Talk:Da Costa's syndrome/Archive 1

Remade
Remade the article - No copyright material this time.

Banfield
The section on "posture" isn't working for me. Nobody outside of the The theory looks like it was created by a non-medical person who is trying to reinvent the wheel -- the "wheel" being garden variety orthostatic intolerance and hyperventilation syndrome. I'd like to remove the last few paragraphs of the "History" section, beginning from the words "From 1982-1983..." Does anyone here -- that is, anyone here except Banfield, who has a clear conflict of interest in judging the merits and notability of his own work -- object? WhatamIdoing 01:08, 21 December 2007 (UTC)
 * No objection here. Nothing I can find in real medical literature sugests it merits such undue space, and I agree about the COI of his expounding anything to do with his own theory in this article. I've posted a note to that effect at User talk:Posturewriter; if necessary, it can go to WP:COI/N. Gordonofcartoon (talk) 02:16, 21 December 2007 (UTC)

I agree with occupying undue space and will be happy to abbreviate my theory to one paragraph of plain text if required. I was attempting to highlight the distinguishing symptoms and the multiple factors relating to chest compression.

However please consider the following; When I first looked at the Da Costa’s syndrome page I found that it was started on 15th May 06, and after 18 months there were only 11 contributions from 5 authors who provided only four lines of text, 8 links and no references, with a wikipedia note requesting help to expand the article. Since I made my first entry only 14 days ago, 75 lines of text in six subdivisions have been added with contributions from 50 additional edits, 18 by myself, and 32 by 5 additional authors, and I have outlined the history of the subject with 6 impeccable references, and other editors have contributed an additional 7 references, and there are now 20 additional links from several authors. Please also consider that Da Costa’s syndrome is a distinct entity in so far as “it is because these symptoms and signs are largely, and sometimes wholly, the exaggerated physiological responses to exercise. . . that I term the whole ‘the effort syndrome’ “ (T.Lewis 1919) since referred to as a synonym for the ailment. With regard to orthostatic intolerance the triggers for symptoms appear to be different and there is no mention of chest pains, particularly, and, most commonly in the left inframammary area. That pain is a defining essential in Da Costa Syndrome history, and dysautonomia doesn’t account for it’s location, or why most ot the pains are asymmetric. However I have suggested how persistent postural compression of the chest produces all of the symptoms of Da Costa’s syndrome, including chronic orthostatic hypotension, and intolerance, in relation to faintness and fatigue.

In regard to the hyperventilation syndrome the set of symptoms is similar but different, and the cause is excess oxygen consumption and “Most cases are caused by anxiety or stress”, whereas in Da Costa’s syndrome the cause is low oxygen consumption, hypoventilation, during exhausting work such as running. As you may appreciate it has been quite difficult to make these distinctions when so many similar symptoms and syndromes overlap. I respect the observations of Da Costa, and the principles of wikipedia, and appreciate your need for authoritative references, which is why I have used them in constructing and evaluating my ideas, and provided them for consideration. posturewriter —Preceding unsigned comment added by Posturewriter (talk • contribs) 07:27, 22 December 2007 (UTC)


 * Max, I apologize if my previous comments weren't clear. I don't want your made-up theory shortened; I want it removed entirely from this article.  Wikipedia is not a reasonable place for promoting our pet theories.  When a physician's group or a peer-reviewed scientific journal publishes your theory, then I'd be happy to include it.  So far, however, the medical communities response has basically been resounding indifference, with a side order of rude remarks about your ignorance, and that means that your pet theory is not notable enough to justify even half a sentence on Wikipedia.  WhatamIdoing (talk) 18:42, 27 December 2007 (UTC)
 * I agree, and am removing it. And we also generally need to summarise the 'case history' material (the "35% had symptoms, 38.3% had mild disability, and 15% had severe disability" kind of thing). This is an encyclopedia article for general readership, not a med journal literature surrvey.


 * I've also posted it to WP:COI/N. Gordonofcartoon (talk) 01:05, 29 December 2007 (UTC)

WhatamIdoing, thank you for your courtesy. I understand that wikipedia verification policy allows a person to present a reasonably arranged set of facts, so long as each of them can be independently verified from multiple quality sources, and in some cases the contributor needs to provide exceptional sources of the highest quality, for the editors to consider. I have therefore added to the after 1950 history section with an extract from an exemplary source : The reference details are: Paul Wood, O.B.E. (revised edition 1956) Diseases of the Heart and Circulation, Eyre & Spottiswoode, London p.937-947. . . Paul Wood, O.B.E., was Director, Institute of Cardiology, London. Regarding the research relating to the fitness programme at the SA Fitness Institute, the training programme was designed on the basis that the volunteers would participate in a programme if they were able to stay within their limits and improve at their own rate. That study verifiably predates the modern methods of treating CFS which include G.E.T. (graduated exercise training), and pacing, which I would like you to consider in relation to notability. Posturewriter (talk)posturewriter —Preceding comment was added at 01:56, 29 December 2007 (UTC)
 * I understand that wikipedia verification policy allows a person to present a reasonably arranged set of facts, so long as each of them can be independently verified from multiple quality sources
 * No. Only if the picture presented by that arrangement is generally agreed not to be a novel interpretation of those facts. Otherwise, it amounts to WP:SYNTH - "Synthesis of published material serving to advance a position". Gordonofcartoon (talk) 12:59, 29 December 2007 (UTC)

Gordonofcartoon, I appreciate your comments and have amended the history 1982-2007 accordingly. The concept of training within limits may have been novel in the 1982 IFRT programme but it is now common practice in "pacing", which has been favorably reviewed in appropriate medical journals, and I have added a scanned copy of one of the newspaper article jpegs to my website ref.16 for verification of the project. Please also note the difference between DaCosta's exertion related symptoms and those of other types of CFS, re; your 'to do' list - Charles Wooley's Diseases of Yesteryear, Circulation, May 1976 p.749, para.2 Posturewriter (talk) posturewriter —Preceding comment was added at 00:31, 14 January 2008 (UTC)

I'm going to go read WP:CIVIL now
Posturewriter, did you "forget" that promoting your own non-notable research ideas constitutes a conflict of interest, or were you just hoping that no one would notice when you added all that information again? The guideline is that a theory needs to have "received significant coverage in reliable sources that are independent of the subject." Until you can produce '"significant" coverage in "reliable" and "independent" sources, your pet theory is not notable enough to justify any space at all in this article.

I'd like to point out as well that this article is on my daily watchlist, and I suspect that it's on several other editors' lists for the same reason. I think you can rely on me promptly noticing future attempts to use this article to promote your theory. (I do appreciate your other efforts, but you need to quit adding your own research theories to this article.) WhatamIdoing (talk) 01:49, 14 January 2008 (UTC)

WP:SYNTH?
I'm not comfortable with the current development of the article. While the explicit Banfield material has been removed, it seems to me that the citations and case material added since have a distinct focus on chest compression, breathing, breathlessness, the diaphragm etc, that smells of WP:SYNTH slanting the whole picture toward the Banfield theory. Gordonofcartoon (talk) 17:38, 8 February 2008 (UTC)


 * Yes, I share these concerns.


 * Additionally, I'm unconvinced that Wikipedia benefits from a blow-by-blow account of nearly every paper that mentions it in passing. I've been thinking the last couple of weeks that at least three-quarters of the history section should be removed (as an issue of undue weight).


 * Posturewriter, why don't you put all this up on your own website? It would be a more appropriate home for such specialized material. WhatamIdoing (talk) 20:34, 8 February 2008 (UTC)
 * As I said above, it's meant to be an encyclopedia article for the general reader, not an exhaustive academic literature survey. Liposuction time? Gordonofcartoon (talk) 20:51, 8 February 2008 (UTC)


 * I believe that you're right. I'm thinking that the history section should be about three short paragraphs and should name the major players and their own made-up names, but not give much, if any, information about the actual studies (which should be properly ref'd if anyone wants to read more).  Does that sound WP:DUE to you?  WhatamIdoing (talk) 23:17, 9 February 2008 (UTC)
 * Definitely. I've just cut another 6000-character essay. Gordonofcartoon (talk) 13:27, 10 February 2008 (UTC)


 * I'm making a start. I just want to make a note here that some of what I'm deleting does not belong in this section because it's a textbook-perfect description of hyperventilation syndrome.  WhatamIdoing (talk) 20:56, 10 February 2008 (UTC)

I just removed the Rosen section as WP:SYNTH. The full text of the article is available online here and it refers to "the effort syndrome caused by chronic habitual hyperventilation" - i.e. hyperventilation syndrome - not "effort syndrome" as in Da Costa, and bundling it with other studies to focus on the breathing aspect looks definite WP:SYNTH. Gordonofcartoon (talk) 13:17, 23 March 2008 (UTC)

Gordonofcartoon; regarding your deletion of my review of Rosen’s study on the grounds that it refers to the effort syndrome caused by chronic habitual hyperventilation rather than the actual “Effort Syndrome”, I refer you to your online reference paragraph 2 page 761 here where he uses the term synonymously with the expression “chronic habitual hyperventilation or effort syndrome” which he supports with citations 9-15 on page 764, one of which is entitled “The aetiology of effort syndrome” dated 1938, and two of which were on the synonymous subject of Irritable Heart by Sir Thomas Lewis, who, as you are aware, coined the term “Effort Syndrome” because of his study which showed that the symptoms often occur exclusively in response to exertion. Rosen’s article is also useful to the history of the subject because it refers to the similarity with the symptoms of modern chronic fatigue syndrome, myalgic encephalomyeltis, and postviral syndromes. Regarding the deletion on the grounds of synthesis; my actual reasons for reviewing this subject related to WhatamIdoings most recent explanation on this discussion page. He says that he deleted much of my review of Oglesby’s 1987 article on Da Costa’s Syndrome, because, in his opinion, it did not belong here because it was a description of the Hyperventilation Syndrome. I therefore reviewed the medical literature to find Rosen’s study which discusses hyperventilation as a possible cause of the Effort Syndrome, and two others which shed doubt on it, so I wrote brief reviews and grouped them together on the article page in chronological order to include in the gap in the history of research between 1980 and 2008. I also commented on S.Wolf’s research of 1947 because he found that abnormal function of the thoracic diaphragm was responsible for the breathlessness. I am therefore replacing the article because Rosen did use the term effort syndrome synonymously, and I was not synthesising anything of my own initiative but was responding to someone else’s idea.Posturewriter (talk) 08:32, 24 March 2008 (UTC)posturewriter
 * I'll leave it for now - see what others think - but as I said above, everything you add spins the subject toward a focus on breathing, breathlessness, the diaphragm etc - funnily enough, coinciding with the Banfield theory. Apart from that, this article needs pruning, not expanding: how many times has it been said that this is meant to be an encyclopedia entry for the general reader, not a treatise? Gordonofcartoon (talk) 11:15, 24 March 2008 (UTC)

Proposed page move
Currently, the ICD-10 names several conditions as somatoform autonomic dysfunctions. Da Costa is one of them. What do you think about moving this page to Somatoform autonomic dysfunction and giving each sub-type/named condition its own subsection on the page? It removes some of the WP:SYNTH concerns in declaring Da Costa to be the same as the others. WhatamIdoing (talk) 20:43, 24 March 2008 (UTC)

Rather than be criticised here, I will do some criticising of my own to give good reasons for not moving the page.

1. In 1951 Paul Wood described 6 “cardinal symptoms” of Da Costa’s Syndrome which includes breathlessness which affects 93% of patients, making it the major symptom. It is relevant to give the appropriate amount of weight to the research into that symptom without anyone making any accusations of synthesis for anyone of a hundred different theories on the subject, including Whatamydoing's, and Gordonofcartoon repeated references to hyperventilation. I note that they are not accusing themselves of synthesis of anything!

2. On this discussion page on 10-2-08 Whatamydoing has criticised my review of Oglesby’s Harvard study of Da Costa’s Syndrome by arguing that he is deleting most of it on the grounds that it “does not belong in this section because it's a textbook-perfect description of hyperventilation syndrome.”. . . and on the next sentence dated 23-3-08 Gordonofcartoon criticises my review of Rosen’s study by stating that Rosen was discussing “hyperventilation syndrome - not "effort syndrome" as in Da Costa” My two critics are contradicting each other.

3. When Gordonofcartoon deleted my Rosen study he quoted Rosen from paragraph one “"the effort syndrome caused by chronic habitual hyperventilation" and then he, Gordonofcartoon, argues that Rosen is referring to hyperventilation syndrome, and not the "effort syndrome" as in Da Costa, which indicates that he, Gordonofcartoon, did not read the full article, or the references on page 764, and in fact, he did not even bother to read paragraph 2 where it states “The disability and the habitual hyperventilation or effort syndrome”.here That sentence also ends with citations to the reference section that lists DaCosta related research. I would like to be euphemistic by saying that is not an example of top quality editing.

4. At 8:43 p. m. on 24-3-08 in his most recent comment WhatamIdoing asks “What do you think about moving this page to Somatoform autonomic dysfunction. . . Why don’t you ask Gordonofcartoon who, at 11:15 a.m. on the same day, in the sentence immediately above, criticises me with the argument “how many times has it been said that this is meant to be an encyclopedia entry for the general reader”. Might I say, it is not a place for esoteric jargon.

5. If any editors wish to use jargon which the general wikipedia reader is unlikely to understand, could you please do so on a page which is devoted to the relevant audience, or submit your ideas to the appropriate academic journals. In the meantime can you stop editing this page and leave it to me to present a coherent account of the history of research into this subject, in clear chronological order, written in plain English. Any editors who are willing to assist me constructively in that regard will be appreciated. I assume that is consistent with wikipedia's fundamental policy of democratic compilation and distribution of knowledge to the whole of society.Posturewriter (talk)posturewriter —Preceding comment was added at 09:08, 25 March 2008 (UTC)
 * See WP:OWN. Alternatively, you could consider WP:COI and WP:SOAP. As you have a clear conflict of interest in this topic area, it is you, if anyone, who should be taking a back seat. Gordonofcartoon (talk) 10:15, 25 March 2008 (UTC)

My proposal for the page move is based entirely on our official naming guidelines, which say that "The article title should be the scientific or recognised medical name rather than the lay term or a historical eponym that has been superseded." The current ICD-10 code is F45.3: Somatoform autonomic dysfunction.

I actually thought you'd be happy about this, because the ICD-10 organization gives you an ironclad excuse to put Da Costa's syndrome, cardiac neurosis, gastric neurosis, and neurocirculatory asthenia in the same article. WhatamIdoing (talk) 19:19, 25 March 2008 (UTC)

WhatamIdoing; You have impressive skills with language, and a considerable knowledge of wiki policies. My concerns are with the cavalier expressions you use on this discussion page, when referring to me or my ideas, and with the fact that each time I comply with a policy you add another version of it, or often a completely different policy, in a manner which seems reasonable on the surface, but also appears selective, to suit your purposes (not wiki’s) with the “excuse” (to use your word), that there is some fault in my contributions. You also don’t respond to my criticisms of you. You now refer to another policy regarding “naming requirements” in relation to a page (which was given the title by someone else) which has been used in wikipedia for nearly 2 years, which you want to move into a completely new one entitled “somatoform autonomic dysfunction”. I have viewed the guidelines where there are relavent policies (which you can select from) in our official naming guidelines, which require wikipedia to be written in plain English so that everyone can understand it. Jargon is more appropriate for academic journals which are readable, but only by people who are familiar with it. I also don’t need a new page to give myself an “excuse” (to use your word) to include synonyms, or related conditions, because I can provide them here with the appropriate citations. I think that the page title ‘Da Costa’s Syndrome’ is appropriate because it gives respect to the person who identified it, and someone else, (who was not me), gave a section of the page the title of ‘History’. That section provides a place for all of the evidence and labels to be added chronologically, by anyone, (not just me), so instead of deleting the aspects of my contributions which you don’t agree with, (by describing it as synthesis to justify removing it), you can present your evidence with a brief, concise paragraph on the subject of “somatoform autonomic dysfuntion”. If you think it is too complicated and deserves it’s own space then you can set up a page for that specific purpose without moving this one. You might also consider that you and other editors have used several modern labels, and that they change from one year to another, whereas history is consistent.Posturewriter (talk)posturewriter —Preceding comment was added at 08:03, 27 March 2008 (UTC)
 * This really needs more input: a) over the possible conflict of interest, and b) over the medical assessment. I've posted it to WP:COIN and WP:MED. Gordonofcartoon (talk) 12:12, 27 March 2008 (UTC)

Gordonofcartoon; I have posted a response to the comments you made on WP:COIN. Regarding your referral to me as “self-identified”; the only mention of my name currently in wikipedia was made by you there, and WhatamIdoing at the top of this page. My User page is blank. Regarding your comment that my "edits invariably add material relating to breathing-related studies" - I often refer to respiratory studies which are prominent in the research because they affect 93% of those patients according to Paul Wood in 1956 on the article page. Posturewriter (talk)posturewriter —Preceding comment was added at 00:35, 30 March 2008 (UTC)


 * I'd support a page move to the proper scientific name for this condition. To address your concerns about accessibility by the layperson Posturewriter then there is no issue with creating a redirect from this page to a new page, or a disambiguation page if that is more appropriate. Inclusion of a sentence (Also known as Da Costa's Syndome, or something along those lines) at the beginning of the article should be completely satisfactory in ensuring no layperson is confused. I am also aware that to someone with limited knowlege of this disease (the definition of a layperson surely?) the name Somatoform Autonomic Dysfunction is far more informative than "Da Costa's Syndrome". SuperTycoon (talk) 10:45, 8 April 2008 (UTC)


 * The page move system automatically creates such redirects. WhatamIdoing (talk) 18:02, 8 April 2008 (UTC)

SuperTycoon; I first found out about this condition when I read a medical dictionary for the general reader in 1975. The description of symptoms was clear and precise and written in plain English. It was published by someone like Reader’s Digest, but I cannot recall exactly. I later found that the technical terminology was “neurocirculatory asthenia” so I started using Dorland’s Medical Dictionary, and went to the University of Adelaide medical library to review the relevant research articles. I wrote my theory five years later, and in due course the director of the S.A. Fitness Institute asked me to co-ordinate a study of the condition because the staff cardiologists were too busy organising exercise programmes for patients with asthma, arthritis, obesity, smoking, and heart disease, and weren’t interested in this subject, but conducted the medical assessment of the volunteers. Newspapers reported an account of the South Australian study two years later and one of them has been scanned and placed on-line for editors who asked me to confirm it. I have also published a book on posture and health between 1994 and 2000, during which time I sold it to public schools and libraries. It was supported by 130 references from all sources, with the earliest being Hippocrates, and it contains 12 pages on my translation of 17th century medical terminology into modern English. If it was not for the word Da Costa’s syndrome being so clearly defined in a book for the general reader I would not have found it. I understand that wiki official naming guidelines give priority to plain English over jargon, and. . . “The names of Wikipedia articles should be optimised for readers over editors, and for a general audience over specialists”. I don’t have any objection to someone else setting up separate pages for specialists who can understand the sophisticated terminology and I could direct general readers to it for those who need to learn more. posturewriter —Preceding unsigned comment added by Posturewriter (talk • contribs) 09:26, 9 April 2008 (UTC)


 * 'Somatoform autonomic dysfunction' is the group name, not the 'official term' for the conditions listed under it. The present article name is correct and should not be replaced with the name of the group.
 * What I do not understand though is why this condition is listed there. Surely this is a physical disorder, not psychosomatic. Guido den Broeder (talk) 22:38, 13 May 2008 (UTC)


 * This category includes:
 * Cardiac neurosis
 * Da Costa's syndrome
 * Gastric neurosis
 * Neurocirculatory asthenia
 * Posturewriter has gone to great lengths to convince everyone that at least three of these four labels represent the same condition. It would be stupid to create three identical articles, except changing the name at the top.  We could create redirects for them; however, then we have to choose the "right" name -- which is DCS according to Posturewriter, and NCA according to most writers in the middle of the 20th century.  If we dump them all into one larger article on the slightly broader subject, then we solve the problem entirely:  no one can claim that they don't belong together, and no one will complain that the 'wrong' name was chosen for the main page.
 * Don't think of this as a "page move" so much as a "merge proposal" -- it's just that the page to be merged to doesn't exist yet. WhatamIdoing (talk) 21:33, 15 May 2008 (UTC)

Cruft
This article continues to grow more and more bloated with lengthy and unreadable dumps from papers. I'd like to have another go at reducing it to something informative and readable, and have left a message for Posturewriter asking for cooperation. Gordonofcartoon (talk) 20:50, 13 May 2008 (UTC)

Physical v psychosomatic
GDB wrote: "Surely this is a physical disorder, not psychosomatic"

IMO, most people who supposedly have DCS probably do have a physical disorder that affects autonomic nerve function. I'm with Jenny King: Most of them have a problem with habitual hyperventilation, which may or may not be triggered by anxiety. HVS explains all of the symptoms. It also explains why fitness training helps some patients, because when you exercise, you change (improve) your breathing patterns. Similarly, the "cardiac" DCS symptoms look strikingly like postural orthostatic tachycardia syndrome.

So, yes, most so-called DCS patients do have a "physical" problem -- and their physicians have a "sloppy diagnosis" problem. The existence of more precise labels, and better treatments, is why the term DCS has fallen out of use during the last half century. It's not because anyone believes that these patients or their problems don't exist; it's because we better understand their situations.

The dominant view is that most DCS patients are misdiagnosed, or at least under-diagnosed. Since the term has been around for so long, it's been folded into the ICD codes as essentially an anxiety disorder (or several anxiety disorders), thus the F45.3 coding. F45.33 is where you file all psychogenic respiratory problems, including anxiety-related hyperventilation. If cardiac palpitations predominate, then you can file it under F45.31. This is perhaps just as misleading as calling a panic attack a "psychosomatic disorder," but there is also some truth to it: many DCS patients do have an anxiety disorder. WhatamIdoing (talk) 22:05, 15 May 2008 (UTC)


 * The research seems to indicate that symptoms worsen after exertion, i.e. there is what we call exercise intolerance. An anxiety disorder or any other psychosomatic phenomenon cannot explain that. With primary cardiomyopathy, infection and malnourishment ruled out, the cause must be some kind of poisoning or pollution. Such a cause is not uncommon in warfare, with its heavy use of metals and chemicals without proper protection. So no, I don't think most of these patients were misdiagnosed. They had the Gulf War Syndrome of their era. Guido den Broeder (talk) 22:29, 15 May 2008 (UTC)
 * Remember WP:SOAP and Talk page guidelines. This is not a venue for general discussion on the subject. Gordonofcartoon (talk) 00:45, 16 May 2008 (UTC)
 * The point is, that the article shouldn't present the opposite as a fact. Guido den Broeder (talk) 07:24, 16 May 2008 (UTC)


 * Guido, I'm not sure what 'the opposite' is in your note.
 * Reliable sources (indeed, authoritative sources) call DCS an anxiety disorder, so the article says that.
 * Reliable sources also say that most so-called DCS patients do not have DCS, but instead have one of several related, hereditary, "physical" problems with their autonomic nervous system, so the article says that. (Exercise intolerance, BTW, is a hallmark of autonomic nervous dysfunction.)
 * What's your problem? We reported what the reliable sources said.  WhatamIdoing (talk) 03:39, 17 May 2008 (UTC)
 * I have found no reliable source saying that DCS is an anxiety disorder. The source provided does not say so. Therefore, I have removed that particular statement. Guido den Broeder (talk) 18:39, 20 May 2008 (UTC)
 * Source found. Gordonofcartoon (talk) 19:53, 20 May 2008 (UTC)
 * Sorry, but that webpage is complete rubbish. Guido den Broeder (talk) 20:59, 20 May 2008 (UTC)
 * In what way, apart from being written doctors saying something you don't like? Guido, I've assumed good faith so far, but if you continue this, I'm going to have to call WP:COI. Addendum: I have called it:
 * You have, to say at the least, strong connections with a patient advocacy group whose general view is that conditions of this type aren't psychological. And we can bring in Requests for comment/Guido den Broeder. Do you want to take it there? Gordonofcartoon (talk) 23:30, 20 May 2008 (UTC)
 * Excuse me? Are you getting personal because your pov is not backed up by reliable sources? If you find a published article that shows the syndrome to be an anxiety disorder, by all means put it in. But a random website won't do to support such a major statement in the lead, a statement that completely contradicts the WHO classification. Guido den Broeder (talk) 07:27, 21 May 2008 (UTC)
 * Note what this website further has to say: "Classically, Da Costa's syndrome develops in two situations: in the relative or friend of an individual who has recently been diagnosed as suffering from a cardiac condition..." Do you want that in the article as well? We do have some standards on Wikipedia. Guido den Broeder (talk) 07:34, 21 May 2008 (UTC)

Guido, please red the first paragraph of the Paul ref, and then restore the anxiety description. Note that you have to read the actual article, not merely the abstract. WhatamIdoing (talk) 13:54, 24 May 2008 (UTC)
 * I was going to look into this source, since the abstract is ringing a lot of alarm bells, but I cannot find the full text. Could you cite that paragraph for us? Guido den Broeder (talk) 14:12, 24 May 2008 (UTC)
 * Never mind, I found it here:, thanks to Posturewriter. Guido den Broeder (talk) 14:33, 24 May 2008 (UTC)
 * I've read it. What Paul says is in fact the opposite of what you claim: he says that patients would 'now' (i.e. in the 1980's) be (wrongly) labelled with e.g. anxiety neurosis while in reality neurocirculatory asthenia is easy to diagnose. Guido den Broeder (talk) 14:38, 24 May 2008 (UTC)


 * I'd say that your summary is an, um, unusual interpretation of that paragraph. Here's exactly what it says:
 * "Da Costa's Syndrome or neurocirculatory asthenia has a long and honourable history in the medical literature and in clinical medicine. Yet it is infrequently mentioned today.  It is unlikely to have disappeared; it probably exists much as before but it is more often identified and labelled in psychiatric terms such as "anxiety state" or "anxiety neurosis".  There is no harm in this shift in diagnostic labels" [towards a "psychiatric" explanation].
 * This paragraph clearly states that DCS is generally considered to be an anxiety-related condition, and that this author in particular sees "no harm" in that label. Later in the article, he refers to "the whole area of the treatment of disorders associated with anxiety" with a particular class of medications as being controversial -- further indication that DCS is usually classed as an anxiety disorder.  He never states that DCS is not, in his opinion, un-associated with anxiety, or that other physicians are "wrong" to use that label.  WhatamIdoing (talk) 19:52, 24 May 2008 (UTC)
 * No, it does not. It says 'more often' and 'labelled'. Ulcers also got labelled as psychiatric disorders. Read the entire article and you may understand better. Guido den Broeder (talk) 21:02, 24 May 2008 (UTC)


 * Guido, there are many sources that indicate a connection to anxiety. See, for another example, Dorland's Medical Dictionary:  "it is considered to be a manifestation of an anxiety disorder"  WhatamIdoing (talk) 22:46, 24 May 2008 (UTC)
 * I'm not doubting that. It has been fashionable to call all kinds of conditions anxiety disorders. However, this is simply one of those many website that is making statements not based on reliable sources, and therefore it is itself also not reliable. Guido den Broeder (talk) 00:13, 25 May 2008 (UTC)


 * No, Guido, Dorland's Medical Dictionary is not just "one of those many websites". It is one of the major medical dictionaries and is used by English-speaking healthcare workers around the world.  WhatamIdoing (talk) 02:27, 25 May 2008 (UTC)
 * That might make it notable, but not reliable. Guido den Broeder (talk) 11:31, 25 May 2008 (UTC)

Dorlands as a reliable source
Dorland's medical dictionary is used by students and professors at every single English-language medical school in the world. Thousands of physicians reference it. As a flagship publication from the world's largest scientific publishing house, Elsevier, it clearly meets the WP:V description of "books published by respected publishing houses," and in fact it is used as a reference in hundreds of Wikipedia articles. Guido den Broeder apparently still thinks that this major reference work is not considered a reliable source for the purposes of the WP:V policy. Please reply below and let Guido know whether you think Dorland's is a reliable source. WhatamIdoing (talk) 13:55, 25 May 2008 (UTC)
 * As WP:RS says, the reliability of a source depends on the context, i.e. what you want to cite it for. In this case, the dictionary makes a statement about the nature of Da Costa's syndrome, but does this without research and does not provide any sources as evidence for that statement. Hence, while it could be a reliable source for many other things, it is not a reliable source for that statement, and copying it as fact would be original research. Guido den Broeder (talk) 14:36, 25 May 2008 (UTC)
 * Dorland's is a reliable source. No dictionary cites its sources—we expect it to be a reference point as to the definition of terms. We have to assume its authors have made a good effort at establishing the consensus academic opinion on each subject. Is there evidence that this dictionary is held in poor regard? It won't be infallible, no source is. It won't be comprehensive, since it only allocates a paragraph or so to each word. But to 100% dismiss it requires evidence from an equal or higher authority. Not one's personal opinion. There's nothing "original research" about using a dictionary definition in an article. Colin°Talk 15:02, 25 May 2008 (UTC)
 * The higher authority would be the WHO. This dictionary directly contradicts the WHO classification. In general, dictionaries make very poor sources in Wikipedia terms, exactly because they generally don't cite sources. They may be excellent and trusted dictionaries, but that does not make them a reliable source per WP:RS. Therefore, Wikipedia does not use dictionary definitions, period. Guido den Broeder (talk) 15:19, 25 May 2008 (UTC)
 * Note furthermore that WP:RS says: "Sources should directly support the information as it is presented in an article". That was not the case here, the article text was not taken from the dictionary but consisted of speculation beyond it, also without actually citing this source. Guido den Broeder (talk) 15:30, 25 May 2008 (UTC)
 * I'm not going to get drawn into how the sources are being used in the article. The issue was the dismissal of Dorland's. By WHO, do you mean, this? I'm afraid I don't see any contradiction, though the WHO statements are necessarily broader as they are classifying several disorders. Wikipedia does use dictionary definitions. I don't know what gives you that idea. Colin°Talk 15:47, 25 May 2008 (UTC)
 * Some other evidence regarding Dorland's being an authoritative source:
 * "Dorland's Illustrated Medical Dictionary, which has been the premier dictionary for health care professionals for over 100 years"
 * it's available through the Journal of the American Medical Association's website (members only)
 * "First published in 1900, Dorland's Illustrated Medical Dictionary is universally acknowledged as the world's finest medical dictionary."
 * These are products of a straight google search, which had 111,000 hits. Taber's medical dictionary, the one I use, had about 15,000 less.
 * Just FYI, I'm of the totally unscientific and baseless opinion that "Somatoform disorder" means "we have no idea what we're talking about, you must be crazy" so I'm not going to get into whether the source was used appropriately, I'm just remarking that Dorland's is a reliable source.Somedumbyankee (talk) 17:48, 25 May 2008 (UTC)
 * Even a well-known and highly respected dictionary is only a tool, not a reliable let alone authorative source. Dictionaries consist entirely of simplifications. Guido den Broeder (talk) 12:56, 27 May 2008 (UTC)

Startle reflex?

 * At the time it was proposed, Da Costa's Syndrome was seen as a physiological explanation for soldier's heart, or signs and symptoms shown by some veterans such as an elevated startle reflex.[5] These would now be understood as both physiological and psychological, and called PTSD.

I have not found any source for this except this one interview and people quoting Wikipedia. AFAIK there is no research that shows an elevated startle reflex for soldier's heart. Elevated reflexes are not unheard of as a byptroduct of an autonomic disorder, by the way, so it would not be evidence for being equivalent to a PTSD. Guido den Broeder (talk) 18:37, 20 May 2008 (UTC)
 * If nobody knows another, more reliable source, I am inclined to reduce this sentence to At the time it was proposed, Da Costa's Syndrome was seen as an explanation for soldier's heart' (also removing 'physiological' since at the time there was no distinguishment between physiological and psychosomatic). Guido den Broeder (talk) 08:16, 22 May 2008 (UTC)

Effort syndrome?
Effort Syndrome presently redirects to this article, which does not seem correct to me as it is not specifically a post-war syndrome, and the name also does not imply all the symptoms that appear in Da Costa's syndrome. Any ideas? Guido den Broeder (talk) 08:43, 22 May 2008 (UTC)

Guido den Broeder: Thankyou for your question, and please accept my apologies for the delay. I have had some criticism to respond to. You will find some information on ES by scrolling down to the 1919 history chronologically here however WhatamIdoing deleted it here   You may also wish to check out the following number 15, by Sir Thomas Lewis in the reference window on that page, and also Lewis T. (1933) Diseases of the heart, The MacMillan Co., New York p.158-164. As you have mentioned Da Costa described a range of symptoms which seemed to be cardiac in nature, but where there was often no evidence of heart disease in 1871, during the American Civil War. Decades later, in World War 1, Sir Thomas Lewis studied a similar set of symptoms and noted that in some cases they only occurred during exertion so he called it Effort syndrome. Most authors since then have used the terms as synonyms but they are slightly different. Essentially most people who get these symptoms during exercise also get them at other times, and associated with other symptoms. Sir James MacKenzie attributed the symptoms of breathlessness, fatigue, and faintness etc. to pooling of blood in the abdominal and peripheral veins during exercise, which reduces blood flow to the brain. I included that information in the last paragraph of the 1916 chronology here again but WhatamIdoing deleted it here. You may also notice that the various studies of Da Costa’s refer to symptoms which occur in civilian life, before, during, and after wars, so there are overlaps to be considered later. I hope these references are helpfulPosturewriter (talk) 06:37, 28 May 2008 (UTC)posturewriter
 * I plan to have a look at the page's history since I feel that too much has been deleted. Guido den Broeder (talk) 21:30, 28 May 2008 (UTC)

Category
I have changed the categorization of the article to Somatoform disorders. Personally I think this classification is wrong as well, but it's the official one by the WHO and we should follow that. Guido den Broeder (talk) 09:30, 22 May 2008 (UTC)

Response to 5000 words of criticism in the twelve days between 12-5-08 and 22-5-08
EdJonston and NPOV editors; To save duplication I am responding to the current COI issue 2 on this discussion page and have notified you of that on the WP:COIN page.

I have been watching the COI process with interest for the past week, and have attempted a start on a response several times, but each time another editor, or a repeat by the same editor came up with another policy reason for suspending me, or deleting or blocking my contributions, so I decided to wait until the dust settled.

WhatamIdoing has swamped the COI editors with an overwhelming amount of information on the 15th May here and on the 17th May here   and on the 18th May here  to convince you to warn me not to contribute to the Da Costa’s Syndrome article page anymore. Given those circumstance I can understand your decision to block me from future contributions, but please give me my right of reply, as this is a discussion page, which refers to both sides contributing before making any final decision. To prepare my response I have been printing out an increasing number of pages (more than 7) of editors comments from the past 12 days (5000 words), with three editors being critics, JFW, User:WhatamIdoing, and User:Gordonofcartoon, and one appears in support, User:Guido den Broeder, and with you being the NPOV administrator. (WhatamIdoing on his own, has presented over 1500 words of criticism on the WP:COIN page, and 500 words on this discussion page above, making his total more than 2000 words in one week, so I think it is reasonable for me to present a 2300 word response since I am also responding to an additional two critics where the combined total against is more than double that at 5000). The three critics appear to be sifting through the fine print of wikipolicy to find something (anything) which they can use as a pretext for deleting the information, and have independently and simultaneously come up with four different policies - breach of copyright, conflict of interest, cruft, and page move. They have also used seven labels for what they suggest now, or previously are the obvious, ‘garden variety’ [], ‘text-book perfect’ [], or correct modern name for Da Costa’s syndrome, namely, orthostatic intolerance, hyperventilation syndrome, post-war syndrome, PTSD, anxiety disorder, neuroses, somatoform autonomic dysfunction, and more. They are using phraseology which creates the impression that they are experts on this topic and can casually discuss it with apparent ease, but please note that WhatamIdoing has argued that it is hyperventilation syndrome [], and Gordonofcartoon has argued that it is not [, so they are contradicting each other. WhatamIdoing also said that I declare “that DCS is a Chronic fatigue syndrome, with no reference”. Here are two references that he deleted . You can see them by scrolling down the page to the chronological date. [[Paul Dudley White]] in 1951 referred to ‘neurocirculatory asthenia’ as the synonym, (Paul Dudley White spent most of his career from 1917 to at least 1972 studying this subject) and S.D. Rosen used the ‘effort syndrome’ as the synonym in his 1990 study.

I will comment on some of this and hope you give me the courtesy of considering it, and if you and, or other NPOV editors could please check the Da Costa article page (what remains of it), and the full discussion page, the current and previous COI pages - where most of these matters were resolved in my favor because of the lack of response to my replies here []. Please note that WhatamIdoing said that the matter was not contested here. Could you please also check the previous WikiProject Medicine page on this topic, and the wiki Articles for deletion page about a theory which some editors criticise and I am not allowed to mention.

I will now start with User:JFW who has accused me of not providing enough information about myself to make it clear that I am the author of that theory, and he implies that I have been deliberately evasive User talk:Posturewriter. By contrast User:WhatamIdoing is complaining that I have been promoting myself and my ideas to such an obvious and extreme extent that I am violating wiki COI policy WP:COI/N. They are contradicting each other again by interpreting the same information in exactly the opposite way to justify suspending me by using opposite arguments, to support two completely different policies. Also on 18-12-08 on the WikiProject Medicine page JFW said that I had a habit of citing my own work without mentioning that I only did that on a previous discussion page (not an article page) because the editors asked me to confirm my identity and publications in major newspapers etc. and it was in response to notability requirements etc. which became progressively more demanding   and JFW also said “The condition is largely historical (see  which is an excellent review) and could be described as ‘irritable heart syndrome’ or somesuch”, which he also linked to 'Irritable bowel syndrome' wiki page. I followed the link to IBS 4.1, which discredited the somatoform and psychosomatic theories because they were in the same category as gastric ulcers, which were previously regarded as an example of ‘learned illness behaviour’, and psychosomatic conditions until the real cause and a reliable cure for ulcers was discovered in the 1990’s.

Did he notice that? - If so, then why didn’t he remove all reference to anxiety in the opening paragraph on the Da Costa’s article page to make it consistent with the other two ailments in this category e.g. here on the gastric ulcer page where there is no reference to anxiety. Also, with regard to that evidence, why does WhatamIdoing want to invent a new page called Somatoform autonomic dysfunction here and call it an anxiety disorder when he said on the discussion page on 15-5-08   that the Da Costa’s syndrome patients “probably do have a physical disorder that affects autonomic nerve function” and on the next paragraph writes more definitely “yes, most so-called DCS patients do have a ‘physical’ problem”. The word somatoform has the opposite meaning because it refers to symptoms or ailments which have no physical or physiological evidence to account for them , and WhatamIdoing also states in the first three lines that the autonomic feature is a response, not a cause, here , and Da Costa research history is full of evidence of physical or physiological cause, including, as Sir James MacKenzie said in 1916, the pooling of blood in abdominal veins reduces blood flow to the brain and causes the fatigue and faintness during exertion. EdJonston, did you notice that all this trouble with my critics started after I entered that review last week on 12-5-08, and WhatamIdoing deleted it within 3 days here , and collectively two other editors also introduced four different policies of complaint. Did those criticisms divert your attention away from that important fact from history?, which is independently verifiable and from the most reliable source - a major scientific medical conference on the subject! I am reporting on other peoples research, not my own. I am just the messenger here. That is typical of the type of information, and the speedy delete that follows. They delete most references to the observations, discoveries, and measurements of the physical, physiological, biochemical, and neurological abnormalities, especially, as in the case just mentioned, the most important ones. It gives the impression that they are erasing all of that information from the article page to make their choice of the label ‘somatoform autonomic dysfunction’ look plausible. There have been more than 50 labels for Da Costa’s syndrome, and the ‘modern’ ‘accepted’ label tends to change every decade. Wikipedia is a democratically compiled encyclopedia, yet WhatamIdoing has suggested various reasons that other labels be considered, such as orthostatic intolerance or hyperventilation syndrome, etc. and now insists that only the mainstream dictionary or coded definitions should be given. If that is what wikipedia wants then all that is required is a photocopy machine and a medical dictionary as source material for every disease? Then it wouldn’t be necessary to to ask members of the public to assist with compilation. Some months ago I prepared a replacement for the original medical dictionary type description in the introduction, with one that included the views of all people, including researchers of the past (those who concluded that it is an anxiety disorder, and those who found evidence that it is physical), and the evidence and opinions of patient action groups, and individuals, which is collective and inclusive and therefore NPOV, but because of the other editors predictable response I haven’t posted it. Is it wikipedia policy to exclude the evidence and opinion of all of those other people. I am writing the history of Da Costa’s syndrome research and presenting the major discoveries in chronological order, and have made many references to psychological or social factors which influence the condition where appropriate, for example here, but other editors are trying to convince you that I am cherrypicking articles to suit my own ideas. Please consider the actual meaning of Somatoform, and then look at the history of research, and decide the naming issue, and then tell me if you need any more information about the copyright issue where I am giving information for free. I notified all COI editors in the last paragraph of the previous COI issue that I put the reference window on my website after joining wiki, and reviewed the best sources I could find because editors asked for independently verified sources of the highest quality. I use that as a source for selecting the best of the best to abbreviate for wiki and then WhatamIdoing says that I am using wiki as “a dumping ground” for my original research.

Also, if Gordonofcartoon thinks that Harvard quality research is cruft (rubbish that needs to be swept under the carpet - I don’t, and anything rejected by wiki has been put straight back onto my website, and now new reviews are put there in full before I abbreviate them for wiki, and I am giving wiki other people’s evidence and opinions, and keeping my own). Also, about something else that I entered once in good faith, and was accused of being disrespectful for adding it a second time. I was accused of taking up undue space for non-notable research, so I abbreviated it and explained on the discussion page that I had provided online proof of publication in a major newspaper, as requested, in a reasonable attempt to make it notable. WhatamIdoing just implied on this COI page, that I added that edit the second time, without change, and without mentioning my reasons on the discussion page, and then he ignores evidence of multiple major state newspaper accounts, as if they don’t exist, and says that I must only use independent peer reviewed major journal citations for everything , and  he says I am on watchlists and will be deleted again unless I only use quotes from major peer reviewed journals , and then Gordonofcartoon deletes reviews of major peer reviewed journals on the grounds of a new policy of synthesis. In the meantime I accepted the deletion again, in accordance with the advertised warning re; if you are not prepared to accept merciless editing don’t contribute. This process was repeated later, by responding to my reply with a page move suggestion here. I have contributed, I write without fear or favor, I have won most of the debates for six months, and complied with policies where required, I have been warned about being on watchlists, and editors have attempted to discredit me through personal attacks here. When Supertycoon misunderstands me as a medically ignorant person here, how am I supposed to respond without revealing my actual background here  , yet Gordonofcartoon again chooses to say I have self-identified in his second sentence here. Does he want me to say nothing so that he and WhatamIdoing can continue misrepresenting me as medically ignorant here and here.

I have been accused of editing against consensus, to create the impression that many editors are against me, when currently only two editors are doing 95% of the criticising. Those two editors don’t apologise when I prove that they are mistaken on issues here, but choose to continue relentlessly here , but with new policies. My critics don’t seem to me to be editing for NPOV to improve the presentation which is supposed to be their role, but more like they want to be contributors with an opposing view, yet when I invite them to do that by setting up another page with another terminology, they don’t. If they set up such a page from their own initiative it would already be there but it isn’t, so their only motive is to remove this one. That is neither good editing, nor genuine contributing. WhatamIdoing was discussing COI relentlessly last week, and he ignored your advice to take a break and continued until he persuaded you to warn me for disruptive editing. I thought it was a good idea to take a break so that I could spend some time thinking about this. I also thought that it was discourteous for WhatamIdoing to ignore your request for a break, and that it was a violation of wiki discussion policy.

Also, I am not an editor, I am a contributor, and the editors are being disruptive to my contributions. They aren’t editing, they are using the slightest fineprint policy reasons for deleting entire slabs of information which are extracted from reliable, independently verifiable sources.

Could you please give me two weeks to reply to any future issues before making any decisions, because I prefer not to act hastily in regard to this volume of elaborate criticisms re: I don't wish to make comments that can be misconstrued again, or interpreted as violating another policy, or in plain English, they will say I am at fault if I do, and at fault if I don't etc.  Posturewriter (talk)posturewriter  —Preceding comment was added at 04:16, 24 May 2008 (UTC)


 * Please cut this readable length. Gordonofcartoon (talk) 12:21, 24 May 2008 (UTC)
 * Make an effort, don't attack someone and then refuse to listen to what he has to say in his defence. Guido den Broeder (talk) 13:44, 24 May 2008 (UTC)
 * Firstly, it's not my job to make an effort, it's PostureWriter's to follow TALK. Secondly, it looks like classic WP:SOUP to me. Gordonofcartoon (talk) 03:32, 30 May 2008 (UTC)
 * It's either soup or Virginia Woolf. I think he's objecting that his opinion is being shut out and that other editors are being too factual, people are objecting with opinions that contain too much information.  There may be a valid concern here, but it just isn't very persuasive since it rambles so much.  "Also, I am not an editor, I am a contributor, and the editors are being disruptive to my contributions." seems to be the argument.Somedumbyankee (talk) 04:13, 30 May 2008 (UTC)

If WhatamIdoing and Gordonofcartoon use 5000 words to criticise me on this, and the WP:COIN page in one week, then I think that it is reasaonable for editors to consider my 2500 word replyPosturewriter (talk) 07:38, 30 May 2008 (UTC)posturewriter

PBS interview
I'm restoring. It looks considerably tendentious to remove as "non-notable PTSD source making unsourced claims" an interview with "Matthew Friedman, executive director of the VA's National Center for PTSD". That position makes his view a notable viewpoint, and there's no obligation for people cited to provide sources. Gordonofcartoon (talk) 12:31, 24 May 2008 (UTC)
 * Neither Friedman, nor his center has on article an Wikipedia, nor can I find any reason why they should have one (could be my fault, but that's how it is). It is a well-known phenomenon that people tend to see all things in this world as belonging to their personal niche, and hence consider them nails, horses, or post-traumatic stress syndromes, as the case may be. There are countless such centers, we cannot possibly build Wikipedia articles in this manner.
 * Find a (reliable) scientific study that links Da Costa's syndrome and PTSD, and you can put it in. But no random websites, please. Guido den Broeder (talk) 13:39, 24 May 2008 (UTC)


 * Guido, this is a reliable source. The speaker is the head of the largest government health agency in the entire world that specializes in PTSD.  He has both an MD and a PhD:  a physician, a researcher, and a professor at Dartmouth's medical school.  PBS is a the US's primary educational television system.
 * He names Da Costa as one of the early post-war syndromes in a brief review of the history of post-war syndromes. There are no experimental studies that compare DCS to anything as modern as PTSD.  (How exactly would you run that experiment?  Randomly assign a DCS or PTSD label to different people and see what happens?)  However, anyone with a little bit of basic information can look at the definitions and see that there could be some overlap, and that both phenomena were first described in the context of soldiers.  WhatamIdoing (talk) 14:12, 24 May 2008 (UTC)
 * Fair enough, opinions on notability can differ. But by your reasoning the source cannot possibly be reliable. We cannot draw conclusions based on people's speculations, no natter how many titles they have. All we have to go on is the historical research, which does not report symptoms common to PTSD, as far as I can see (but correct me if I'm wrong). Guido den Broeder (talk) 14:15, 24 May 2008 (UTC)


 * I'm totally confused by this response. Let's try this again:
 * These statements are a plain facts:
 * Matthew J. Friedman is widely considered to be one of the world's foremost authorities on PTSD.
 * Matthew J. Friedman has published more than 50 articles in peer-reviewed scientific journals about PTSD.
 * Matthew J. Friedman is the Executive Director of the Veterans Health Administration Center for PTSD.
 * Matthew J. Friedman is on the faculty of the Dartmouth Medical School, where he teaches psychiatry and neuroscience.
 * Matthew J. Friedman is a physician.
 * How do you add up these facts and get "by your reasoning the source cannot possibly be reliable"? By my reasoning, this is one of the most reliable sources in the entire world for this information.  Who else could be a reliable source on the postwar syndromes if someone who has dedicated his entire professional career to PTSD isn't?  WhatamIdoing (talk) 19:34, 24 May 2008 (UTC)
 * Also, his or his oragnisation's presence or not on Wikipedia is irrelevant. Gordonofcartoon (talk) 19:36, 24 May 2008 (UTC)
 * He may be a reliable source on PTSD (I'd have to check that, points 2-5 say nothing and 1 is your statement), but not on Da Costa's syndrome, on which he has not done any research AFAIK. But if you think that a single remark by one physician in an interview is enough to overthrow the WHO classification, I suggest we ask for expert comment. Guido den Broeder (talk) 20:58, 24 May 2008 (UTC)


 * You might also like to look at : "The 20th century offered many examples of post-war syndromes such as Da Costa's syndrome, irritable heart, shell shock, effort syndrome, medical evacuation syndrome, post-traumatic stress disorder, and Gulf War syndrome."  DCS is regularly, routinely, and frequently placed in the spectrum of post-war syndromes.  In fact, I'm not sure that anyone except you has ever questioned this.  WhatamIdoing (talk) 22:42, 24 May 2008 (UTC)
 * Thanks. From the citation it is clear that Da Costa's syndrome is NOT considered the same as PTSD in this publication, but a different post-war syndrome. There are many post-war syndromes. I am not questioning that Da Costa's syndrome is one of them, on the contrary. But they are not all the same. Some are physical, some are psychosomatic, and with some we don't know. Guido den Broeder (talk) 00:07, 25 May 2008 (UTC)

Still not convinced that a number of reliable sources think that DCS is just an older description of PTSD? Try these sources...


 * "For at least a century before PTSD was officially born, investigators noted somatic, physiologic, and behavioral consequences of trauma, currently embedded in the DSM-IV criteria. As early as 1871, Da Costa described the autonomic cardiac symptoms of soldiers exposed to the horrors of the Civil War."


 * "What kind of syndromes can be considered as post-traumatic? When, in 1871, Jacob Mendez da Costa, an American army physician, described the syndrome of irritable heart (Da Costa 1871, Paul 1987), he described a post-traumatic syndrome within the cultural context of his time." (ISBN 0471978736, page 205).  (For more on "the cultural context of his time," and the political pressures, see page 35 in this publication.)


 * "During the Civil War, a PTSD-like disorder was referred to as the ‘Da Costa's Syndrome’ (3), from the American internist Jacob Mendez Da Costa (1833–1900; Civil War duty: military hospital in Philadelphia)."


 * "Reports of disorders following war experience certainly go back to the American Civil War (1861-1865). At this time a physician (Jacob Mendez Da Costa) described patients who developed palpitations (which are consistent with panic attacks or PTSD). The psychiatric aspects were not fully recognized and the condition was known at that time as “Da Costa’s heart”." (ISBN 1862593376; chapter 11 of Pridmore's psychiatry textbook is online here)

Guido, I can keep this up just about as long as necessary, but I think I've made my point. Note that I'm not trying to influence your personal POV here. Whether or not you or I personally agree with a connection to PTSD is absolutely irrelevant. As I've said above, I personally think that more DCS cases can be explained by autonomic nerve dysfunction (with primary symptoms of hyperventilation and vasovagal dysfunction [e.g., fainting if you stand too long]) than by anything else, including PTSD. As Wikipedia editors, however, we have to represent the breadth of the published record instead of just our private views, and many, many reliable sources that think DCS is, or is highly related to, PTSD. This view may not be deserve the exactly same weight as the WHO schema, but the view is definitely a significant presence in the literature and deserves representation in this article. WhatamIdoing (talk) 03:42, 25 May 2008 (UTC)


 * That is a common misconception. An article should not reflect the breadth of the published record, but the breadth of the published reliable record. Of these four sources, the first three only express an opinion not backed up by research, while the fourth did look at elements of the research and (therefore) only concludes 'consistent with' - which is correct, but of little value (it is consistent with all kinds of disorders). We cannot put original research in the article by saying that DCS is an anxiety syndrome or would be considered a form of PTSD. The best we can do is the same as Paul did, i.e. mention that such labels are sometimes attached, but we cannot write that these labels are correct. And then we would need to do that in a way that keeps the article neutral. Guido den Broeder (talk) 11:29, 25 May 2008 (UTC)

Summary style
WhatamIdoing; In 1871 Da Costa came to the conclusion that many factors seemed to overlap in causing a syndrome which has since been named after him, but close study revealed that it was "Fevers" 17%, "Diarrhoea" 30.5%, "Hard field service, particularly excessive marching" 34.5%, and finally, "Wounds, injuries, rheumatism, scurvy, ordinary duties of soldier life, and doubtful causes" 18%, and the symptoms are palpitations, breathlessness and fatigue in response to exertion, but you deleted that evidence here and now you are saying that it is the modern equivalent of Post-traumatic stress disorder where the wikipedia page describes it as being caused by “an anxiety disorder that can develop after exposure to one or more terrifying events in which grave physical harm occurred or was threatened” here Posttraumatic_stress_disorder

You also quote Oglesby (by referring to him as Paul 1987). Oglesby says that it won’t do any harm to call DCS an anxiety disorder nowadays (meaning it is OK for the time being), so long as it is understood that in order to gain a proper understanding of the condition “It is educational to review and summarise the past. What has been forgotten should not necessarily be forgotten” here.

If Oglesby of Harvard Medical School regards evidence from history as important, why have you deleted my review of his research history by calling it cruft’ (lingo for unimportant obsolete rubbish that has limited interest to readers and needs to be swept away) here and here. You will recall that I did a one page review of Oglesby’s 10 page history of medical controversies on this topic, and Gordonofcartoon deleted it and replaced it with one or two lines about anxiety here. He essentially deleted reliable independent evidence from a reputable peer reviewed journal and replaced it with his opinion. I would like all NPOV editors to read Oglesby’s full article here

Also please note that on the next edit WhatamIdoing deleted a lot of other evidence of the type that Oglesby recommended “should not necessarily be forgotten” here Also, in the opening paragraph of the article page here you say that Da Costa’s syndrome causes the symptoms, when the syndrome is a set of symptoms, and not the cause of them?Posturewriter (talk) 08:03, 27 May 2008 (UTC)posturewriter


 * Just a minor note: If you read the cardiologist's obituary, you'll see that Paul is his last name, not his first.  WhatamIdoing (talk) 03:32, 29 May 2008 (UTC)


 * WhatamIdoing; thanks, I have been curious about the apparent non sequitur in his name, given that his research is published in English language journalsPosturewriter (talk) 06:32, 29 May 2008 (UTC)posturewriter
 * Unusual, isn't it? The first time I saw it, I thought that the printer made a typo.  WhatamIdoing (talk) 18:27, 29 May 2008 (UTC)


 * Because this is an encyclopedia for the general reader, not a treatise for the expert. We summarize information that will be interesting to the average reader, who is neither a physician nor a patient.  The information that "should not necessarily be forgotten" is information that should not necessarily be forgotten by the physician who is charged with diagnosing or treating this, not the average reader.
 * What the average reader needs to know is this: It's an old name, there's some diversity of opinion on what it "really" represents, and nobody really uses this diagnostic label any longer (because the doc who thinks its HVS uses that label, the one who thinks its PTSD uses that label, and so forth).  The average reader has absolutely no need for an explication of all the papers that talk about this phenomenon.  WhatamIdoing (talk) 13:46, 27 May 2008 (UTC)
 * Actually, this is an encyclopedia for everyone, and everything. Further, while we don't need to spell out every detail of every study, neither do we need to summarize in such a fashion that entire threads of research are forgotten. Guido den Broeder (talk) 21:28, 28 May 2008 (UTC)


 * Please read WP:MEDMOS. WhatamIdoing (talk) 23:12, 28 May 2008 (UTC)
 * That page is not about what Wikipedia is, and its comment in passing is wrong. See Wikipedia. Guido den Broeder (talk) 23:51, 28 May 2008 (UTC)
 * I have now corrected that page, one that you have edited a lot and where I have noticed that you are consistently making this mistake. Guido den Broeder (talk) 00:21, 29 May 2008 (UTC)


 * "That page" is an official guideline that was developed through an extensive process of community input and revision. I see that your "corrections" have been reverted -- three times within one hour.  WhatamIdoing (talk) 02:34, 29 May 2008 (UTC)
 * Which only means that the page is wrong again. There are many errors in official guidelines, especially where things are mentioned in passing. This guideline is not a guideline on what Wikipedia is and can therefore not be used to make your point. Guido den Broeder (talk) 09:01, 29 May 2008 (UTC)


 * You have been invited on that page to make a case for your preferred version. Let's continue the discussion there.  Any editor is welcome to join the discussion.  WhatamIdoing (talk) 18:24, 29 May 2008 (UTC)
 * It is (again) the one making the claim who has to make his case. Guido den Broeder (talk) 18:52, 29 May 2008 (UTC)

ICD-9
Pleas note that ICD9-CM is not a WHO product, it is published by the National Center for Health Statistics. Guido den Broeder (talk) 07:33, 27 May 2008 (UTC)

Surgeon General
Found a lot of interesting material at from the Office of Medical History. Guido den Broeder (talk) 08:46, 27 May 2008 (UTC)

It is interesting. I will have a look at that reference and comment laterPosturewriter (talk) 06:37, 28 May 2008 (UTC)posturewriter

Names for this phenomenon
Guido,

These names represent exactly the same condition:


 * Cardiac neurosis
 * Da Costa's syndrome
 * Neurocirculatory asthenia
 * Irritable heart syndrome
 * Effort syndrome

The names change as people attempt to more precisely define the condition, or want to promote their personal views of the cause. So Cardiac neurosis is "DCS, and I think it's entirely psychological"; Neurocirculatory asthenia is "DCS, caused by weak nerves affecting the heart"; Irritable heart is "DCS, and it's entirely physical"; and so forth.

Saying that they're different is entirely unsupported by any of the published papers -- it's like saying that Gay-related immune deficiency is not AIDS.

So: The article currently cites several papers that assert these are the same condition, and many more have been cited in the past (but deleted because it made the article too detailed). I invite you to produce reliable sources which assert that these are materially different. In the absence of that, I invite you to quit introducing this particular factual error into this article. WhatamIdoing (talk) 13:56, 27 May 2008 (UTC)
 * What factual error would that be?
 * It's the other way around, the claim that two things are the same needs proof.
 * To explain this situation, however: one can say that to some extent these names they were attached to the same condition or at least share a certain subset of symptoms. Only to some extent though, where the main point is that DCS is restricted to post-war syndrome, whereas NA includes the general population; furthermore DCS is more detailed in its symptom description while NA in part presupposes a certain etiology. These two are therefore not the same, but could be equivalent or interchangeable. However, that is not a fact, but a statement by authors. The other three diagnoses are so poorly defined that mentioning them in the article at all serves no purpose IMHO. Guido den Broeder (talk) 14:18, 27 May 2008 (UTC)


 * Actually, DCS is not solely a post-war syndrome, nor even a post-trauma syndrome. Some individual authors emphasize that aspect, but it is certainly not the only interpretation.
 * Most papers about DCS use one or more names interchangeably. See this information from NORD, which lists several terms (more than I give above) as exact synonyms.  Many original scientific papers, such as this one and this one name several of these as exact synonyms.  So I have good, reliable sources -- both original research papers and independent, third-party reviews -- that all assert that these terms are synonyms.
 * Unless you can produce several reliable sources that say these names represent materially different syndromes, then I ask you to please quit changing the article to promote your unsourced, personal POV that they are different. WhatamIdoing (talk) 19:49, 28 May 2008 (UTC)
 * I strongly suggest that you follow WP:CIVIL. Meanwhile, once again, your first two sources are unreliable, while the third does not do what you claim it to do. Guido den Broeder (talk) 21:21, 28 May 2008 (UTC)
 * Please explain why you believe that the National Organization for Rare Diseases -- the preeminent organization for rare diseases, which is considered the most authoritative and comprehensive organization in the entire world for rare diseases, and whose work is cited with approval by several governments, including, for example, the US and Canada -- is "unreliable."
 * Please explain why a report by Paul Wood, MD, FRCP, published in BMJ, is "unreliable." On what grounds, exactly?  Are you aware that Paul Wood was a physician at the National Hospital for Diseases of the Heart, in the Effort Syndrome Unit itself?  Do you think he somehow held that position without knowing anything about the sole subject of the entire unit?
 * Please explain how "THE purpose of this report is to summarize present-day knowledge about neurocirculatory asthenia (anxiety neurosis, neurasthenia, effort syndrome) with special attention to its relationships with life situations..." can be interpreted in any way other than "These four names refer to exactly the same thing."
 * I find your lectures about civility offensive and suggest that you stop using that policy as a bludgeon in your ongoing efforts to thwart my efforts to make this article accurate. WhatamIdoing (talk) 23:10, 28 May 2008 (UTC)
 * I am not going to repeat the same exercise over and over again. Your original research will not make it into the article, and that's the end of it, no matter how many sources you are willing to misinterpret. Guido den Broeder (talk) 23:54, 28 May 2008 (UTC)


 * So I interpret this remark as meaning that you've been unable to find a single plausible source to support your POV, and that you find it difficult to claim with a straight face, for example, that the head of a unit dedicated to this syndrome doesn't know what it's called. Thank you for your comments.  I'll restore the correct information, with the extra sources listed here.   WhatamIdoing (talk) 03:01, 29 May 2008 (UTC)


 * WhatamIdoing; You have used 2 references to argue that 5 diagnostic labels are synonyms for Da Costa’s syndrome, including cardiac neuroses and neurocirculatory asthenia here . However, although many authors use them as synonyms, not all do. For example, Oglesby Paul, who you often refer to as one of your reliable sources, uses the term neurocirculatory asthenia as a synonym for Da Costa’s syndrome, and Cardiac Neurosis as a synonym for cardiophobia, when he says that “Not all patients with neurocirculatory asthenia have a cardiac neurosis, and not all patients with cardiac neurosis have neurocirculatory asthenia” - which were his exact words in his closing paragraph on page 313 here [. In plain English he is saying that some people get palpitations, breathlessness, faintness and fatigue during exertion (Da Costa’s syndrome), but they don’t misinterpret it as heart disease, or worry about it (cardiophobia) - they just avoid the levels of activity which cause the symptoms[[User:Posturewriter|Posturewriter]] (talk) 06:32, 29 May 2008 (UTC)posturewriter
 * @WAID: It's the claim that needs evidence, not the removal of it. Your claim can, however, not be proven. It is not possible to prove that two different diagnoses address the same condition, and therefore no article should say something like that. What it can say is what it already says, that sources consider them equivalent, or that they are used interchangeably, or that they have the same code, etc. But that's all. The article doesn't need to repeat it a million times either. Using the best reliable source (Paul) suffices. Guido den Broeder (talk) 09:08, 29 May 2008 (UTC)

(Undent) Thanks, Posturewriter. I've incorporated that information. Is there another example of this distinction being made explicit that you might like to include, or is this good enough for now? WhatamIdoing (talk) 19:11, 29 May 2008 (UTC)
 * Please don't lie in your edit summary. I have again reverted your massive edit for which there is no consensus, and will look if something can be salvaged from it tomorrow. Guido den Broeder (talk) 20:11, 29 May 2008 (UTC)

WhatamIdoing; Regarding your request for a second example of synonym usage discrepancies; Some authors have used the word hyperkinetic heart syndrome as a synonym for Da Costa’s syndrome, however, If you go to Oglesby Paul’s paper you will see his comment “The hyperkinetic heart syndrome also appears to be different from neurocirculatory asthenia and should also be considered as a separate entity” in paragraph 2 of page 313 here. Also, if you refer to Paul Wood’s 1941 article, you can see his heading “Terminology: Definitions: History”, where he writes “There can be no better name than Da Costa’s syndrome” and gives his reasons in paragraph 2 here. Posturewriter (talk) 07:38, 30 May 2008 (UTC)posturewriter


 * Thanks, PW. Then I think we won't mention "hyperkinetic heart syndrome" at all, since I haven't seen anyone claim that it's the same.  Are you satisfied with the current list of labels?  I thought about setting up redirects for each of them to this page.  WhatamIdoing (talk) 15:15, 30 May 2008 (UTC)
 * I think it's worth going to more secondary and tertiary souces, since selecting primary sources always raises issues of the fairness of choice. There are a couple of overviews in Oxford Companion to Medicine (reliable, yes? - ) which confirm the synonyms and also provide context (particularly the overlap with civilian diagnoses).
 * da Costa described what has been variously termed as "soldier's heart", "irritable heart", or disorderly action of the heart. He noted that many of the soldiers affected had not been involved in combat but had suffered disruption of their normal lives and been obliged to face hardships and unaccustomed physical activity. They suffered breathlessness, fatigue and exhaustion, palpitations and faintness after even modest exercise ...


 * Disorderly action of the heart or effort syndrome became a problem during the Indian Frontier wars, and in the Boer War, when a succession of unimaginative Commissions were inclined to impute the symptoms to unsound harnessing of the soldiers' equipment and to the somewhat rigid forms of drill which then prevailed.
 * Sir Thomas Lewis studied ‘soldiers' heart’ which was ‘a chief malady in (WW1}; one such case was numbered for every four cases of wound’. Lewis preferred the term effort syndrome to distinguish it from valvular disease of the heart. By the summer of 1918, 70 000 cases had been classed as cardiovascular disease and of these 44000 cases of effort syndrome became pensioners. In the last two years of the war it was found that 44% of those diagnosed as effort syndrome had symptoms on enlistment. It was also observed that 53% of effort syndrome cases were teetotal and the more severe cases drank less than those with mild symptoms. Lewis's book The soldier's heart and the effort syndrome, first published in 1918, was re-written and published in 1940.
 * Sydney Brandon "battle neurosis" The Oxford Companion to Medicine. Stephen Lock, John M. Last, and George Dunea. Oxford University Press 2001.


 * And -


 * Functional cardiac disorders
 * During the American Civil War J. M. DaCosta described a syndrome in soldiers who had what were apparently cardiac symptoms such as chest pain and palpitation but who in fact had normal hearts. This condition, often called ‘irritable heart’ or ‘soldiers' heart’, caused so much invalidism among British soldiers in World War I that a special heart hospital, directed by Thomas Lewis, had to be set up to deal with it. Lewis re-named it the ‘effort syndrome’ because the symptoms occurred on exertion and he devised a remedial system of physical exercises which enabled over 35 000 men to be returned to active service. There was no one cause of the syndrome. In some it was undoubtedly due to the terrible strain of trench warfare. But in others, especially in new recruits, it was reasonable to label it neurocirculatory asthenia or cardiac neurasthenia, and to regard it as a form of cardiac neurosis. Hyperventilation was later shown to be a causative factor in some. The condition was well recognized in civilian life even before 1914, so it was not a malady confined to soldiers – with the important exception of those who were totally exhausted by warfare.
 * Arthur H. Crisp "cardiology — history" The Oxford Companion to Medicine. Stephen Lock, John M. Last, and George Dunea. Oxford University Press 2001. Gordonofcartoon (talk) 18:25, 30 May 2008 (UTC)


 * WhatamIdoing; If you want more redirects, as mentioned here try a website called Disease of a Thousand Names here  . Note that it lists more than 80 synonyms for the Chronic Fatigue Syndrome, including neurocirculatory asthenia, Soldier’s Heart, Effort syndrome, and Da Costa’s syndrome - Do you think that they are all the same? just because they are used as synonyms. -  Dorland’s various editions include some that do not appear on this list, because, as published under two different names, they span 100 years of this topic of controversies, and heated debatesPosturewriter (talk) 07:59, 1 June 2008 (UTC)posturewriter


 * Actually, I thought I'd just do redirects for the names in bold face at the top of this article. They seem to be fairly well supported.  WhatamIdoing (talk) 15:23, 1 June 2008 (UTC)
 * As a personal website, Disease of a Thousand Names isn't a reliable source anyway. It makes no distinction between generally-accepted and outright maverick identifications (for instance, the identification of post-polio syndrome with ME/CFS). Gordonofcartoon (talk) 15:54, 1 June 2008 (UTC)


 * WhatamIdoing; Regarding your statement that you haven’t seen anyone who uses the term hyperkinetic heart syndrome and neurocirculatory asthenia as synonyms here ; Please go to the ‘Medical Dictionary Online’ where it defines ‘hyperkinetic heart syndrome’ by referring to a collection of symptoms which includes the palpitations, breathlessness, and dizziness of Da Costa’s syndrome, and refers to it as ‘neurocirculatory asthenia’ here  . Please then go to ‘biology online’ where it describes hyperkinetic heart syndrome as “beating excessively fast and/or causing subjective awareness of continual cardiac activity” here  As Oglesby Paul suggested; it is important to know the difference between a condition which involves one symptom, namely abnormal palpitations of the heart, and a condition which involves a whole set of symptoms, namely Neurocirculatory asthenia i.e. Da Costa’s syndrome, in the second paragraph on page 313 here  Why do you think it is not important enough to mention?Posturewriter (talk) 07:33, 3 June 2008 (UTC)posturewriter
 * Medical Dictionary Online
 * Unreliable: zero editorial credentials; and no indication how the material was compiled.
 * Biology Online
 * Unreliable: it's a user-submitted site moderated by a handful of unknown biology postgrads. Gordonofcartoon (talk) 17:03, 3 June 2008 (UTC)

Original research
I see that some editors have made quite a mess of this article while I was inconvenienced. There is more original research in it than ever. I'll address the issues anew when I have more time. Guido den Broeder (talk) 00:08, 6 June 2008 (UTC)
 * Differences since your last edit were mostly by me I believe. It's the same number of references (19), I believe my changes were mostly reordering per WP:MEDMOS, so any original research issues remained from  your edit.  I did create a lead section per the manual of style, which may give the appearance of duplication of content but this is an artifact since the lead summarizes the body.  It should be the exact same amount of original research.
 * You weren't inconvenienced by the way, you were blocked for edit warring. WLU (talk) 23:06, 6 June 2008 (UTC)
 * Guido, let me suggest that you avoid any possibility of additional edit warring accusations by discussing the changes that you'd like to make in advance. WhatamIdoing (talk) 23:42, 6 June 2008 (UTC)

Names in the lead
I've altered the intro to focus on the main synonym. We've got so obsessed wth the multiple possibilities that the chief one has become buried. Gordonofcartoon (talk) 01:15, 7 June 2008 (UTC)


 * That looks good to me. The initialism (DCS) isn't commonly used; could we lose that as well?  Also, do you think that we should put the synonyms in bold face at their first appearance?  I have ambitions of creating redirects for each of them.  WhatamIdoing (talk) 05:33, 7 June 2008 (UTC)
 * I like WAID's ideas, I don't know about putting the civil war reference in the first and second paragraphs in the lead. That being said, I've done little research on the matter so it could be propos.  WLU (talk) 21:04, 7 June 2008 (UTC)

Interpretations
WhatamIdoing: Regarding the subject of “Naming Phenomenon’; i.e. ‘observable facts about the name of something’; hundreds of researchers have tried to give all sorts of names to Da Costa’s syndrome for more than 100 years, but Da Costa’s syndrome is still Da Costa's syndrome, and that is the title of the page, so that is what I have been writing about.

You referred to it as Orthostatic Intolerance and Hyperventilation syndrome on 21-12-07 here, and continued with ‘habitual hyperventilation syndrome’ here  and then to a ‘somatoform autonomic dysfunction’ on 24-3-08 here  and later to PTSD here  and in the first two sections of the article page here , and again with another five labels of your choice on 27-5-08 here. As far as the initials DCS is concerned I thought that you were the first to introduce it here, and now you decide that it isn't commonly used and inappropriate now?. I assumed that you was using it as an initialism, i.e. an abbreviation of the title. If you don't think it is a good idea now, why did your introduce it two weeks ago.

Also, according to my copy of Dorland’s Medical Dictionary; a ‘syndrome’ is a collection or set of symptoms, and included in the 10 page list is ‘Da Costa’s syndrome’ with the synonym; “neurocirculatory asthenia” which is described as “a symptom complex characterised by the occurrence of breathlessness, giddiness, a sense of fatigue, pain in the chest in the region of the precordium, and palpitation. It occurs chiefly in soldier’s in active war service, though it is seen in civilians also”.

Hyperventilation syndrome is defined as “an emotional disorder in which rapid deep breathing caused by emotional tension, anxiety, or acute fear produces giddiness and clouding of consciousness, and sometimes apprehension, confusion, numbness the hands and face, muscular cramps of the hands and feet, and a sense of air hunger”.

‘Da Costa’s Syndrome’ is clearly different to ‘Hyperventilation Syndrome’, so why do you want to make them the same?, and ‘orthostatic intolerance’ is a symptom, not a cause, and the appearance of ‘autonomic dysfunction’ is an associated feature, as you said “most people who supposedly have DCS probably do have a physical disorder that affects (i.e. produces 'a material influence upon or alteration in') autonomic nerve function” here i.e. it is an ‘affect’, not a scientifically proven cause. Some people are born with it, and the condition affects some men before, during, and after wars, and women in civilian life after viral infections and pregnancies, so why do you want to call it Soldier’s Heart, post-war syndrome, or PTSD.

I have been contributing to the history section with descriptions of the progress of significant medical research discoveries which are useful in identifying the distinguishing features. According to my copy of Webster’s Collegiate Dictionary the word ‘history’ is defined as “a chronological record of significant events”, which is different to the word ‘obsolete’ which is defined as “no longer in use”. Describing the history is an effective and therefore useful way of clearing up all the confusion by showing how all the names evolved and inter-relate, and according to Oglesby Paul "it is educational to review and summarise the past. What has been forgotten should not necessarily remain forgotten" in his second paragraph here Why are you deleting that important and relevant historyPosturewriter (talk) 07:42, 7 June 2008 (UTC)posturewriter


 * PW: I used the initialism DCS here on the talk page for my own convenience, much like I abbreviate editors' names on occasion.  I did not introduce it into the article or recommend that it be introduced into the article.  Do you have a problem with it being removed?  WhatamIdoing (talk) 17:32, 7 June 2008 (UTC)

WhatamIdoing; I agree that the use of the initialism DCS is a good idea here, given the volume of text, but, as you say, not appropriate on the article page, where the full term Da Costa's Syndrome should be used where necessaryPosturewriter (talk) 09:07, 8 June 2008 (UTC)posturewriter


 * As for the other issue: The "reliable sources" re-interpret DCS every couple of decades.  The article therefore presents the changing interpretations.
 * Some of these interpretations are dramatically different from each other: Some are convinced it's driven entirely by anxiety.  An old theme (rejected by Da Costa) was the weight of the gear and style of the belts used by infantry.  (Da Costa rejected this theory because it turned up in cavalry as well, who had entirely different gear, without any of the compressive features.)  Jenny King says most "DCS" patients have chronic hyperventilation.  Many cheerfully assign it to the PTSD continuum, and nevermind all the DCS-labeled people with no apparent trauma.  Some researchers will tell you privately that giving someone a DCS diagnosis before giving them a tilt-table test is malpractice.  Others note the overlap with IBS, fibromyalgia, restless leg syndrome, etc., and think it's likely to be caused by whatever causes those conditions.  (Current mainstream view:  Hereditary autonomic dysfunction.  Major alternative views:  Various pollutants, or stress.)
 * Since there's really no gospel truth here, or no ideal source, we present all of the major interpretations. We do not really attempt to choose between them, and indeed we should not be in the business of choosing "this" properly sourced interpretation over "that" equally properly  sourced interpretation.  Deciding that Paul's paper is the one true interpretation of DCS (which just happens to line up with our personal POV) is not our job.  We just say that these interpretations exist.  If you have suggestions on how to more clearly present this, please feel free to propose your ideas here.  WhatamIdoing (talk) 18:10, 7 June 2008 (UTC)


 * WhatamIdoing; Regarding your comments above; As I proceeded to present the research findings in chronological order on the article page I noticed that it was a good way of enabling wiki readers to see the date of the discovery, the name of the researcher, the nature of the observation or discovery, and the effect it had on the course of research and labels. I was therefore filling in the gaps between the existing items from 1864 through to 1997. Regarding the field pack straps around the soldier’s chest. During strenuous or sustained exertion the tight straps prevent the full expansion of the lungs on inspiration when maximum oxygen uptake is needed, and that results in a cumulative oxygen debt. The straps can also aggravate or produce cardioptosis. Regarding hyperventilation; Dorland’s describes the type of breathlessness as polypnea (shallow rapid breathing), and the type of breathlessness in Da Costa’s syndrome is described as dyspnea (in particular; the type of dynpnea which  involves occasional slow, forced deep sighs, especially during sustained physical exertion) Posturewriter (talk) 05:48, 14 June 2008 (UTC)posturewriter


 * Guido den Broeder; I agree with your comments on your talk page on 1-6-08 here, which I will now respond to on this discussion page to avoid duplication. As you imply Da Costa's syndrome is ‘a’ post-war syndrome, but not ‘just’ a post-war syndrome.
 * For example the condition also affects women in peace time, so it can’t be ‘just caused by war’. Similarly there are many post war syndromes, not just one. For example the shockwave and mustard gas syndromes of WW1, the nuclear fallout syndromes related to WW2, the Agent Orange syndromes of the Vietnam War, and the toxic oil fume syndromes of the Iraqui war. Also, if viral infections, or the fatigue that they cause, contributes to Da Costa symptoms, then toxins may play a part, but that has yet to be decided. Da Costa’s was just Da Costa’s syndrome, but in all wars since there has been one or more syndromes occurring in some cases separately or mixed together. The Da Costa article page describes the history of research into the first properly described post-war syndrome. In peace time the condition is a type of chronic fatigue syndrome which involves effort intolerance (effort limitations), as explained by Paul Dudley White, the typical symptoms “are precipitated by excitement or effort, and “it constitutes a kind of fatigue syndrome” . . . and in some cases . . . “it is more or less a chronic condition“ . . . and . . . “That such a state of ill health exists there can be no doubt, no matter what its pathogenesis or exciting factors” . . . but that 1951 evidence was deleted by WhatamIdoing on 12-5-08 here
 * I have tried to add more information relevant to your question, and others related to naming issues in my reply to WhatamIdoing just above this paragraph; here ,
 * I hope this clarifies any apparent discrepancies Posturewriter (talk) 09:07, 8 June 2008 (UTC)posturewriter

Comments on the novel “Soldier’s Heart”
WhatamIdoing; In the past you have repeatedly required me to only provide material for the Da Costa article page which is supported by references from "reliable", independent, peer reviewed, medical and scientific research journals of the highest quality. For example here. I would therefore like you to remove the reference to the children’s fiction novel called “Soldier’s Heart” which was presented as the lead on the first line of the article page by editor WLU on 31-5-08 here The novel is loosely based on the true story of Charley Goddard, a tall and strong, uneducated 15 year old farm boy who spent all day, and most of his nights working as a manual laborer in the fields, and volunteered for the American Civil War. Although there is some mention of soldier’s heart, battle fatigue, shellshock, and post-traumatic stress disorder in the two and a quarter page foreword, there is nothing about any of those medical conditions in the body of the text in the small paperback novel. The breathlessness etc. that he experienced were no different to the temporary symptoms which affect a healthy teenager at the end of a tightly contested cross country race, followed by a few nights profound sleep, or restless sleep if over exerted. Charley Goddard didn’t have any indications of chronic disabling fatigue that are typical of Da Costa’s syndrome, insofar as he went in and out of four battles, with the last involving a downhill charge at full speed, when he was felled by two bullets, and the post-war symptoms described three years later could be more appropriately explained as the complications of those wounds. Namely; he limped about with a walking stick, probably due to a bullet wound in his leg or back, and he passed blood, probably due to a bullet wound in the kidney or bladder, and his fatigue would relate to constant blood loss. There were no antibiotics in the nineteenth century so almost all such people were dead within three years because of repeated bladder infections which eventually spread to the brain to cause delirium and death. His thoughts of suicide would have related to the leg wound making him unemployable as a farm laborer, and his lack of education would have made him uncompetitive for office work. Unemployment, poverty, and the loss of friends due to the loss of occupational social contacts etc., would be more typical, and more plausible causes of his depression. His recollections of war were described as memories, not as the horrendous, uncontrollable nightmares and flashbacks of Post-war syndromes. Therefore, although the book is an excellent and entertaining children's novel, it is not suitable as an example, or as a reference for the Da Costa page. Please note that Da Costa syndrome patients were typically, but not always, thin sedentary workers who had been sent off to war without any physical training. They were then loaded with heavy 60 lb. knapsacks strapped tightly to their backs and chests, and required to keep up with physically fit farm laborers on 26 mile forced marches until they became exhausted. After being discharged to hospital, they made a partial recovery but for months or years afterwards were affected with a chronic condition which involved palpitations, chest pains, breathlessness, faintness, and fatigue upon mild exertion, such as when walking fast, or climbing one flight of stairs etc. (i.e. with an effort syndrome which limits exertional capacity), which is described in the 1916 edit here.

Also please consider that Da Costa wrote his account of the syndrome after the war, in civilian life, and milder forms occur before wars, so the term Soldier’s Heart does not warrant any place in the lead  because it is misleadingPosturewriter (talk) 07:00, 26 June 2008 (UTC)posturewriter
 * Your personal diagnosis for Charley Goddard is quite irrelevant (WP:NOR). The novel is not a medical reference for the article; it's another topic with the name "Soldier's heart", and a disambiguation link is perfectly normal.
 * However, the disambiguation page Soldier's heart does need expanding to include, at least, the 2008 Brian Delate movie, so if that's done, the disambiguation at the top could be changed to the more generic "For other uses, see". Gordonofcartoon (talk) 12:07, 26 June 2008 (UTC)


 * The book isn't in the lead. It's a "hatnote".  This is Wikipedia's convention for disambiguation notes.  If you don't like it, take it up with WP:HATNOTE.  WhatamIdoing (talk) 00:29, 28 June 2008 (UTC)


 * Gordonofcartoon; When another editor places a reference on the Da Costa article page it is relevant for other editors to check it. There was nothing about Da Costa's syndrome symptoms in the text, so it is inappropriate to refer to it.
 * If you wish to question my interpretation, you will need to read it yourself and give me chapter and page numbers to assess.
 * Otherwise, as I appear to be the only one who has actually read it, I would like you to remove the following hatnote . . . “This article is about the medical condition also known as "soldier's heart". For the novella by Gary Paulsen, see Soldier's Heart (novel)”  . . . Any mention of 'Gary Paulsens novel' is irrelevant, and the mention of the term Soldier’s Heart is superfluous, because it i duplicates the term in the text of the page, and  because the  condition affects civilian men, and is more common in civilian womenPosturewriter (talk) 01:56, 28 June 2008 (UTC)posture writer


 * If you search for soldier's heart, you might end up at Da Costa's syndrome instead of Soldier's Heart (novel). Do you want a kid whose looking for the book to read through the whole DCS page in total confusion, just so "your" article looks the way you want it to?  WhatamIdoing (talk) 02:41, 28 June 2008 (UTC)


 * WhatamIdoing; Do you think that the average wikipedia reader is going to look for references in the children’s section of their local library to improve their level of knowledge to that of an uneducated teenage hillbilly who would have lived and died 150 years closer to a little brown creek than todays big pond?Posturewriter (talk) 03:26, 28 June 2008 (UTC)posturewriter


 * No, I think that some of them will type soldiers heart into the search box and look at several links until they find what they're looking for. Da Costa's syndrome is one of those links, because this article includes the words "soldier's heart".  On this search (today), the disambiguation page Soldier's heart is halfway down the page, Da Costa's is at the end of the page, and the Paulsen novel isn't even in the top 500 (where I quit looking).  WhatamIdoing (talk) 05:06, 28 June 2008 (UTC)
 * Any mention of 'Gary Paulsens novel' is irrelevant
 * It's another thing with the same name; how more relevant can you get? For comparison, see Full metal jacket bullet, which has a hatnote to Kubrick's movie Full Metal Jacket. Obviously the latter is not a reference for the former, but as it has the same name, a link is appropriate and expected.
 * Incidentally, a reliable source - the New York Times review cited from Soldier's Heart (novel),  (you'll need a Bugmenot login) - says of the book that Goddard's ... life is shattered by what we now call post-traumatic stress disorder and what was then known as soldier's heart. Gordonofcartoon (talk) 14:10, 28 June 2008 (UTC)


 * Any mention of 'Gary Paulsens novel' is irrelevant
 * Alternatively, you can argue that the novel is indeed irrelevant to this article, and its very irrelevance is why we need the hatnote. The fundamental meaning of the hatnote is "If you are looking for the Paulsen novel, you are in the wrong place, so please go away."  It's exactly as relevant as the teacher beginning the first class of the term with an announcement of the teacher's name and the name of the class, and if you aren't enrolled in this class, you are in the wrong place and should leave now.  It is most emphatically not a recommendation that anyone read this book.  WhatamIdoing (talk) 03:06, 30 June 2008 (UTC)


 * Gordonofcartoon; For the purpose of reviewing someone else’s reference I borrowed a copy of Gary Paulsen’s novel “Soldier’s Heart” published by Macmillan Children’s Books in 1998. The foreword of two and a quarter pages contains the terms “post-traumatic stress disorder” in the second paragraph, and “Soldier’s Heart” on the last line. The actual story is then presented with 102 pages of text, followed by some authors notes etc. I also have a copy of Da Costa’s original research article published in 1871. None of the symptoms of Da Costa’s Syndrome are mentioned in Paulsen’s novel.
 * Wikipedia policies and guidelines are not carved in stone, and allow for common sense. Hatnotes shouldn’t be used as a reason for giving an entirely irrelevant reference undue weight on the top line of an article page when such items have previously been placed more appropriately in separate “See Also” or “Related” sections, where they have shared equal consideration as alternative labels etcPosturewriter (talk) 07:41, 29 June 2008 (UTC)posturewriter.
 * For the purposes of the hatnote, it doesn't matter what the book says; for all I care, it could say soldier's heart is a kind of small flowering plant. A hatnote is not a reference. It is purely for disambiguation of topics with the same name, and conveys no implication of relative importance or 'framing'.
 * If you interested yourself in other articles on Wikipedia, you might develop some better knowledge of the conventions here. Do you believe that The Vampire Bat is a reference for Vampire bat or, as cited in WP:HATNOTE, Dunwich (Lovecraft) is a reference for Dunwich?
 * As WhatamIdoing said, if you don't like the way it works, take it to Wikipedia talk:Hatnote - but you won't get a different answer. Gordonofcartoon (talk) 23:41, 29 June 2008 (UTC)


 * PW, I just want to add that I'm sorry you read that book. Paulsen makes a living from writing deliberately depressing books to promote his anti-war/anti-military views.  He has a particular talent for sympathetically disgusting descriptions.  I have read about ten of them and only found one that was worth my time.  They are, unfortunately, officially recommended or required reading in many, many American schools.  WhatamIdoing (talk) 03:06, 30 June 2008 (UTC)