Well Action Psychotherapy

"ME/CFS/Chronic Fatigue. It's not a real illness, it's all in the mind." I've heard this sentiment over and over again from professionals who should know better; I couldn't disagree more.

This does beg the question of "what is a real illness?" but for the sake of this post let's say it's "a functional disorder which is mainly physical in character, examples being a broken leg, heart failure, an illness caused by bacteria or viruses, a malfunctioning immune system or an acquired brain injury.

Disclaimer: I'm not a medical doctor ... but:

Chronic fatigue is a life changing condition. It has a similar impact on life as finding yourself wheelchair-bound or losing both your legs ... or worse.

Chronic fatigue is not one thing. It's a description of a set of symptoms which can have various combinations and many causes.

Symptoms include, but are not limited to:

• Crushing tiredness after completing relatively simple tasks such as cooking, cleaning, going to the shops, having tea with a friend.
• Experiencing tiredness as pain.
• Muscle pain, which can be relieved with gentle massage.
• Anxiety attacks in response to stimulation such as: watching TV, reading a book, listening to music, being in a noisy environment.
• Disrupted sleep patterns.
• New food intolerances and unusual digestive symptoms.
• Intermittent "Brain Fog".
• Loss of concentration, sometimes to the point of being unable to interpret speech. This can be particularly isolating and distressing.
• Intolerance of cluttered or untidy environments (too much visual stimulation).

Chronic fatigue is usually triggered by some particular event or situation, but recovery doesn't proceed when the situation changes. Recovery can take years, and might never happen.

Chronic fatigue used to be known as "Neurasthenia" and treatment by a psychiatrist and a psychoanalyst was the misguided recommendation.

Known causes:

• Extreme physical stress. Extreme sports enthusiasts, and the specialist medics who treat them, are well acquainted with this form of the illness.
• Glandular fever. Especially if the sufferer doesn't keep resting until they're fully recovered.
• Covid. The symptoms of "Long Covid" have their own particular pattern slightly different from other manifestations of chronic fatigue.
• Common viruses. "Pushing through" flu or similar diseases can launch chronic fatigue.
• Organophosphate poisoning. Also known as "nerve gas", these chemicals are also present in some insecticides. Its presence in sheep dip caused an "outbreak" of ME/CFS amongst UK farmers in the 1980s.
• Some rheumatic diseases, especially those that affect young adults like ankylosing spondylitis, leave sufferers more susceptible to chronic fatigue.
• Emotional shock. Well known for triggering some auto-immune diseases, sudden bereavement or relationship breakdown can also trigger chronic fatigue, adding weight to the theory that many forms of the disease may be auto-immune in nature.
• Burn-out. High performing individuals who have over-stretched themselves continuously over a period of years.

Is there a cure?

Those who take ME/CFS seriously are all agreed: rest for as long as it takes, and that could be years.

The prognosis differs according to the underlying cause:

• Organophosphate poisoning => permanent irreversible disabling nerve damage.
• Auto-immune conditions => recovery in less than 3 years but the ever-present threat of relapse.
• Glandular fever => very variable, can be lifelong.
• Long Covid => this hasn't been around long enough to have a good idea, but at least partial recovery between 6 months and 3 years seems to be the pattern so far.
• Extreme physical stress or burn-out => usually complete recovery within 3 years, but some people are more susceptible to relapse.

Can psychotherapy help?

CBT has been shown to be effective in relieving the depression and anxiety often associated with chronic fatigue.
It can also be very helpful in managing the ups and downs of the illness: making the most of good days without plunging you back into illness, and finding ways of coping with the bad days without slipping into despair.

Psychotherapy helps with some of the social impacts that follow from chronic fatigue: relationship breakdown, alienation from a sceptical family, loss of job and status, loss of meaning, etc.

Group psychotherapy, for example group gestalt, group analytic or group psychodrama, can help a lot with alleviating the social isolation.

Deep psychotherapy can help individuals who find it difficult or impossible to rest, thus keeping the illness going. Exploring why somebody is driven to succeed or compete, or investigating strategies to keep oneself from desperate boredom while debilitated, can be very helpful.