Betrayal of the Severely Ill?
Appendix 5: Medical Journal of Australia Editorial
Editorial: The Medical Journal of Australia 1995; 163: 285-286.
Chronic fatigue syndrome: what's in a name?
Robert H. Loblay
Diagnostic labelling can serve many useful purposes, including conceptural, prognostic, therapeutic and socio-cultural ones. However, it can also serve as a cloak for ignorance, prejudice or misguided beliefs. Adoption of the purely descriptive term "chronic fatigue syndrome" has certainly been a useful step forward as it is free of mechanistic prejudices. However, there remains the difficult question of who should be labelled as having CFS, and under what circumstances. On the one hand, excessive medicalisation can sometimes contribute to disability, and even a relatively non-committal label such as "chronic fatigue syndrome" is not always appropriate. On the other hand, a label such as "somatisation disorder" calls into question the reality of illness and renders ambiguous the individual's status as a "patient". According to Kipowski, "it [somatisation] involves both mind and body, and as a mimicry of 'real' disease, is a state of being that is neither wellness nor 'legitimate' sickness". It should be borne in mind that ambiguity may itself hinder an individual's ability to cope with illness. Whatever the underlying mechanisms, the reality of suffering in patients with chronic fatigue states must be recognised. Diagnostic criteria are useful to a point, but they should be applied with a good dose of clinical judgement.
Return to the AHMF Letter to the RACP.
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