Dr Geoff Holloway, Dr Jaya Pinikahana
Institute for Behavioural Research in Health
The Social Construction of CFS
Chronic Fatigue Syndrome (CFS) is more than a purely biological phenomenon. It also has clear psycho-social and cultural dimensions. This paper explores how the diagnosis of CFS is negotiated and constructed within the patient/physician interaction. Effective negotiation by the sufferer and pre-orientation of the physician seem to be key factors in legitimating the diagnosis of the illness.
Patients typically respond to the fatigue, loss of concentration and other symptoms only after some period of disruption in work or social performances. Physicians try to identify physical signs of the illness through consultations with patients and testing for indicators or signs of an underlying physiological disorder.
While the physician's diagnostic decision seems to be based on both the number of symptoms and clarity of evidence, it also relies upon the patient's ability to convince the physician about the severity of the symptoms and the physician's conviction that CFS is a 'real' illness.
While the attribution of the label of CFS can bring some relief to patients in that they have some recognisable label for their illness, this can be offset by the uncertainty of the prognosis and the stigma associated with an illness that is often interpreted socially as malingering or laziness.
Reference is made to the strong moral component attached to the CFS label; implications for workers' compensation are also discussed.
The research, which is based on a survey of all CFS sufferers who are registered with CFS support groups in Perth (about 200) and interviews with 50 sufferers and 25 physicians (including alternative practitioners), will be used to identify the social factors associated with the onset of the illness, the social consequences that follow, the perceived efficacy of different treatment regimes and, hopefully, the social factors and socio-psychological profiles of people who recover as compared with those who continue to suffer.
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