I'm sure that's part of it. When I worked in liaison psychiatry I'd usually avoid overly 'psychiatric' interpretations but explain my role in terms of all illnesses having an emotional element - being anxious, for example, tends to make us experience pain more acutely - and while I couldn't offer a cure for their illness, I might be able to help moderate the pain/anxiety/fatigue.
CFS patients tended to reject even that line of reasoning and seemed, on average, more invested in a dichotomous all-or-none physical-or-'in the head' view of illness. I'm pretty sure there's been research carried out which broadly backed this up - although God knows I'd be hard-pushed to put my finger on it.
The socioeconomic profile is evening out as the condition (or, IMHO, conditions) gain more and more press coverage - which is, in itself, interesting.
As you say, some of the general anger may arise from the fact that no consistent organic deficit or imbalance can be found to account for chronic fatigue states - and there's no easy 'serotonin imbalance' style euphemism at hand to give treatment a comfortingly 'medical' gloss. I'm sure there's also frustration at the fact that, faced with an increasing demand for treatment/explanation physicians have, in desperation, recommended try-it-and-see measures (bed rest, for example) which have subsequently proved ineffective. Even so, I'm not sure that this in itself accounts for CFS sufferers' generally low tolerance of medical failure and their sensitivity to feeling 'fobbed off'...
My own personal opinion (and I emphasise 'personal opinion') is that Chronic Fatigue Syndrome represents one of those culture-bound 'expressions of distress' which arise mysteriously among populations at certain historical junctures and disappear just as abruptly. While the population of individuals labelled 'ME' is probably a heterogeneous one, I'd say the largest number develop chronic fatigue symptoms as a sort of atypical depression afflicting people who a) face a life situation which is, in some way, stressful, b) have a tendency to somatise their distress, and c) have no easily-identifiable way of escaping their situation.
I've absolutely no idea where the 'biochemical lesion' might lie but it's worth noting that fatigue, low mood, poor sleep and impaired energy levels are also core symptoms of depression and, as such, it's reasonable to speculate that serotonin and noradrenaline may play a part. If memory serves, Simon Wesselly of the Maudsley, reviewing the various treatment avenues, concluded that SSRI antidepressants, cognitive behaviour therapy and a graded exercise programme proved helpful in up to 70% of cases.
If it is a 'disease of modern culture', I guess we have to wait until it evolves into something else... |
