At the end of the last century the maladie à la mode was a condition whose chief symptom was extreme fatigue. According to one account "subjects cannot complete the simplest act in one effort... without feeling insurmountable lassitude." Patients also complained of headache, stomach upset and sensations of all kinds. Neurasthenia was put on the medical map by a New York neurologist, George Beard, in 1867. It spread rapidly, especially in France and Germany. Dr Adrien Proust, whose son Marcel was a lifelong neurasthenic, wrote one of the most popular texts on the subject.
Although physicians could find no objective signs of disease, Beard believed the illness to be organic: a depletion of the energy available to the brain, as a result of overwork brought on by the demands of modern civilisation. There were always acrimonious disputes about the validity of neurasthenia among doctors, especially among sceptical British neurologists, but it did not fall completely out of use as a diagnosis until the 1940s.
This unusual book by three psychiatrists, all involved in treating chronic fatigue, finds compelling parallels between neurasthenia and its late 20th century cousin-myalgic encephalitis or ME. This, too, is a disputed illness. Many doctors regard the diagnosis with suspicion. However, since this book was published chronic fatigue syndrome (CFS), as the medical profession prefers to call it, has been officially recognised by the department of health.
CFS came to public attention in the mid-1980s, the typical patient being the City whizz-kid who went down with "yuppie flu." There is no doubt that CFS can have devastating consequences. But the problem for CFS patients is that although they feel ill, like the neurasthenics, they look healthy and have normal test results. Without the security of a clear diagnosis they have had to face the scepticism of GPs, employers and even friends.
Sufferers firmly believe that an organic cause for their illness will be found and in the meantime provide theories of their own. These range from over-prescription of antibiotics, vaccination, immune dysfunction possibly caused by pollution, bad air, the water, dental amalgam, candida infection and chronic brucellosis. "It is an overload disease unique to this century," wrote one sufferer.
Medical researchers have also been busy investigating CFS, producing a large scientific literature that is exhaustively reviewed here. The results are inconclusive. "The closer one gets, the less one understands it," confess the authors. They doubt that any specific cause will be found. The evidence for a psychological component to the illness is not straightforward either.
CFS, the authors conclude, is a process with many causes, not a discrete disorder. But now that it is officially recognised, there is a committee to produce guidelines for treatment. The best known treatment for neurasthenia was the rest cure in a private sanatorium, with massage, electricity and special diet. Bed-rest, however, by weakening muscles and altering immune function, is now known to be a very bad idea. Patients have responded best to a short-term therapy which concentrates on altering thoughts that may prevent recovery. But they emphasise that no treatment will succeed if the doctor does not listen sympathetically to the patient. Indeed, this book is part of the response to the campaign of CFS sufferers who approached the medical profession for help and found it wanting.
Chronic fatigue and its syndromes
Simon Wessely, Matthew Hotopf, Michael Sharpe
Oxford University Press 65
