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Is CFS psychological or physical? This seemed such a stupid question that I never bothered to consider it. I estimate I must have now seen more than 4,000 patients with Chronic Fatigue Syndrome, and it is clear CFS is primarily a physical disorder.

It is only when patients have been ill for several months and been told by their physicians that nothing is wrong that they get secondary psychological problems. The only place where CFS does not exist is in the brains of small-minded doctors.

The reason the "physical or psychological" debate continues is because the usual tests for pathology come up showing normal results. GPs find ill patients, do the usual screening tests, which come up normal, and feel this allows them to turn around to patients and conclude there is nothing physically wrong.

If, however, the screening tests included SPECT scans [an imaging technique using gamma rays], sensitive tests of the hypothalamic-pituitary-adrenal axis [major part of the neuroendocrine system that controls reactions to stress and regulates processes including digestion, the immune system, mood, and energy usage], T cell subsets [white blood cells that play an active role in immunity], biopsies to look at mitochondrial abnormalities, mitochondrial function tests, antioxidant status, and tests of xenobiotic loads, enterovirus sequences in muscle and brain, trace element levels, vitamins, essential fatty acids and amino acid profiles - then lots of abnormalities would be found.

Doctors would diagnose serious metabolic and hormone problems and patients would be taken more seriously.

I believe the fundamental problem in CFS patients is that they have lost their ability to respond to stress, be this physical, mental, nutritional, emotional, infectious, financial, etc.

Our systems can be likened to a car - when we are pottering, we are in first gear. But as soon as the pressure goes on, we need to move up a gear or two, or three gears, or occasionally into overdrive, to cope with the situation. We can do this by releasing stress hormones from the hypothalamus, pituitary, and adrenal glands producing adrenaline, cortisol, sex hormones etc.

This effort can be sustained for a short length of time but eventually the person must "recharge the batteries" with good food, holidays, fresh air, sleep, and correction of all the above abnormalities with respect to mitochondrial function, antioxidants, xenobiotics etc.

With any illness there is a psychological component, but with CFS this is secondary to a physical illness. I am always amazed how well adjusted are my CFS patients are - and depression is not a common feature.

The difference is that CFSs want to do things, but if they do they feel ill. They also tend to wake late. With depression, patients don't want to do anything, but if you push them to exercise, they actually feel better. Usually they have early morning wakening.

I suspect this is why the "stimulating" antidepressive drugs seem to make CFS worse - they increase the desire without improving the performance and therefore worsen the frustration.

Recommended reading: The Stress of Life by Hans Selye, McGraw-Hill [first published 1956 and updated]

* Dr. Sarah Myhill, MD, is a UK-based CFS specialist focused on preventive healthcare, nutrition, and patient education. This material is reproduced here with permission of the author from Dr. Myhill’s patient-information website, http://www.drmyhill.co.uk. ^RSarah Myhill Limited, Registered in England and Wales: Reg. No. 4545198.