For those who find every wafting chemical of the urbanized, industrialized world to be more than their bodies can bear, the syndrome known as environmental illness or multiple-chemical sensitivity is as real a medical condition as diabetes or thyroid disease.
But now researchers assert that some, if not all, symptoms of environmental illness, from fatigue to headaches, confusion to nasal congestion, are probably the results of a mental disorder.
In a report being published today in the Journal of the American Medical Association, Dr. Donald W. Black and his colleagues at the University of Iowa College of Medicine, said they found that when they evaluated a group of patients in whom environmental illness has been diagnosed the patients were much more likely to meet the criteria of a current or past psychiatric problem than were a group of normal people selected from the community.
Many of the patients diagnosed with chemical sensitivity syndrome, said Black, were likely to be depressed, anxious, obsessive-compulsive or to display some other mental ailment.
"It's my belief that people diagnosed as having environmental illness in most cases do have something wrong: a garden variety emotional disorder," said Black.
But physicians who insist that environmental illness is real argued that the Iowa study had been naively conceived and sloppily executed.
"I don't think there's ever been a study done comparing healthy community members with a group of patients who suffer from a chronic illness that hasn't found more psychopathology among the patient group," said Dr. Leo Galland, an internist in New York who treats many people with environmental illness. "Being sick tends to make people depressed."
Galland said the study might have been worthwhile had it compared patients diagnosed as having environmental illness with people who suffer from asthma or some other disease considered to be organic by the medical community.
As it is, he said, "the study is a waste of time."
Nobody knows exactly how many people suffer from environmental illness, but the disorder has gained extensive media attention lately and is increasingly being taken seriously by doctors and others.
People with the disease, and the specialists -- called chemical ecologists -- who treat them believe that the condition results when chemicals or substances in the environment or in food disrupt the immune system, leading to nausea, respiratory problems, headaches, dizziness, rashes, fatigue and many other afflictions.
Some people go to extremes to eliminate hostile chemicals from their lives, avoiding newspapers because of the newsprint, shunning deodorants, perfumes and synthetic fabrics, and even lining their homes with aluminum or moving to remote spots where the contemporary, toxic world is less likely to intrude.
But those with the syndrome often do not display the typical signs of an organic disorder.
In contrast to people who suffer from allergies, the bodies of those people diagnosed as having environmental illness may not make antibodies that signal a misguided immune reaction to an external substance. Hence, some doctors have been skeptical of the assertions of the chemical ecologists.
Black, a psychiatrist, admits he began his study on the premise that the syndrome was not a true medical disease.
In the study, Black and two co-workers interviewed a group of 23 people previously diagnosed by chemical ecologists as having the environmental syndrome.
Using standard psychiatric methods, the researchers determined that 15 of the patients, or 65 percent, had symptoms of a mental disorder.
"It's clear just from talking with some of them that they had ordinary depression," he said. "If they were offered standard anti-depression treatments, their symptoms would probably go away very promptly."
When the researchers applied the same interview procedure to 46 community members, 13, or 28 percent, showed signs of psychiatric distress.
Black said he believes a diagnosis of environmental illness or multiple chemical sensitivity can have grave consequences.
"Patients become fanatical about the diagnosis," he said. "Their whole life revolves around the illness, some of them rebuilding their homes according to environmentally 'acceptable' standards, or moving from one part of the country to another."
Critics of the study said that nearly all people with environmental illness had sought psychiatric help, only to find their symptoms lingering, or even getting worse, from anti-depression medication.
Other experts said that even if many of the symptoms of the syndrome are caused by depression or some other mental illness, the depression itself may well have been sparked by toxins in the environment.
"I don't think any psychiatrist can tell me what causes mental illnesses like depression and neurosis," said Dr. Max Costa, professor of environmental medicine and pharmacology at New York University Medical School. "Chemicals can enter the brain and produce toxic effects."