Environmental Illness and Patients With Multiple Unexplained Symptoms

To the Editor.  —The excellent studies on "Environmental Illness"¹ and "Patients With Multiple Unexplained Symptoms"² in the January 1986 issue of the Archives highlights some similarities between these two groups. Both groups consist mainly of early middle-aged women with long histories of feeling unwell. They usually associate the onset of ill-health with a precipitating factor: either an emotionally charged event, or exposure to an environmental "toxic" substance. Both groups tend to have multiple vague symptoms without obvious medical causes, and are frequent visitors to doctors' offices, consuming a disproportionate amount of health care time, investigation, and money. For both groups, illness is a life-style, but while one is in search of a diagnosis, the other has found it! Judging from the histories of many patients with "environmental illness," they seem to be graduates from the group of patients with "multiple unexplained symptoms."³We recently evaluated³ a