Chronic Fatigue Syndrome

An outbreak of a puzzling fatiguing illness in northern Nevada in 1984 was a beginning for the later named chronic illness: Chronic Fatigue Syndrome (CFS)(Holmes, Kaplan, & Steward, 1987 as cited in Friedberg, 1996). CFS is a relatively new name for a disorder, of unknown etiology, characterized by debilitating fatigue and other somatic and neuropsychiatric symptoms (Farrar, Locke, & Kantrowitz, 1995). In 1988 CSF was first recognized as a diagnostic entity by the Center for Disease Control (CDC) (Holmes et al., 1988 as cited in Anderson & Ferrans, 1997). Previous to this, CFS was referred to as myalgic encephalomyelitis (ME), neuromyasthenia, post viral fatigue syndrome, chronic Epstein-Barr virus/mononucleosis syndrome, Icelandic disease, Akureyri disease, royal free disease, chronic brucellosis, and fibromyalgia syndrome (Farrar et al., 1995; Schweitzer, Kelly, Fordan, Terry, & Whiting, 1995). Historically, CFS resembles, quite strikingly, the 19th Century condition known as neurasthenia. Some theorize that CFS has arisen for socioeconomic and reasons reflecting the particular circumstances of the late 20th Century (Farrar et al., 1995). A contemporary rival of neurasthenia, historians say, CFS has been marked by its occurrence during a social transformation time in the role of women. Over the past two decades, the rapidly changing role of women may have created an impossible set of expectations to achieve in the workplace, to nurture a family, and to embrace social commitments (Friedberg, 1996). From childhood to adulthood, women learn that their roles in family and society are caregivers, mothers, wives, and sexual partners (Tarvis, 1992). Our culture wrestles with the expanding role of women and the mismatch between women's ambitions and social possibilities (Abbey & Garfinkel, 1991). In our society today women constitute 48% (nearly half) of the U.S. workforce (Boston Women's Health Book Collective, 1998). The combination of unpaid work in the home and paid work outside the home affects women's overall health (Boston Women's Health Book Collective, 1998). Cultural and societal expectations don't yet counterbalance women's movement into the working force with expectations of families to redefine the balance of responsibilities on their home front. Women feel conflicted about the balancing of their working lives and careers with their family obligations and personal well-being. The diagnosis of CFS provides a legitimate reason for their fatigue, emotional distress, and associated psychophysiological symptoms and allows them to withdraw from situations they find intolerable on the basis of illness rather than their own volition (Abbey & Garfinkel, 1991). With this influence CFS could be interpreted as a cultural idiom of distress or a form of culturally sanctioned illness behavior which historically parallels interpretations of the 19th Century conditioned know as neurasthenia (Kleinman, 1988 as cited in Abbey & Garfinkel, 1991). Controversy regarding all aspects of CFS (its definition, etiology, treatment, and pathogenesis) continues to affect the medical community and rehabilitation of patients with CFS. Prevalence Twenty percent of all medical visits to primary care clinics involve a complaint of significant fatigue (Friedberg, 1996). If fatigue is persistent and debilitating, and cannot be identified as a symptom of a known medical or psychological condition, an evaluation for CFS is indicated (Friedberg, 1996). CFS has been reported in North America (U.S., Canada), Europe (Britain, France Germany, Italy, Spain, Sweden), Israel, Japan, Australia, and New Zealand (Farrar et al., 1995). Reported incidence of CFS suggests that women are diagnosed two to three times more frequently than men (Straus et al., 1988 as cited in Anderson & Ferrans, 1997). One study estimated prevalence of CFS ranging from three to 10 in 1,000 (0. …

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