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Handbook of Chronic Fatigue Syndrome. Edited by L. A. Jason, P. A. Fennell and R. R. Taylor. (Pp. 794; 58.50; ISBN 0-471-41512-X.) John Wiley Sons: Chichester, UK. 2003
| Content Provider | Semantic Scholar |
|---|---|
| Author | Fennell, Patricia A. |
| Copyright Year | 2004 |
| Abstract | In 1869 George Beard described fatigue as ‘the Central Africa of medicine, an unexplored territory into which fewmen enter ’. TheHandbook of Chronic Fatigue Syndrome provides a number of differing theoretical accounts of chronic fatigue syndrome (CFS) along with a variety of assessment and treatment strategies. The Handbook illustrates that CFS is no longer ‘an unexplored territory’ and there is no shortage of ‘explorers ’. Anyone reading it from cover to cover will discover that there is still no clear consensus regarding the definition, aetiology, diagnosis, prevalence, assessment and treatment of CFS. CFS remains controversial and the Handbook adds some very contrasting perspectives to the on-going debate. Some contributions are stimulating, scholarly and scientific while others are contentious or apocryphal. Why do we have so many disparate views and so little consensus regarding CFS? In the management of chronic illness, and CFS in particular, conventional medicine stands accused of various crimes ranging from ‘benign neglect ’ to ‘ iatrogenesis ’. Perhaps there would be no controversy if CFS fulfilled the current medical definition of disease. Western medicine has its origins in the rationalist scientific method. The whole emphasis of the scientific method is on proof. Disease became defined as a biological event with pathology, a specific entity, concrete and identifiable. CFS does not currently fulfil these criteria because CFS does not have a unique symptom profile or specific diagnostic laboratory marker. Fatigue, like pain, is a subjective sensation – it is private data that cannot be objectively measured. The severity of fatigue can only be gained by listening to the personal report of the sufferer. Any symptom that causes suffering should be taken seriously with or without objective corroborative data. CFS is, according to its definition, medically unexplained. Medically unexplained symptoms (MUS) consistently account for 20–40% of all consultations. MUS, and CFS in particular, continue to pose a challenge to the orthodoxy of medicine and psychiatry. Perhaps it is biomedicine’s own belief system, its ‘ institutional dualism’ – the separation of the mind and the body that is ultimately responsible for the controversy surrounding CFS. Doctors may, in the absence of an identifiable disease – (‘not in the body’ – ‘nothing the matter ’), explicitly or implicitly, label the patient’s problem as psychological or psychiatric – (‘all in the mind’), although CFS is inconsistently associated with mental-health problems. People have always sought credible explanations for their symptoms and understandably they tend to reject a psychological explanation for a set of symptoms that they experience in a very real and physical way. Medicine’s failure to provide an explanation can appear to reject the reality of the patient’s physical symptoms and the patient may feel disbelieved and alienated. The explanatory void left by medicine can create uncertainty and distress for the patient, damage to the doctor–patient relationship and the void is filled by the anarchic growth of alternative explanatory models. Perhaps it is medicine that needs to change by moving towards a new, more inclusive clinical method that does not exclude this substantial proportion of patients. Doctors often see their primary role as excluding disease. Technological advance has placed increased importance on biochemical and physical abnormalities, objective data, rather than the patient’s symptoms, their emotional well-being, their beliefs, or their social and cultural background. Cognitive behavioural therapy (CBT) is well reviewed in the Handbook. Research shows that CBT is an effective treatment for CFS. Despite Psychological Medicine, 2004, 34, 1137–1142. f 2004 Cambridge University Press Printed in the United Kingdom |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | https://static.cambridge.org/resource/id/urn:cambridge.org:id:binary:20170223033122482-0099:S0033291704233207:S0033291704003204a.pdf |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
