issue is much bigger
than just my disease.
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When I first got sick,
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old friends were reaching out to me.
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I soon found myself a part
of a cohort of women in their late 20s
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whose bodies were falling apart.
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What was striking was just how
much trouble we were having
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being taken seriously.
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I learned of one woman with scleroderma,
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an autoimmune connective tissue disease,
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who was told for years
that it was all in her head.
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Between the time of onset and diagnosis,
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her esophagus was so thoroughly damaged,
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she will never be able to eat again.
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Another woman with ovarian cancer,
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who for years was told
that it was just early menopause.
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A friend from college,
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whose brain tumor was misdiagnosed
for years as anxiety.
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Here's why this worries me:
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since the 1950s, rates of many
autoimmune diseases
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have doubled to tripled.
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Forty-five percent of patients
who are eventually diagnosed
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with a recognized autoimmune disease
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are initially told they're hypochondriacs.
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Like the hysteria of old,
this has everything to do with gender
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and with whose stories we believe.
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Seventy-five percent
of autoimmune disease patients are women,
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and in some diseases,
it's as high as 90 percent.
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Even though these diseases
disproportionately affect women,
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they are not women's diseases.
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ME affects children
and ME affects millions of men.
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And as one patient told me,
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we get it coming and going --
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if you're a woman, you're told
you're exaggerating your symptoms,
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but if you're a guy, you're told
to be strong, to buck up.
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And men may even have
a more difficult time getting diagnosed.
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My brain is not what it used to be.
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Here's the good part:
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despite everything, I still have hope.
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So many diseases were once
thought of as psychological
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until science uncovered
their biological mechanisms.
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Patients with epilepsy
could be forcibly institutionalized
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until the EEG was able to measure
abnormal electrical activity in the brain.
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Multiple sclerosis could be misdiagnosed
as hysterical paralysis
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until the CAT scan and the MRI
discovered brain lesions.
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And recently, we used to think
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that stomach ulcers
were just caused by stress,
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until we discovered
that H. pylori was the culprit.
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ME has never benefited
from the kind of science
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that other diseases have had,
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but that's starting to change.
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In Germany, scientists are starting
to find evidence of autoimmunity,
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and in Japan, of brain inflammation.
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In the US, scientists at Stanford
are finding abnormalities
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in energy metabolism
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that are 16 standard deviations
away from normal.
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And in Norway, researchers
are running a phase-3 clinical trial
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on a cancer drug that in some patients
causes complete remission.
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What also gives me hope
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is the resilience of patients.
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Online we came together,
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and we shared our stories.
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We devoured what research there was.
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We experimented on ourselves.
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We became our own scientists
and our own doctors
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because we had to be.
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And slowly I added five percent here,
five percent there,
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until eventually, on a good day,
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I was able to leave my home.
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I still had to make ridiculous choices:
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Will I sit in the garden for 15 minutes,
or will I wash my hair today?
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But it gave me hope
that I could be treated.
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I had a sick body; that was all.
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And with the right kind of help,
maybe one day I could get better.
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I came together with patients
around the world,
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and we started to fight.
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We have filled the void
with something wonderful,
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but it is not enough.
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1492
14:40
I still don't know if I will ever
be able to run again,
269
868662
4037
14:44
or walk at any distance,
270
872723
1897
14:46
or do any of those kinetic things
that I now only get to do in my dreams.
271
874644
3909
14:51
But I am so grateful
for how far I have come.
272
879143
3090
14:55
Progress is slow,
273
883955
1485
14:57
and it is up
274
885464
1292
14:59
and it is down,
275
887310
1256
15:01
but I am getting a little better each day.
276
889222
2913
15:06
I remember what it was like
when I was stuck in that bedroom,
277
894013
3919
15:10
when it had been months
since I had seen the sun.
278
898548
2948
15:15
I thought that I would die there.
279
903226
2088
15:18
But here I am today,
280
906961
1567
15:21
with you,
281
909255
1282
15:23
and that is a miracle.
282
911513
2061
15:28
I don't know what would have happened
had I not been one of the lucky ones,
283
916606
3619
15:32
had I gotten sick before the internet,
284
920377
2177
15:34
had I not found my community.
285
922995
1974
15:37
I probably would have already
taken my own life,
286
925777
2728
15:41
as so many others have done.
287
929028
1907
15:44
How many lives could
we have saved, decades ago,
288
932094
3224
15:47
if we had asked the right questions?
289
935957
1903
15:50
How many lives could we save today
290
938626
2149
15:53
if we decide to make a real start?
291
941592
2162
15:57
Even once the true cause
of my disease is discovered,
292
945205
3043
16:00
if we don't change
our institutions and our culture,
293
948881
3475
16:04
we will do this again to another disease.
294
952380
2376
16:07
Living with this illness has taught me
295
955658
1994
16:09
that science and medicine
are profoundly human endeavors.
296
957676
2928
16:13
Doctors, scientists and policy makers
297
961153
2591
16:15
are not immune to the same biases
298
963768
2887
16:19
that affect all of us.
299
967568
1579
16:23
We need to think in more nuanced ways
about women's health.
300
971377
3052
16:27
Our immune systems are just as much
a battleground for equality
301
975119
4102
16:31
as the rest of our bodies.
302
979245
1582
16:33
We need to listen to patients' stories,
303
981253
2344
16:36
and we need to be willing
to say, "I don't know."
304
984542
2565
16:40
"I don't know" is a beautiful thing.
305
988024
2352
16:43
"I don't know" is where discovery starts.
306
991235
2592
16:47
And if we can do that,
307
995365
1422
16:49
if we can approach the great vastness
of all that we do not know,
308
997447
3695
16:53
and then, rather than fear uncertainty,
309
1001166
1952
16:55
maybe we can greet it
with a sense of wonder.
310
1003142
2511
16:58
Thank you.
311
1006342
1351
17:04
Thank you.
312
1012096
1240

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ABOUT THE SPEAKER
Jennifer Brea - Filmmaker
Jennifer Brea was a PhD student at Harvard when, one night, she found she couldn't write her own name.

Why you should listen

Over the following months, while doctors insisted her condition was psychosomatic, Brea became bedridden. She started filming herself and the community that she discovered online, collecting the first footage of what would become a feature documentary about myalgic encephalomyelitis (ME), often referred to as chronic fatigue syndrome. The film, Unrest, which will premiere at the 2017 Sundance Film Festival, tells Jen's story as well as the stories of four other patients living with ME.

Brea is also the founder of #MEAction, an online organizing platform for ME patients around the world, many of whom cannot leave their homes.

More profile about the speaker
Jennifer Brea | Speaker | TED.com

Data provided by TED.

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