This is an easy-to-follow self-help guide aimed at people suffering from broadly-defined CFS. As a specialist, I would recommend it for two subgroups: those with post-viral fatigue complicated by anxiety, depression or inadequate coping, and the individuals whose CFS followed a protracted period of stress. The latter differ from acute-onset, post-infectious cases in that they often have more symptoms and tend to recover more slowly. However, they are not difficult to recognise. These individuals had a challenging job, took little time to relax, then succumbed to a bug from which they failed to recover as normal. They tried to cope but found it increasingly difficult to shake of colds and flu, until one day they came down with an infection which left them totally exhausted. Every organ seemed to malfunction and then someone suggested ME. What is important to note here is that these are not shirkers who take a week off at the drop of a hat. To the contrary. They are often teachers filling in for sick colleagues, nurses doing extra shifts in understaffed Hospitals, These are the diligent, caring members of society who gave up their free time - and health - to help others. They are individuals living stressful lives who were close to sources of infection. They also tend to be strong-willed people who made the wrong choices.
For those kind of patients, this book is a gentle reminder of the basic rules for survival, about pacing activities, about saying no, about avoiding the traps which many of us fall in to (other than alcohol and drugs). There is also sound advice on dealing with common fears, and sympathetic sections on coping with pain and sleep problems. However, the book lacks balance, It overstates the role of psychosocial factors, there is a far from impartial discussion of alternative views, it does not cover somatic symptoms other than those caused by stress and deconditioning and there is virtually no information for the severely affected with special needs. Most importantly, it does not recognise the intelligence and strengths which many patients possess; qualities they can use to help them cope more effectively with the emotional and 'physical' aspects of the illness. It's a theory-led approach, where the underlying message is that the fatigue and other symptoms are largely perpetuated by negative thoughts, unhelpful behaviours and the effects of stress. Evidence to the contrary is dismissed or downplayed, and consequently, it is only appropriate for people who fit that description.
The title implies that the book also relates to ME. It does not. According to Campling and Sharpe, it is the old term for CFS and, therefore, refers to the same illness. Yet the conditions are not even defined in the same way. The criteria for ME require that the fatigue follows minimal exertion; the criteria for CFS do not. In a sense, ME is to CFS what migraines are to headaches. It is more complex, more neurological and less predictable. It is an odd mistake in a book aimed at challenging inaccurate and misguided beliefs.
Despite its limitations, this is one of the better texts on dealing with the psychological aspects of CFS. It may not be particularly authoritative or evidence-based in relation to aetiology and research, but it will help many patients improve their coping skills and thus regain at least some sense of control over their health.
To get an idea of the book's bias, compare it with Living with ME by Charles Shepherd (London: Vermilion, 1999, £9.99. ISBN: 0091816793). Although a few years old, this remains the most impartial of the self-help guides on the market. The sections on definitions and research are excellent and to cut a long story short, its a superb introduction to the subject for health professionals as well as patients.
Copyright EM. Goudsmit 2001.
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