Chronic Fatigue Syndrome (CFS)/ME as a twentieth-century disease: analytic challenges

The challenges of chronic fatigue syndrome (often called myalgic
encephalomyelitis, especially in the UK) (CFS/ME) to
analytical and medical approaches are connected with our
inability to understand its distressing somatic symptoms in
terms of a single identifiable and understandable disease
entity. The evidence for the roles of viral aetiologies
remains inconclusive, as does our understanding of the
involvement of the immune system. The history and social
context of CFS/ME, and its relation to neurasthenia and
psychasthenia are sketched. A symbolic attitude to the
condition may need to be rooted in an awareness of psychoid
levels of operation, and the expression and spread of CFS/ME
may sometimes be aided by the ravages of projective
identification. Psychic denial, sometimes violent, in
sufferers (especially children and adolescents) and their
families may be important in the aetiology of CFS/ME. We draw
out common threads from psychodynamic work with five cases,
four showing some symptomatic improvement, analytic
discussions of three cases being presented elsewhere in this
issue of JAP.

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