Chronic Fatigue Syndrome is a multifactorial disease, and it can present with both physical and psychiatric symptoms, and hospital-based studies have shown that over 50% of CFS patients meet the diagnostic criteria for major depression. Unfortunately, in such circumstances it has often been the case that in the absence of a definable physical cause, many patients were diagnosed as clinically depressed. Non-specialist General Practitioners were being asked to differentiate between CFS and depression, and in a situation where little was known about the former, it was common to label the physical symptoms as the psychosomatic outworkings of major clinical depression. It was precisely this situation which Chris encountered subsequent to that first viral attack, as she visited the doctor ever more frequently to complain of ‘pains and fatigue.’ The visits to the doctor were of course complicated in Chris’s case by the additional ‘weird’ symptoms of heightened senses of smell and taste, which might have suggested an enhanced sensitivity to allergens, and this, together with repeated viral attacks, should have indicated that all was not well with her immune system. To be fair, sufferers usually insist that the symptoms they experience have an exclusively physical cause, and are often so convinced of this, that their doctors are persuaded to arrange extensive physical examinations, that can even include endoscopic searches. This latter kind of examination usually produces little in the way of a result, leaving the medical consultant exasperated, and the G.P. ‘out-of-his-depth’ and embarrassed about having made a seemingly pointless referral. The truth is that CFS is holistic in nature, and is unexplained by primary physical or psychiatric causes.
Consequences
The physiological symptoms of CFS are not life threatening, nor are they of indefinite duration, for sufferers do recover, albeit often five, ten, or fifteen years on from inception. Unfortunately, long term illnesses of this nature, together with the associated, entrenched psychiatric problems, have far-reaching effects on sufferers’ lives and (to use that dreadful word!) ‘lifestyles.’ Afflicted professionals, such as doctors or teachers are initially able to use up extensive paid sick leave, but find ultimately that they are compelled to give up their careers. It tends to be axiomatic that the busiest, most effective, professional people fall prey to CFS. The busy life in laboratory, surgery, or classroom becomes inexorably reduced in scope, until finally, in the worst cases, the sufferer is scarcely able to cross a room without the most excessive effort and pain. Usually, alongside and inextricably bound up with this remorseless advance into incapacity, comes a complete upheaval in the individual’s personal values. Additionally, the individual’s perception of role and status within both the family unit and wider society, undergo an enforced and painful realignment. Andrew Ferguson quotes the German theologian, Jurgen Moltmann, who identifies the problem precisely when he remarks: “If health is taken as a supreme value, it may lead to the suppression of illness and that ‘the sick are pushed out of the life of society.’ An individual who becomes seriously ill may lose his or her sense of their own worth.”
Financially, the sufferer’s household is obliged to endure trauma of unprecedented proportions, as two often substantial salaries, become—in the more fortunate cases—one small, early, retirement pension, plus various disability benefits. Such financial strictures bring with them an enforced humility, which may prove to be a difficult psychological burden to bear. The value of the sufferer’s whole family unit may be seen to plummet in the ‘eyes of society,’ as two ‘involved’ professionals (perceived as net contributors) become ‘carer’ and ‘cared for’ respectively (both perceived as net beneficiaries). Children, teenagers especially, are without doubt traumatized by the complete reversal of fortunes, as houses, schools, and friends change in the kaleidoscope of stress-filled days passing before them. Adversity can, of itself, bring about aberrant behavior in the young.
At the outset of the illness, sufferers from Chronic Fatigue Syndrome usually become aware of physical symptoms such as muscle and joint pain, fatigue, sleep disturbance, abdominal discomfort, and body temperature fluctuations, but there is a second set of symptoms which are of potentially greater significance. This group comprises sheer mental incapacity of a completely debilitating order, invariably including impairment of memory, a persistent lack of concentration, and often difficulty in comprehending the spoken word. Keyboard performance, that is, the use of a typewriter or word processor displays these problems in microcosm, where the work produced frequently contains omissions and repetitions, and where work sessions are severely curtailed, perhaps restricted to only thirty minutes duration. Most professionals and business people struggle ‘manfully’ on in the face of physical pain and discomfort, given that their work is often sedentary and of a cerebral nature, but they are simply unable to function in the face of such mental incapacity. It is arguably this latter group of symptoms which terminate so many professional careers, and was certainly responsible for Chris’s long, slow slide into firstly anorexia, and secondly depression.
We were later to discover that anorexia—as a symptom of CFS— is encountered by up to forty percent of sufferers albeit as a minor one. Indeed there are two so-called minor symptoms of CFS—nausea and anorexia—which have been suggested as strengthening the CDC (United States Centers for Disease Control and Prevention) case definition of CFS. In actual fact the anorexia exhibited by CFS sufferers is true anorexia (from the Greek meaning no appetite), and for Chris this was manifested as an absence of appetite due to masking by the associated CFS symptom of nausea, which itself was a function of her enhanced sense of smell. The anorexia displayed by Chris, in this first year of her illness, is to be contrasted with the ‘usual’ presentation wherein the ‘normal’ sufferer is very very hungry indeed—despite protestations to the contrary. From the initial ‘triggering’ of the illness by that first viral attack, it took fully fifteen months for Chris to reach a weight of six and a half stone. It was then that concerned family and friends suggested that a holiday—the first in six years—might be just ‘what the doctor ordered.’ In fact, it was precisely the opposite of the doctor’s advice.
Anorexia Nervosa
What the doctor now saw, correctly as it turned out, was that the anorexia associated with CFS had now in fact become anorexia nervosa, that is, the so-called slimming disease most frequently associated with young girls. There had been a seamless transition from a minor symptom of CFS to a psychiatric illness in its own right, one which has the highest mortality rate of all such illnesses. The doctor’s advice was against travelling, and the coach journey to southern France was a painful one for the six and a half stone, yet undismayed Chris. Nothing could have shown Chris’s deterioration over the past twelve months more clearly than that holiday. The sight of this thin, milk, white figure in a blue sun-hat, who spent too much time in the toilets, was completely out of place amongst the healthy, bronzed Europeans relaxing by the camp pool. Because we were holidaying with two other couples—our close friends—we had between us half a dozen kids, and this meant a great deal of time was spent eating socially as a group. Now social eating causes anorexics great problems, especially in restaurant situations, for despite careful and judicious selection from the menu, it is rarely possible to control portion size. The remedy is found in impromptu exits to the toilets in order to vomit, or if all else fails, the taking of laxatives to relieve fictitious constipation. It