Historically Speaking: Three Influences on the Way we Think about CFS/ME

Abstract

This chapter is partly a response to the question raised in the previous one: How should we classify CFS/ME ? There are instructive parallels between the diagnosis of CFS/ME and its nineteenth-century equivalent, neurasthenia. In each case our thinking has been influenced by three historical/cultural processes: (1) medicalisation, which brings human troubles into the medical sphere; (2) medical theorising; and (3) medical professionalisation, which includes the development of specialities such as psychiatry, neurology, and complementary medicine.

Once a situation comes to be regarded as an illness, medical theories must follow. The history of neurasthenia turned less on scientific theories than on different cultural responses to the ambiguities of illness. A traditional response was to think of illness as a disturbance of the whole organism but the ‘ontological ’ idea of a discrete ‘disease ’ fitted better with the progress of scientific medicine. The advance of medical specialisation has favoured the view that either the brain or the mind is the locus of disease in neurasthenia. Explanations of illness that are oriented towards whole systems and whole persons lack the authority and legitimacy of organ-based specialities. Medicalisation, medical theorising, and medical specialisation have jointly created an environment in which patients who lack a discrete biological cause for their symptoms seem more mysterious and extraordinary than perhaps they are.