Your Book Review: Exhaustion Finalist #13 in the Book Review Contest

Sly Saint

Sly Saint

Senior Member (Voting Rights)
While exhaustion and tiredness are universal after we’ve exerted ourselves, and resolves with rest, Schaffner is concerned here with chronic, pathological fatigue and weariness. This type of exhaustion isn’t just tiredness; aside from the ‘brain fog’ already mentioned, people describe hypersensitivity to light and noise, mood changes, diffuse or changing aches and pains, or fluctuating neurological or bowel symptoms. When the exhaustion is prominent and other easily-diagnosed conditions are excluded, individuals today will receive a diagnosis of something that is variously called Chronic Fatigue Syndrome (CFS), Myalgic Encephalomyelitis, Systemic Exertion Intolerance Disorder (SEID); or whatever unsatisfactory name is currently in fashion. As Schaffner does, I will use Chronic Fatigue Syndrome/CFS in this review, more because of its ubiquity and that it is agnostic to potential causes of the condition (SEID is the more recent term, but it’s too early to say whether it is going to catch on).
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Schaffner gives a reasonable accounting of the way CFS was characterised – post-polio fatigue being noticed in the 1950s, the discovery of Epstein-Barr Virus (EBV) in the 1960s and the initial thoughts that EBV was a robust cause of CFS, the subsequent discovery that about 95% of the population has had EBV so this explanation couldn’t be complete, followed by classification of the syndrome settling into a cause-agnostic set of symptoms. This, however, didn’t stop the fighting.

Essentially the conflict lines up between three rough groups. The first is the patient advocacy groups, who are made up of a group of sufferers of the condition and (some of) of their carers and family, who firmly believe that there is an undiscovered viral or autoimmune condition that not only caused their condition but continued to exert its effects in their ongoing symptoms. It’s not simply that they had an infection and are now deconditioned or slow to recover; it’s that the condition was never properly diagnosed, is continuing to account for their ongoing exhaustion, and could people please stop referring them to psychiatrists. This group is heterogeneous but on the whole prefers names for the condition that imply an ongoing disease process, such as myalgic encephalomyelitis.
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but Schaffner has the medical/psychiatric historian Edward Shorter to set us straight:

The Saga of Chronic Fatigue Syndrome represents a kind of cautionary tale for those doctors who lose sight of the scientific underpinning of medicine, and for those patients who lose their good sense in the media-spawned ‘disease of the month’ clamor that poisons the doctor-patient relationship… A whole subculture of chronic fatigue has arisen in which those patients too tired to walk give each other hints about how to handle a wheelchair and exchange notes about how to secure disability payments from the Government or from their insurance companies.
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CFS researcher Simon Wesseley:

We suggest that agents such as EBV or viral meningitis can lead to the experience of abnormal symptoms, such as fatigue, malaise and myalgia. However, the transition from symptoms to disability may be more closely linked to cognitive and behavioural factors. Hence interventions such as CBT designed to reduce disability and counteract maladaptive coping strategies ought to be more effective in reducing disability than symptoms. The evidence so far supports this model – many patients do show considerable improvements in disability and everyday functioning, but are not rendered symptom-free by cognitive or behavioural interventions.

Wesseley is right about the evidence: there is some evidence for CBT and graded exercise, with Wesseley himself providing one study into the latter – a study that led to him getting death threats from patient groups.

Why the death threats? The sense of intense anger and distress at the mere whiff of a non-biological component of the explanation, or a non-biological treatment, is due in part to the long process people go through to get to a diagnosis. CFS is a condition that assumes the trappings of biomedical Western medicine, but suffers from the inconvenient lack of concrete blood and X-ray results that would convince biomedically-minded doctors to take it seriously. Sufferers describe going from doctor to doctor, receiving greater or lesser doses of Shorter-style hostility or incomprehension, sometimes only coming across the diagnosis online. Having been told, explicitly or implicitly, that “it’s all in your head”, the natural response is to kick as hard as possible in the other direction.
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full review here:

https://astralcodexten.substack.com/p/your-book-review-exhaustion

you can comment

original book being reviewed Amazon product ASIN 0231172303
 
This is seriously like prepubescent virgins writing about sex. I don't think it's possible to gain real expertise on those issues without taking into account the life experience of those living it. This is what happens otherwise, it's just as silly posturing and boasting about their imagination.

Everything they write about could apply to peptic ulcers by changing maybe 10 words. Well, could have applied, if the quintessential psychosomatic disorder at the time hadn't been taken off their hands. No lessons learned from that. Absolutely none.
 
I haven't read the book, just the review. I found it hard to tell what both reviewer and author think about ME/CFS.

It came across to me as someone finding some historical information about how diseases not understood by doctors through centuries have been interpreted, and assuming that they were all talking about the same thing in different ways.

What seems to have happened is they have taken at face value assumptions that CFS, burn out, depression, and any other condition that causes fatigue are all the same thing.

I ended up completely confused about how much of the book was nonsense, and how much bits of history tied together to try to make some sort of hypothesis.

I concluded it sounded like a book written to entertain rather than to inform.
 
The first is the patient advocacy groups, who are made up of a group of sufferers of the condition and (some of) of their carers and family, who firmly believe that there is an undiscovered viral or autoimmune condition that not only caused their condition but continued to exert its effects in their ongoing symptoms.
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I don't recognise this group of people.
 
chrisb said:
Apparently Schaffner is a mBIT coach. That is multiple Brain Integration Technique if you did not know. I didn't.
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Does mBIT indicate that the integration involves multiple brains or it involves multiple or different integration techniques? Presumable the former requires some form of brain washing to align the brains of a number of people or alternatively telepathy.

I was being flippant, but I am not sure the ‘reality’ is any more reassuring:

mBIT - multiple Brain Integration Techniques

mBIT is a suite of tools and techniques for communicating with, integrating and harnessing the power of your multiple brains (head, heart and gut brains).

In developing mBIT, what we discovered in essence, is that each of your brains has a competency that is its 'highest expression' and that the three brains, when operating via these competencies, produce synergistic effects and bring greater wisdom to decision making, relationships and life. The highest expressions are Compassion (heart), Creativity (head) and Courage (gut). When all three work together they produce amazing results!

See https://www.mbraining.com/
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So telepathy with yourself, unless one proposes that one of these three brains has some form of potential executive function in relation to the others, in which case does it make sense to talk about three brains?
 
The author, Anna Schaffner, Professor of Cultural History at the University of Kent, also says of herself:

In my coaching practice, I combine state-of-the-art and science-based coaching techniques, especially insights from ACT (Acceptance and Commitment Therapy), with tried-and-tested ancient wisdom. While I always adapt my tools and methods to unique client needs, my general focus is the importance of deepening self-knowledge, as well as work on values and character strengths. I also integrate ancient Stoic techniques, with a focus on the circle of control, and on the art of letting go. New is not always better. Sometimes, it is the ancient models that hold the key to our most urgent present-day problems.

See https://www.annakschaffner.com/about
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I have not looked at the book, but it seems from the review, its comments and the author’s own site, that she, like so many others, completely fails to differentiate between the idea of chronic fatigue and the condition of Chronic Fatigue Syndrome or ME/CFS.

I have no objection to self help techniques as a leisure activity, some people feel they constructively fill their lives with them. However they can be very dangerous when assumed to be effective treatments for serious medical conditions.
 
Why is it that almost everyone pushing this pseudoscience appears to be making money from it one way or another? Often in the form of a stable low-effort business that would end if the scam were exposed.

Rhetorical question, of course.

Also LOL at ancient wisdom. Talk about cultural beliefs. And that mBIT is way too on the nose as The Moods being a direct descendant of The Humours, just slightly tweaked.
 
There appear to be dozens of uninformed but verbose fools responding to the original long nonsense review, confidently speculating at length about what they imagine 'CFS' might be, tens of thousands of words of waffle. The idea that ME (or Chronic fatigue syndrome as Schaffner calls the disease. Of course she does, because it fits her own 'Exhaustion is fatigue, fatigue is chronic fatigue syndrome' waffling) as though ME is public property and the general public have been invited to speculate and pronounce about what it is and what causes it. And they do. Waffling on and on about the people who have it in a dehumanising manner as though we are inanimate objects or subhumans. They refer to Shorter, they refer to Showalter, they condemn the 'd**th threats, they regurgitate every nonsense gaslighting and spiteful press article they have ever read about ME.

Edit. Most of those reviewers have acquired a HUGE sense of entitlement in relation to this disease and the people who suffer from it, entitlement to prattle on their endless speculating, gaslighting, drivel, with no self consciousness that what they are writing is ignorant dross. They need to get off the case and stop feeding.


I hope I never meet any of them. I would rather never encounter another human being for the rest of my life than be subjected to more gaslighting and dehumanisation.
 
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