Miranda Hart is getting attacked for writing a book about how she recovered from chronic fatigue and illness by reducing stress in her life and using other techniques to improve her mental and physical wellbeing. Such approaches are pseudoscience, say the critics, who are largely other people with the poorly understood condition known as myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS).
In Hart’s new book, I Haven’t Been Entirely Honest With You, she recounts her worsening health over most of her adult life, with repeated infections and debilitating cycles of pain and fatigue that left doctors stumped. When several years ago, Hart’s fatigue got so bad that she collapsed on the floor and could not get up, she began a quest to learn more about the links between mind and body.
Hart now believes that the initial trigger for her poor health was infection with Lyme disease, caught aged 14 while in the US, as she had a flu-like illness while she was there. She says that this may have led to long-term immune system problems that caused other repeated infections and worsening fatigue, manifesting as ME/CFS. This condition can include a huge range of symptoms but the chief ones are severe fatigue, muscle pains and problems with memory and concentration.
But Hart also believes that the key factor preventing recovery was her stressful lifestyle, coupled with her insistence on keeping going and keeping up appearances – much like the character of her fictional mother in the TV series, Miranda.
Hart says she has now mostly recovered, because of how she has changed her lifestyle and her mindset, which she calls brain rewiring. This includes making time for activities that make her feel happy and relaxed – such as spending time in nature or with supportive friends – and building gentle exercise and movement into her daily life.
It also required Hart to accept the fact she may sometimes get illness symptoms, using distraction techniques to divert her attention elsewhere rather than overly focusing on them. “I had allowed my identity to become almost entirely about my health,” Hart says in her book. “Every fear or irritation towards my physical condition was worsening it.”
Usually, when a celebrity reveals that they have recovered from a severe illness, they get nothing but sympathy and support. Why have things been so different for Hart?
There could be several explanations. Firstly, everything about ME/CFS is surrounded by controversy. There is no medical agreement on what causes it, there are no approved tests for it, and we have very limited treatments. Some doctors think it is really an umbrella term for people with different disease processes going on.
The big issue though is that ME/CFS can be a distressing, debilitating condition with a quarter of those affected housebound or bedbound, according to the NHS medical guidelines body, NICE. Yet medical students get little or no formal training in the condition; many of those affected have to cope with doctors thinking that they are making up their symptoms or imagining them. After years of suffering and disbelief, advice that stress reduction and lifestyle changes could be helpful can seem insulting. People may have previously had to put up with unhelpful advice that they could “snap out of it”.
To be fair to Hart, she is very clear in her book that she believes the symptoms of ME/CFS are as real as those of any other illness. “It’s so very important to make it clear that this is a physical condition,” she says in her book. “ME/CFS, long Covid and others are not anxiety conditions (or cries for help or laziness, as people can still be absurdly labelled).”
Hart believes that in her case, the initial infections combined with other conditions and workload stress led to her brain keeping her immune system on “high alert”, leading to persistent fatigue and other physical symptoms. Tackling that stress was the key to her getting better, although it was a long process with ups and downs along the way.
In fact, most doctors and scientists would agree that stress can cause physical symptoms in the body and that reducing stress can sometimes alleviate those symptoms. There is growing appreciation among scientists that faulty processes in the brain can contribute to illnesses such as those involving pain, fatigue and the immune system – and that targeting these processes can lead to improvements.
To take a few examples of where Hart’s approaches chime with mainstream medical advice, talking therapy is recommended by official NHS guidelines for people with ME/CFS. While it is no cure, such therapy helps some people manage their symptoms and improve functioning. So that’s hardly pseudoscience.
Lifestyle approaches such as gentle exercises and talking therapies are also recommended by the NHS for anyone who has long-term pain, whatever the cause.
There have also been recent advances in targeting the vagus nerve, a network of nerve pathways that let the brain influence inflammation, the immune system, and gut function, among other things.
Electrical stimulators for the vagus nerve are an approved treatment for depression and are being investigated for other illnesses including arthritis and inflammatory bowel disease, conditions with clear physical origins.
There is also a group of related conditions called functional neurological disorders – with symptoms ranging from seizures of unknown origin to inexplicable paralysis – which are thought to be caused by faulty brain processes. Distraction techniques are emerging as the mainstay of treatment for this group of disorders – for instance, trying to name everything in a room that is a certain colour is a recommended technique for stopping this kind of seizure. Hart’s approach of spotting everything in a room that is a nice colour sounds similar, but with a “Miranda” twist.
It’s true that the book does contain a few scientific claims that could be described as dodgy. For instance, she cites work by deceased Japanese author, Dr Masaru Emoto, who claimed that human consciousness could affect the molecular structure of water and even make rice go mouldy. Needless to say, Dr Emoto’s work has since been discredited. It would be a shame if this small detour detracts from Hart’s descriptions of using legitimate NHS-endorsed approaches.
The criticisms of Hart are therefore unfair. It is concerning, too, that she is not the only person with ME/CFS to have had an online kicking for saying psychological factors may have played a role in their health. Earlier this month a gardening writer was accused on X of “harming” the ME community for saying in The Guardian that striving to get outside in her garden had given her hope and a sense of purpose.
The maligning of Hart, given her high-profile status, is in many ways shining a spotlight on a concerning aspect of the online communities for people with ME/CFS. This is that while they may be helpful for people struggling with uncaring or uninformed doctors, they can be unsupportive for those who have found benefit from stress reduction and other mind-body techniques.
Indeed, Hart has explicitly said that she just wants to spread the word that she personally found the techniques in question helpful, but she is not claiming that everyone with ME/CFS should follow her example. “It happened to improve my physiology, it might for some, it may not for others,” she said on Instagram last week.
Given that ME/CFS is such a debilitating condition, with so few treatment options, isn’t anything that gives a chance of recovery worth hearing about?
Clare Wilson is science writer at the i paper. She was previously a reporter for New Scientist, specialising in medicine and life sciences
