Chronic Fatigue Syndrome: A Moral Exploration of Illness and Accountability, 2025, McMurray

[forestglip]

Chronic Fatigue Syndrome: A Moral Exploration of Illness and Accountability

Jennifer McMurray

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Abstract
Chronic fatigue syndrome (CFS) is a complex and often debilitating condition characterized by persistent fatigue accompanied by a variety of additional symptoms that often include muscle pain, cognitive impairment, and post-exertional malaise. Despite affecting millions worldwide, CFS remains poorly understood and frequently stigmatized.

This paper explores historical and contemporary social perceptions of CFS, framing them within broader discussions of health, morality, and personal responsibility. By drawing on parallels to conditions like neurasthenia and hysteria, this research examines how societal values—particularly those shaped by the Protestant ethic and eugenics—have influenced perceptions of illness and morality.

It highlights how attributing unverifiable illnesses to personal responsibility affects societal attitudes toward those with CFS. Additionally, this paper explores the gendered dimensions of CFS, historically linked to women yet increasingly recognized in men. Recent developments, including the condition’s overlap with long COVID-19, emphasize the ongoing need for research and improved treatment strategies.

Web | PDF | The Motley Undergraduate Journal | Open Access

 

[ME/CFS Science Blog]

By drawing on parallels to conditions like neurasthenia and hysteria, this research examines how societal values—particularly those shaped by the Protestant ethic and eugenics—have influenced perceptions of illness and morality

This would very much surprise me.

I've read a lot about psychosomatic in ME/CFS and other diseases and to me it was pretty clear that it came from progressive circles, who were working in response to eugenics.

 

[Utsikt]

This would very much surprise me.

I've read a lot about psychosomatic in ME/CFS and other diseases and to me it was pretty clear that it came from progressive circles, who were working in response to eugenics.

That seems to be the opposite conclusion of e.g. Hunt and Hughes. Hunt tied the psychologisation of ME/CFS to the neoliberal (capitalistic) politics, and Hughes’ recent book seems to argue that western psychology in general has very conservative roots, with chapters like «Psychology’s roots in Eugenics» and «From conservative past to Neoliberal present».

 

[ME/CFS Science Blog]

Hughes’ recent book seems to argue that western psychology in general has very conservative roots, with chapters like «Psychology’s roots in Eugenics

Psychology perhaps, but probably not modern psychosomatics.

Would be interested in how they connect the views of Bettelheim, Kubler-Ross, Franz Alexander, or Engel to neoliberalism or eugenics. The popularity of psychosomatic medicine after WOII (before neoliberalism!) was mostly a counter-reaction against the biological determinism that was central to eugenics.

 

[Jonathan Edwards]

Psychology perhaps, but probably not modern psychosomatics.

I agree. Isee this sort of political analysis as completely missing the basic psychology of chronic illness mismanagement. I suspect it arose partly out of Robert Burns's ubiquitous 'man's inhumanity to man' and partly out of psychodynamic dogmas that, at least in the UK, have been notably championed by the victims of eugenic policies of Protestants. I cannot see any links to modern political movements. And the Guardian, that never misses a chance to call out sexism, laps up the phoney psychology more than any.

 

[Yann04]

I've read a lot about psychosomatic in ME/CFS and other diseases and to me it was pretty clear that it came from progressive circles, who were working in response to eugenics.

One counter example is greek ruler Metaxas. Who had a sort of eugenic view on psychiatry, and blamed bad genetics -> poor mental health/morality -> physical health problems for basically anything. Including workplace injuries. Thus, nearly all illness and injury were moral failures.

One paper I read on him called his ideology psychoabsolutism.

But yes. It’s undeniable that psychosomatics has been pushed and sustained by liberal ideology as well.

 

[Yann04]

That seems to be the opposite conclusion of e.g. Hunt and Hughes. Hunt tied the psychologisation of ME/CFS to the neoliberal (capitalistic) politics, and Hughes’ recent book seems to argue that western psychology in general has very conservative roots, with chapters like «Psychology’s roots in Eugenics» and «From conservative past to Neoliberal present».

Neoliberal-capitalism has a lot in common with liberal-progressivism. Perhaps more so than eugenic fascism. I mean liberalism itself is founded on a sort of capitalist market + progressive on social issues -> social liberalism. Both share a sort of individualism inherent to the liberal view. And whether a conservative interpretation of psychosomatics -> moral failing, or a more progressive in terms of psychosomatics -> need help. They both seem to be quite open to the concept of psychosomatics as it individualises suffering

(Tho I understand liberalism can mean very different things depending on the country, its one of these words that has kind of lost a lot of meaning due to being used in so many different ways).

 

[ME/CFS Science Blog]

One counter example is greek ruler Metaxas. Who had a sort of eugenic view on psychiatry, and blamed bad genetics -> poor mental health -> physical health problems for basically anything. Including workplace injuries

Same with Flanders Dunbar who even attributed physical accidents to psychosomatics and personality type.

But the type of psychosomatics we deal with in ME/CFS is one that denies a biological pathology and emphasizes that full recovery is possible. Clearly that way of reasoning is contrary to the idea of eugenics and biological determinism. And it seemed to have been much more popular in the period shortly after WOII when psychoanalytics was all the rage then after the neoliberal age starting with Reagan and Tatcher in the 1980s.

So I find it quite perplexing that people try to connect the psychosomatic view on ME/CFS with neoliberalism or eugenics.

 

[Yann04]

So I find it quite perplexing that people try to connect the psychosomatic view on ME/CFS with neoliberalism

why neoliberalism?
I mean it demonises welfare/dependence, focuses on personal responsibility, the individual/freedom, shys away from analysing systemic problems and sees them more as individuals failings, has a deeply entrenched healthist view that health is in large part a reflection of someone’s effort/good habits. Surely that is an ideology that pairs very well with the idea of psychosomatics, that if you try hard enough you will recover.

Psychosomatics is undergoing a second “boom” these days I think it’s fair to say, and I’m pretty sure the fact neoliberalism is the dominant system in the west right now isn’t a coincidence.

 

[Hoopoe]

It seems fairly clear to me that one of the goals of the psychosomatic ideology is to be a tool to justify withholding financial support from patients.

That's why in the psychosomatic ideology, ME/CFS must not be a chronic illness, but something treatable. The goal is to create barriers to receipt of financial support. It allows them to make receipt of disability benefits conditional upon having undergone rehabilitation. If the patient refuses or exposes themselves to the accusaiton of not having tried hard enough, they can use that to deny financial support.

It doesn't matter whether the illness is treatable or not. As long as the position that the illness is treatable has sufficient support in society, it can be taken and used against patients.

This is also why it is pointless to debate anything with the PACE trial authors. We want to talk truth, they want to talk politics.

 

[ME/CFS Science Blog]

quite open to the concept of psychosomatics as it individualises suffering

The psychosomatic theories on schizophrenia or autism, thought that the mind of patients told something about the essence of human nature or society, rather than biology or disease. So by studying the symbolism of patients and their symptoms, these physicians thought they could learn a hidden meaning about the world.

So I don't see psychosomatics as being related to 'individualising suffering' or personal responsibility. Proponents of psychosomatics usually argue that people get sick because of societal changes and pressures and they emphasize that people can get better but need the help of a skilled therapist.

There is for example a lot of psychosomatic literature that blames illnesses such as burnout, CFS, but also cancer or heart disease, etc. to the stresses of modern life or alienation of neoliberal society (disappearing of traditional roles and structure). The was the reasoning behind yuppie flu and Wessely and Shorters view that CFS was like depression but patients needed a societal acceptable way of saying they could not keep up.

 

[ME/CFS Science Blog]

It seems fairly clear to me that the psychosomatic ideology is a tool to justify withholding financial support from patients.

That's why in the psychosomatic ideology, ME/CFS must not be a chronic illness, but something treatable... and whether that is true or not is not relevant because the goal is to create barriers to receipt of financial support.

Yes psychosomatic theory is sometimes used as a tool to justify withholding financial support from patients. But psychosomatics isn't about that and it was popular much earlier in other diseases and contexts not related to insurance or disability benefits.

In the case of cancer and heart disease it was for example used to divert blame away from smoking.

 

[Hoopoe]

In the case of cancer and heart disease it was for example used to divert blame away from smoking.

I see that as consistent with what I said. In the context of insurance and welfare it is about disability benefits.

In other contexts, it is about avoiding responsibility in other ways.

The psychosomatic narrative is also used to get patients to complain less about how horrible the disease is. In this case the purpose is to reduce the emotional burden that patients place on others.

 

[ME/CFS Science Blog]

In other contexts, it is about avoiding responsibility in other ways.

No, it's often the exact opposite such as in psychosomatic theories on autism and schizophenia or articles blaming neoliberalism for making people sick, causing illnesses such as burnout and CFS.

It's common for psychosomatics to emphasize societal problems as the cause of the illness. The people who write these theories tend to be romantics and progressives who think that we should take more care of those who do not easily fit in society. They do not tend to be neoliberal proponents who think sick people should fend for themselves. They want to take care of patients and help them get their health back, often in a patronizing way.

 

[Hoopoe]

It's common for psychosomatics to emphasize societal problems as the cause of the illness. The people who write these theories tend to be romantics and progressives who think that we should take more care of those who do not easily fit in society.

Isn't that how psychosomatics was once?

That's not what it is nowadays in my opinion. A part of it is intended for patients as customers. Tell them whatever they like to hear and take their money.

At the institutional level it's about reducing costs, the burden of patients on society, etc. Typical neoliberal and eugenicist aims.

 

[ME/CFS Science Blog]

it's about reducing costs, the burden of patients on society,

That seems more like an argument that proponents of biomedical research would emphasize. Because biomedical research might provide a magic fix like a drug, vaccine or genetic test that could rid of the disease from society almost entirely. It holds much more promise in financial gains than psychotherapy.

So I suspect proponents of psychosomatics do not emphasise cost-saving as much in their theories and papers. They mostly want governments to keep subsidizing their therapies and cannot promise a fix, only to manage the problem appropriately.

 

[Utsikt]

I haven’t gotten very far in Hughes’ book yet, so I can’t comment on their arguments yet.

It's common for psychosomatics to emphasize societal problems as the cause of the illness. The people who write these theories tend to be romantics and progressives who think that we should take more care of those who do not easily fit in society. They do not tend to be neoliberal proponents who think sick people should fend for themselves. They want to take care of patients and help them get their health back, often in a patronizing way.

I can only really speak about the Norwegian context, but it’s my impression that the BPS proponents are against e.g. any measures to reduce the spread of covid because people don’t get sick, they just have maladaptive thoughts and behaviours that make them believe and act like they are sick.

The «help» they want to provide does not appear genuine to me, it appears like a charade - something that is done in order for them to appear like they are helping. How they themselves appear to others is more important than what they actually do.

They don’t actually care if they are helping or not, or even if they cause harm. Wyller’s refusal to properly acknowledge the harm caused by LP with the 13 year old’s suicide attempt in 2008 is a clear example.

All of the therapies in CBT (or MBRT/PRT/LP/etc. for that matter) also place the responsibility firmly with the patients. It’s their actions that can save themselves, even if it requires guidance from others.