While participating in the Feministe thread on fibromyalgia, I’ve been re-reading a few UK-based journal papers on how chronic fatigue syndrome is all in our heads and shit.
I just re-stumbled across this little nugget from the British Medical Journal, in “ABC of psychological medicine: Fatigue”. The Journal’s hugely popular “ABC” series has been widely reprinted into a series of textbooks used in medical schools, including in Australia.
Patients should be told that they are suffering from a common and treatable condition that the doctor takes seriously and for which behavioural treatment can be helpful. While patients may be concerned about possible disease and the need for medical investigation and treatment, it can be explained that no disease has been found, and hence there is no disease based treatment, but that with help there is a great deal that the patients can do themselves.
Identifying unhelpful beliefs—Potentially unhelpful beliefs should be discussed. If a patient has a simple aetiological model (such as “It is all due to a virus”) an alternative approach based on a biopsychosocial formulation can be outlined. This has the advantage of highlighting potential perpetuating factors, as these may be regarded as obstacles to recovery. Doctor and patient can then work together to overcome these. It is rarely productive to argue over the best name for the illness; instead, the emphasis should be on agreeing a positive and open minded approach to rehabilitation.
[Box]: [image – 1836 artwork depicting women walking in a garden-like setting] Image caption: Patients should be encouraged to gradually increase their activity. (“Mrs Bradbury’s establishment for the recovery of ladies nervously affected,” from On Insanity by William B Neville London 1836)
 BMJ 2002;325:480-483