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.