EDITOR,-Michael Loudon continues the debate about the contribution of psychological factors to the development of the chronic fatigue syndrome and the influence of patients’ expectations on the prognosis.
I developed glandular fever over a year ago. For three months earlier this year I had considerable but variable difficulty in getting out of bed in the morning, muscle “woodenness” all over, and wobbly legs in association with a still positive PaulBunnell test. Normal activities have not been a problem for some time now, but I am still struggling to resume sporting activities at something like my previous level.
Why do we seek to make general statements? It is so easy to illustrate the futility of trying to generalise. For example, the teenage son of one of my colleagues on the nursing staff at our hospice died of hepatitis arising from the early stages of glandular fever, despite his transfer to a liver unit. By contrast, I had a normal appetite from the beginning of my illness and no abdominal tenderness. If this lad died of hepatitis and I had no hepatitis at all, does anyone suggest that he did not have a helpful attitude to his illness, while I did to mine? I think not. Why not? Because when we understand and can measure we accept that there is a range of organically based illness.
Surely the reason why there is scepticism about whether the chronic fatigue syndrome has an organic basis is because of the implications for long term absenteeism from work as well as the cost to the country in benefits.
You can read the rest of this comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2541947/pdf/bmj00463-0066e.pdf
Source: Ife S. Influence of patients’ expectations on disease. BMJ. 1994 Oct 29;309(6962):1160-1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2541947/