A view of the helplessness and violence contained in chronic fatigue syndrome†

In this work, originally undertaken 10 years ago, the author asks whether there might be any one particular psychopathology likely to be linked specifically with the physical illness known as chronic fatigue syndrome (CFS) or myalgic encephalitis (ME), and whether CFS/ME aids and abets, and ‘fits’, an original mental state. She thinks the question cannot yet be answered, but hypothesizes that in some personality structures the onset of CFS/ME following a physical illness exacerbates negativity, and is an aspect of ordinary depression where there is a lowering of energy levels and a loss of zest for life, or it may reveal the pathological aspect of unresolved rage. Depending on the degree of pathological disturbance, working with and through the rage may or may not result in a resolution of the symptoms of ME. Some of the problems in the transference and countertransference relationship are considered, which make it extremely difficult to separate out reality from fantasy. There is then the further problem of the denial of the psyche by the patient as part of the violence inherent in the illness. The findings in this paper are corroborated by research undertaken over the last four years and these are incorporated into the paper. One case is presented, an example of ME in a borderline male patient in whom resolution could not be achieved. Copyright © 2005 The British Association of Psychotherapists