Fatigue as an illness

A clinical syndrome characterized by fatigue which is disabling, exacerbated by exertion, and accompanied by other symptoms including poor concentration, irritability, and muscle pain has been recognized at least since the latter half of the last century and possibly before. During the Victorian era patients with this syndrome often received a diagnosis of neurasthenia, a condition of uncertain cause commonly ascribed to the effect of the stresses of modern life on the human nervous system.(D As the years passed the diagnosis of neurasthenia was much less frequently made, and by the early 1900s it was falling out of common usage in Europe. (However, this diagnosis subsequently became popular in the Far East—see ChapteL5..2.:.10.) Why did neurasthenia decline? Although it is possible that the symptom of fatigue also waned in the population, it seems more likely that patients with similar symptoms were given alternative diagnoses. These diagnoses include hypothetical disease explanations, such as chronic brucellosis and chronic Epstein-Barr virus infection, and psychiatric syndromes such as depression and anxiety.

In the last decade non-psychiatric physicians have again become interested in fatigue. They have increasingly recognized that the symptoms of many patients who present with chronic fatigue are not readily explained either by medical conditions such as Epstein-Barr virus infection or by obvious depression and anxiety disorders. Diagnoses used to describe this syndrome include myalgic encephalomyelitis and post-viral fatigue syndrome. However, these are unsatisfactory as they imply an unproven causal mechanism. Therefore the term chronic fatigue syndrome (CFS) was proposed as a neutral description of this condition.(2) In parallel with the increased interest in fatigue states amongst physicians, neurasthenia re-emerged in the ICD-10 psychiatric classification as a fatigue syndrome unexplained by depressive or anxiety disorder.

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