Why CFS Is Not Psychogenic

CFS was once thought of as a psychogenic disorder. The evidence that it is biological disorder is mounting and nobody is calling that anymore these days. But I thought of it when I read the NYT article on the invisible attack on US diplomats in Cuba and China. It raised a possibility that what the US diplomats experienced was a mass hysteria. The similarity to the Incline Village outbreak and subsequent labeling of CFS as middle aged women's hysteria is rather striking: they are both highly clustered, had no known cause, and they could not be replicated. No wonder people not versed with CFS thought that it was a conditioned response to initial infection or chronic stress.

And here is why CFS is not psychogenic even without any biological evidence to such. Most patients, including myself, come into CFS without knowing what Post-Exertional Malaise is. People suspect that they have CFS when they are constantly tired. But the real CFS patients struggle for months with worsening of symptoms after exertion. Then, after searching for answers for another months,  they are either diagnosed or find out themselves that it is CFS. They initially suffer from PEM without knowing what it is.

But a trained response in hysteria requires knowing and learning. The noise from the upstairs neighbor, for instance, can immediately trigger violent outburst to someone who had to put up with the annoyance for some time. It seems automatic as if you don't have control, when in reality you can retrain yourself and detach the response from the stimuli. CBT is a useful tool for that.

PEM in CFS is not immediate; it is delayed like a clockwork by 24 hours, just as buboes break out 24 hours after contacting plague. (Funny that I tell CFS people to avoid exertion like a plague). And it happens the same even when you don't know anything about it, just as buboes break out whether you know anything about plague or not. Since psychosomatic response requires the learning, PEM can't be psychosomatic. By extention, CFS can't be.

Learning about your PEM, BTW, takes long time and hard work. Many times I expected PEM but it did not happen. Even more times I wasn't expecting and then hit by the bus when 24 hours rolled in. You have to take a meticulous log of what you do every day and then eventually learn to predict  which activities trigger PEM. Even now after 11 years, I can't reliable predict. I only know that faster speed and/or fewer breaks cause PEM in general.

Cat Test for CFS Severity

It was meant to be a 3 week sentence, but I managed to extend it into 5 weeks. 2 weeks into it, I went on another biking, for 3 miles this time. It was a trip normally well tolerated, but not while in a 3 week PEM. It reset the clock and 3 weeks penalty restarted all over again.

As if the PEM sentence wasn't enough, the homeless cat we've been taking care of has developed a terrible flea problem. It was getting warm and fleas must be hatching en masse. I had to buy Frontline Plus, a vacuum cleaner and a flea comb to combat the infestation.

The cat moves around. I have to get up, chase it down and then sit again to comb it. I was effectively doing several reps of squat. My legs turned into jello after a few days of that and I still had to vacuum the house twice a day.  By last night I was getting so desperate that while lying in bed I contemplated locking the cat out.

Then, right on cue, I got better today. It's been 3 weeks since the 3 mile biking and I must be out of the jail. Life seems brighter all of sudden.

So, you could use the cat as a test for the severity of your CFS sickness. If you can take care of your cat's flea problem in a small 1 br home with hardwood floor, then you likely have a mild/moderate case. If you can't, you have a severe or moderate case. I'm right on the border. When I'm having PEM, I'm back in severe/moderate condition. When I'm out of it, I'm a mildly sick, functioning patient.

Officially speaking, of course, you are a mild patient if you can hold a job, but have to spend all your evenings and weekends recuperating. And a severe case if you are constantly home/bed-bound. Moderate is anything in between.