Chronic Fatigue Syndrome
Barring a shift in society's values, the only thoroughly legitimate
excuse for ditching the pursuit of achievement is getting sick. That
explains the rise in chronic fatigue syndrome today, reports a team of
Canadian doctors. As with neurasthenia a century ago, it's a case of
people in emotional distress plucking from the cultural climate symptoms
regarded as bona fide evidence of disease.
For the past 100 years, the culture has borrowed ideas from science
to explain the human condition. In neurasthenia, for example, a fixed
quantity of nervous energy was thought to fuel the electrically powered
nervous system. With identical symptoms, chronic fatigue syndrome draws
on "the most dramatic landmarks" in American medicine today--concepts of
infectious disease and immunology. So instead of spent stores of nervous
energy, today's sufferer sports an overloaded immune system and ongoing
viral infection, although no virus has yet been found to be the
culprit.
In both cases, nonspecific somatic symptoms provide " refuges for
those overwhelmed" by modem life, say University of Toronto psychiatrists
Susan E. Abbey and Paul E. Garfinkel. Both ills arose in times of
preoccupation with material success and changes in the role of women. In
the American Journal of Psychiatry they predict the syndrome will fall
out of fashion and the underlying distress will be revealed for what it
is: scientific metaphor dressed for success.
Nonsense, says a team of researchers from the National Institutes
of Mental Health. The link between biology and behavior is real, not
metaphoric, in patients with chronic fatigue syndrome.
Led by Mark A. Demitrack, M.D., the researchers recently discovered
a hormonal deficiency in chronic-fatigue-syndrome (CFS) sufferers.
Compared with 70 normal volunteers, 30 CFS patients had reduced levels of
cortisol--a hormone produced in response to stress.
Whether a stressor is a virus, environmental toxin, or
psychological event, the body reacts the same way. A primitive part of
the brain, the hypothalamus, kicks off a hormonal relay by secreting
CRH--a brain chemical that prompts the pituitary gland to secrete ACTH,
which circulates in the blood and signals the adrenal gland to produce
cortisol. The study showed that not only did the chronic-fatigue patients
have cortisol deficiency, but it resulted from a CRH deficiency.
By itself, cortisol deficiency leads to lethargy and fatigue,
Demitrack and colleagues report in the Journal of Clinical Endocrinology
and Metabolism. The CRH deficit compounds it.
The depressive and lethargic symptoms of CFS patients mirror the
pattern seen in people who have such well-known biochemical imbalances as
hypothyroidism and Cushing's disease. "Finding a common
central-nervous-system defect in these illnesses underscores the fact
that they are all fundamentally medical disorders," say the researchers.
There's only one problem. They can't tell whether the mild hormonal
changes found in CFS patients actually cause their symptoms.
But the hormonal view has an abiding virtue--it takes viruses off
the hook. It even explains why science has spend years searching in vain
for a viral culprit. Since stress hormones blunt immune function, a
deficit of these could leave the immune system overactive, churning out
the antibodies that imply a virus did it.
Photo: CFS: Virus, hormones, or simply a metaphor for modern times?
((c) Peter A. Simon/Phototake)
Tags:
american journal of psychiatry,
american medicine,
brain,
canadian doctors,
cfs patients,
Chronic Fatigue Syndrome,
emotional distress,
energy today,
hormonal deficiency,
hormone,
imbalances,
institutes of mental health,
legitimate excuse,
mark a demitrack,
material success,
modem life,
national institutes of mental health,
nervous energy,
neurasthenia,
role of women,
somatic symptoms,
toronto psychiatrists,
viral infection
