Chronic Fatigue Syndrome: A Moral Exploration of Illness and Accountability, 2025, McMurray

[bobbler]

why neoliberalism?
I mean it demonises welfare/dependence, focuses on personal responsibility, the individual/freedom, shys away from analysing systemic problems and sees them more as individuals failings, has a deeply entrenched healthist view that health is in large part a reflection of someone’s effort/good habits. Surely that is an ideology that pairs very well with the idea of psychosomatics, that if you try hard enough you will recover.

Psychosomatics is undergoing a second “boom” these days I think it’s fair to say, and I’m pretty sure the fact neoliberalism is the dominant system in the west right now isn’t a coincidence.

Yep, I can't put the complex pieces together right now

but the rebranding of psychosomatics that happened in the 90s (it was laughed at almost by most at one point, and certainly seemed obscure that this niche of others deeply believed 'lots of people think themselves ill' - you'd always have the polite excpetionalism of 'maybe they just mean the one in a million extraordinaroy cases', and there were big issues around that time around eliciting of false memories in psycho therapy of certain types)

which very much looked to capitalise on the accounting/sales spiel selling points of the new CBT (over its necessary make-up) of 'it can be a defined number of sessions' (predictable cost) and 'only looks forward' (so to those not subject to it 'doesn't waste time on navel-gazing', to those who will be given it 'not like those therapies where you'll be asked about your mum as a child' which was a cliche at that point - oh how it came full circle/was lying given those who pushed this new type turned out to be those employing dodgy tropes and dodgy personality ideas like Moss-MOrris and Chalder). But was a trick because it was trying to just re-sell and re-package the opposite by dressing the psychoanalytic/psychsomatic ideology under something that was short like real CBT but it wasn't really about understanding any actual condition like real CBT was (which eg designed CBT specifically for OCD by understanding that, or a different model for a phobia) - realising that instead of selling loads of analytic sessions to a few people, better to sausage machine to as many as you can I guess.

and avoided looking at cause ie matching the correct therapy to what the cause was - and thereby was replacing social or situational responsibility and changes with perhaps more expensive 'learn how to cope with it' and then lied that it was short-term 'how to cope whilst that changed then dropped the latter bit

well when you look at those behind eg pushing IAPT , the new 're-education' type psychsomatics/non-CBT etc and the likes I remember looking at the biographies and seeing quite a few of them had written about having spent serious time in RUssia specifically as the Soviet Union was dismantling to form eg RUssia and other countries. ie changing from communism to - at that point in time - capitalism, and then under Yeltsin. Which of course was pretty much the 90s that covered and would have led up to the years before the big IAPT 're-education' initiative type stuff.

I therefore think there are more politics and people-management ideological ideas underneath the content of what people wanted pushed than we might think. I suspect very much that some perhaps saw/see it simply as a new avenue of education ... and indeed we now see the acknowledgement of that as they start naming it as 'psycho-education'.. for those who, in the age where 'nudge/coercion' became another 'thing' sort of believed certain things about human beings less fortunate than themselves just needing to be taught they way they think etc.

I suspect those who at the time really genuinely cared about real mental health and what was termed under that back then (I think they changed the name of the department around 2000 onwards) were conned and had no idea what was going to be removed as real structured care and expertise or how surface-level this stuff was designed to transform proper psychology to. And many still won't open their eyes to notice because they don't want to distinguish between bad 'care' and good under some fallacy requiring it not to be harmful and to be well though-through is somehow criticising the whole idea of any care but in particular the switch and bait that somehow it is saying those subject to such care and who have mental health needs are less when it is really saying they deserve safety and oversight just like with anything else.

The worst thing about it was how the bps model deliberately disrupted that psychology had been using models as standard before that, which could at least because they were top-down like decision tress until that 'bps model' then have A/B testing, focused on matching diagnosis of cause/type to more precise treatment and thereby updating these models, and focused on using qualified psychologists/jobs senior enough to be able to diagnose/spot mis-match in diagnosis vs treatment. For many the assessment started with the situational ie fixing the practical issues to then see if once those had been ameliorated there was still an issue to be dealt with.

BPS model and circular generic CBT delivered by sausage machine stopped all that by drawing a diagram with a circle so none of it could ever be tested in that way. No bits isolated out. And it just became the expectation of coping mechanisms and learning to put a positive spin. ie more concerned about the impacts on the outside world rather than the person suffering and making that actually any better. 'dealing with' the people rather than 'dealing with' what was causing the problem, and would perhaps to anyone put in the same situation (so I think there is some belief there it is a lack of stoicism from the 'I don't want to hear about your problems; move on' gang who always happen to have a very different current situation to build from compared to those they assume things of - and tbh also sells well to those who tend to think a stick and pointing in the right direction is the way forward and somehow see a foundation of stone vs sand as some carrot that will enourage people not to change).

 

[bobbler]

That is certainly how it gets used in practice.


When in reality it is the inverse: failed theories and the theoreticians proposing them need something and somebody else to blame for the failure and human carnage left in its wake, and usually it is the victim who becomes the party 'responsible' for the failure.

The more I read on certain individuals and articles and bits of history the more it seems there was a 'wellness' ideology pushed through specifically under trying to develop a new economics paradigm. And things like 'happiness economics'

And it involved having to suddenly believe that there was such a thing as a 'lack of wellness' (that they saw predominantly in the young as mental health 'affecting their happiness') that was the cause of these other things such as you know social conditions, bad employment, potentially even lower employment levels in whole countries (rather than other differences thinking of france as an example noted by them), and disability which then of course becomes physical disability. SO it is real cart-before-horse stuff. I assume from not really hearing if they were meeting any who actually were in any of those different positions to themselves.

And all slightly due I hate to say to a little bit of a hopeful mindset that this group had 'found the next bit thing' but completely unaware they were taking the faults and limitations of methodologies of the same subjects they claimed they were moving on (economics and basic it just on gdp) and polluted it with assumptions that they didn't seem to have checked particularly - using some weird form of presumptive pseudo-epidemiology for 'different countries problems' but only looking through some very limited lens.

Someone also clearly fed them some 'interesting' (but probably untrue if we looked back today with hindsight) stats and claimed that for those 45yrs and under it was mental health that was the biggest health problem around the early 2000s. I have no idea of the specifics behind this claim (eg does that mean more than 50% of health problems were people only with mental health problems and the inference being why doesn't its budget reflect this?) or if there are lots of other papers claiming different stats etc.

It would also be quite an assumption to think that, even if they did have a clue how to train happiness into people and their training course worked without eg making exam-focused schooling and bullying less of an issue and other things, that whatever by that point had been bundled under that big 'mental health' bucket would all be improved by that same definition of what they thought 'happiness' could be imputed into others by. Who knows what they thought they were doing, what they were actually training in 'in the name of thinking it was happiness' and what relevance it had for very different mental health conditions with very different causes anyway.

I'm trying to get my head into the mind of but I guess the closest I can get to is thinking this is that classic paternalism, ignorant-arrogant, the road to hell is paved with the best of intentions (and I'd add in so little respect they become deaf to the object of them) etc. cliche. Or just being so removed from the problem (often leading a totally different lifestyle with expenses etc) you can't understand the meaning of the words or the picture they build because those saying them don't know to point out that they don't have the 'buffers' that exist for the person they are talking to (they are adapting their own different world as if that one thing had changed).

combining with the usual limited repertoire being on the table (carrot and stick) and the early days of 'interdisciplinary' making for some quite unsophisticated stuff that needed to be sold down quite simplistic lines. Basically the spoonful of sugar (re-education in generic behaviour being sold as 'treatment' as if it was cutting edge or even specific as it might have been before) being for those who weren't being fed the medicine to feel better

But then part of the push for all these stats to prove it works and poor methodology seems to probably have come from this fervour of it being some new economic model and wanting to prove it could somehow replace GDP, without needing to be firmed up quite a bit over the years.

I can just see that cliche potentially of people believing so much in their idea being 'to make people more happy' that all sort of things get employed to massage the stats on outcome of what they actually offer, [over you know using them to get said offer right], in order to prove it works enough that they can 'carry on their important work' . Whether you got into it to career-build from one initial background or another, or because you had real good intentions

Inadvertently the need to keep selling to a diverse audience changes something from the medicine or therapy they thing they are creating into a design by committee and iterative tweaks 'what sells to those with the power to make it happen or stop it'.

None of whom really want to/can tackle some of the hard stuff like employers who might need to change their ways with employees and zero hours contracts or major living condition issues, or what we have seen regarding transport and trains in certain parts of the country, accessibility, discrimination and so on. When you can teach those affected by it to 'cope with it better' etc.

 

[bobbler]

No, it's often the exact opposite such as in psychosomatic theories on autism and schizophenia or articles blaming neoliberalism for making people sick, causing illnesses such as burnout and CFS.

It's common for psychosomatics to emphasize societal problems as the cause of the illness. The people who write these theories tend to be romantics and progressives who think that we should take more care of those who do not easily fit in society. They do not tend to be neoliberal proponents who think sick people should fend for themselves. They want to take care of patients and help them get their health back, often in a patronizing way.

the difference is that unlike eg the Chicago school and certain foci of psychology, psychosomatics doesn't believe it is the causes that are the cause, but the 'individual and their behavioural and coping' that are allowing these issues to be issues.

Or are bringing past trauma 'they could be taught to get over' however horrific that 'trauma' is (I hate that word because it is one that seems to also have been introduced by this bps influx in order to take something horrific that shouldn't have happened to somebody and make them responsible for 'getting over it so they can act normal' whilst pretending it is 'to make them feel better' which is a whole different process and set of support required including much deeper and more time and a lot of understanding and care re: their environment too), and however limited any help to cope might offer help to live their live but needs to also come with understanding from those around eg you can't wholly blame someone who returned from war if someone creeps up behind them and says 'boo' for seeing that as completely inappropriate, and the boss saying the person got given some 'trauma therapy' so it isn't the workplace culture being insensitive but the person not working hard enough on 'their trauma'.

I think the truth of the psychosomatics is that they think that all these people just need to be 'taught to be less vulnerable to stress' whatever the codnition

they aren't talking about 'the stressors' as being the problem, or indeed being understanding of the condition that for example means putting someone with schizophrenia in poverty-stricken, high tension living conditions isn't going to be helpful. Other than to use that as a switch and bait to suggest they can be taught to 'be more resilient' or that is some weakness to be tackled.

Even though actually those with said list of conditions are more likely to have layers of all of these 'stressors/environmental problems' on top of each other, nothing to do with them, but each layer making it exponentially harder and more stressful as there are less options for getting free of it if you have both long hours and poor transport and a noisy neighbourhood affecting sleep, because that bad luck is the causal factor increasing likelihood not the other ways around it might be twisted if you aren't walking thru all of those factors putting yourself in their shoes (whereas some walk themselves in others day and think 'I'll see what I'd do differently than them' - the patronising way). Imagine not being heard properly or really seen by anyone ever on top of all that.

 

[Hutan]

Some excerpts from the paper:

In the 18th century, Scottish physician George Chyene described a widespread nervous disorder in England that was characterized by anxiety, depression, and hypochondria. Cheyne attributed these illnesses to the excesses of modern English life, highlighting how social behaviours and values could worsen health problems. He particularly noted the detrimental impact of overindulgence in food, alcohol, and fashionable lifestyles, which often included late nights and wanton behaviour (Porter, 2001, p. 33). This perspective laid the groundwork for future discussions linking health to moral responsibility.

Hysteria was not merely considered a medical condition; it was also deeply tied toThe Motley Undergraduate Journal 3(1) ideas of moral decline, emotional instability, and irrationality (Marland, 2001, p. 29). Those diagnosed with hysteria were often seen as lacking willpower, self-discipline, and moral fortitude, with their symptoms interpreted as a failure to meet social expectations and responsibilities (Marland, 2001, p. 29).

As the early 20th century progressed, a growing appreciation for leisure appeared to challenge the Protestant ethic (Crawford, 1997, p. 405). However, rather than rejecting traditional values, leisure was redefined to align with them. Leisure time was not meant for ‘slacking,’ but for fostering physical vitality, rejuvenation, and self-improvement (Crawford, 1997, p. 405). It was believed that failure to use leisure time productively would lead to negative consequences (Crawford, 1997, p. 405). These deeply ingrained ideologies continue to significantly shape societal views on illnesses like CFS, often linking the conditions to personal failings.

Although eugenics was eventually discredited as pseudoscience by the scientific community (Wilson, 2024) and the influence of Christianity has waned in the Western world, deeply rooted ideologies continue to shape societal views of bodies deemed wasteful, unproductive, and non-donating to the greater social good. This condemnation is apparent in the way fatigue is perceived, often linked to personal moral failings and associated with slovenliness, one of the seven capital vices (Hardy, 2022, p. 43-44). Rather than eliciting sympathy, fatigue is frequently regarded as a physical manifestation of an individual’s failure to uphold moral responsibility—namely, the duty to maintain one’s health in order to remain productive (Radley & Billing, 1996, p. 221).

Other psychiatrists suggested alternative explanations, such as conversion disorder (a condition in which a person has neurological symptoms—like paralysis or blindness—with no physiological cause) or somatoform disorder (a mental health condition in which a person feels highly distressed or anxious about physical symptoms that are not traceable to a physical cause).

In the 1980s, the focus on health broadened to include not just physical well-being but also mental and spiritual wellness (Crawford, 1997, p. 410). This holistic view of health introduced an even wider moralization, where failing to achieve—or at least strive for—health was often seen as a failure to fully embrace life, understand one's emotions, or appreciate spiritual aspects. And when discussions about health are linked to personal responsibility, it is common to encounter views like those expressed by Canadian author, academic, and sometime politician Michael Ignatieff, who in 1988, stated, "We not only get the diseases we deserve: we get the diseases we want" (Ignatieff, 1988, p.29 as cited in Crawford, 1997, p. 411).

Such rhetoric not only provides an opportunity for self-congratulation on the state of a person's good health but also offers an opportunity for moral judgment of those experiencing poor health, with little consideration for health matters outside a person's control. Therefore, it is important to critically examine the societal beliefs about health and the implications for those who do not experience good health or fail to conform to the dominant health ideals of the time.

Media narratives, such as the one presented by Dr. Howard Seiden in a 1987 Toronto Star article, often suggested that women’s attempts to ‘have it all’ were the root of their illness. Seiden’s article presents a fictional medical case—implied to reflect a broader trend—of a woman seeking advice from multiple experts and exploring alternative therapies to combat her overwhelming fatigue. When doctors recommend that she slow down, she dismisses their advice and instead pursues alternative perspectives. Seiden goes on: And, when one seeks, it comes to pass that one finds… Could a new or recurrent infection with EBV [Epstein-Barr Virus] cause Yuppie Flu? If only it were true. Then, we could tell everyone with non-specific symptoms that they were suffering from chronic Epstein-Barr virus infection. They'd regain their dignity. It wasn't that they couldn't cope with the hectic pace. No, sir, it was a nasty virus (Saiden, 1987).

The moralization of fatigued working mothers who are eventually diagnosed with CFS can fuel social scrutiny and self-doubt, prompting questions about whether a mother’s participation in the paid workforce is so potentially harmful to the family unit that it is not worth the risk. The framing of ‘yuppie flu’ reinforces this notion, suggesting that the condition results from excessive ambition or greed and that a woman’s professional success comes at the expense of family stability. These narratives not only shape how individuals navigate their roles within the family, workplace, and society but also reinforce broader societal expectations of motherhood. Whether someone is perceived as too lazy or too ambitious, unexplained fatigue is often framed as a failure of personal responsibility or moral character, with those affected frequently regarded as burdens on society.

 

[Jonathan Edwards]

It seems to be a long list of unevidenced statements about how dogmatic claims by obscure people account for people's thoughts and behaviour - exactly like the essay itself.

I find Shakespeare more insightful.

 

[Hutan]

The paper is published in an undergraduate journal. The paper reads a bit like how an article written by me when I was an undergraduate probably would have ended up, if I was writing about a group of people that I didn't really know. That is, not adding anything new, some misperceptions, meaning well but occasionally being a bit insulting.
e.g.

This resistance to explanations involving personality traits and maladaptive coping strategies may stem from an awareness of stigmas surrounding psychological disorders. Patients may fear being perceived as "weak of character" or undeserving of support (Radley & Billing, 1996, p. 222, 227). Moreover, having their motivations questioned can be particularly distressing as it undermines a patient’s sense of self-worth and personal agency (Radley & Billing, 1996, p. 228).

 

[Trish]

I'm not sure why a communication and media studies student is writing an article about the history of how CFS has been interpreted and treated by medicine and society. I assume this is part of a thesis or extended essay project.

The historical bits extracted from various historical and recent sources is just a collection of quotes or paraphrases of what she's read rather than making any overarching argument or analysis. The attempt to bring it up to date with current thinking by medical and wider society shows up just how limited the author's knowledge it, I think. Unsurprising from a student in an unrelated field.

The paper reads a bit like how an article written by me when I was an undergraduate

I have a similar feeling. It shows the ability to do reading research and put it together in historical order, but no depth of knowledge or analysis.

My concern about essays like this being published is the lingering impression it leaves with the reader may be unhelpful, with its vague attempt to see it as a gendered issue, oddly not on the grounds of prejudicial views about women being too feeble to cope with the modern world, but a concern that men with CFS are missing out on being diagnosed.

I think it also gives the impression that CFS is the same as neurasthenia and that it's about people not coping with whatever the current societal pressures are on women particularly. So it conflates CFS with overwork, stress, burnout, and never really says these are not the same thing, or gives any indication of how severe and disabling ME/CFS is.

 

[Hoopoe]

Presumably some prejudice against the illness stems from confusing descriptions of exertion intolerance with unwillingness to tolerate the stress of ordinary activities of daily living.

If the patient, before describing their intolerance of exertion, does not specify the corresponding activity level, the listener might assume a normal level of activity.

 

[rvallee]

In the 18th century, Scottish physician George Chyene described a widespread nervous disorder in England that was characterized by anxiety, depression, and hypochondria. Cheyne attributed these illnesses to the excesses of modern English life, highlighting how social behaviours and values could worsen health problems. He particularly noted the detrimental impact of overindulgence in food, alcohol, and fashionable lifestyles, which often included late nights and wanton behaviour (Porter, 2001, p. 33). This perspective laid the groundwork for future discussions linking health to moral responsibility.

This is a good example of so many problems with psychiatry and where it applies to psychosomatic ideology. It takes a wildly privileged person to think this in 18th century Scotland. This is someone who was born into privilege, has never known anything but people who also live in privilege, and can only think of society as being a derivation of their own lives and perspectives. They also pretty much made all disorders to be about deviations from those norms.

You see this a lot in so many urban-dwelling psychiatrists imagining that they don't see many farmers and other village-dwellers in their fancy office in downtown London, Vienna or some other large city, where 90% of their patients will be made of over-privileged city-dwellers who have never worked a manual day of labour in their lives. Because how would some farmer suffering from something like ME/CFS ever find their way into the office of a privileged city psychiatrist who socializes with dukes and rich merchants?

This is just egocentrism in action. They look at what is immediately around them and can't think of life that is unlike what they see and experience. I generally find the people who work at things like this to be very small-minded egocentric people. They simply lack perspective other than their own and that of the people they socialize with. Not any different from any aristocracy or oligarchy out there.

 

[Utsikt]

This is a good example of so many problems with psychiatry and where it applies to psychosomatic ideology. It takes a wildly privileged person to think this in 18th century Scotland. This is someone who was born into privilege, has never known anything but people who also live in privilege, and can only think of society as being a derivation of their own lives and perspectives. They also pretty much made all disorders to be about deviations from those norms.

You see this a lot in so many urban-dwelling psychiatrists imagining that they don't see many farmers and other village-dwellers in their fancy office in downtown London, Vienna or some other large city, where 90% of their patients will be made of over-privileged city-dwellers who have never worked a manual day of labour in their lives. Because how would some farmer suffering from something like ME/CFS ever find their way into the office of a privileged city psychiatrist who socializes with dukes and rich merchants?

This is just egocentrism in action. They look at what is immediately around them and can't think of life that is unlike what they see and experience. I generally find the people who work at things like this to be very small-minded egocentric people. They simply lack perspective other than their own and that of the people they socialize with. Not any different from any aristocracy or oligarchy out there.

I think this also shows why this kind of psychology where «society» is blamed might actually be blaming the individual. Because their solution is not to change society, but to change the individual’s morality etc.

 

[bobbler]

I'm not sure why a communication and media studies student is writing an article about the history of how CFS has been interpreted and treated by medicine and society. I assume this is part of a thesis or extended essay project.

The historical bits extracted from various historical and recent sources is just a collection of quotes or paraphrases of what she's read rather than making any overarching argument or analysis. The attempt to bring it up to date with current thinking by medical and wider society shows up just how limited the author's knowledge it, I think. Unsurprising from a student in an unrelated field.


I have a similar feeling. It shows the ability to do reading research and put it together in historical order, but no depth of knowledge or analysis.

My concern about essays like this being published is the lingering impression it leaves with the reader may be unhelpful, with its vague attempt to see it as a gendered issue, oddly not on the grounds of prejudicial views about women being too feeble to cope with the modern world, but a concern that men with CFS are missing out on being diagnosed.

I think it also gives the impression that CFS is the same as neurasthenia and that it's about people not coping with whatever the current societal pressures are on women particularly. So it conflates CFS with overwork, stress, burnout, and never really says these are not the same thing, or gives any indication of how severe and disabling ME/CFS is.

I suspect that if it is an undergraduate who isn't 'mature' (which I've now realised is in itself an ambiguous and insulting term) but was born around the mid-late 2000s then that is also important context to remember with regards the subject being communication and media studies

Simply because they weren't watching it live when the newspapers and TVs were 'yuppie flu-ing'

And there is perhaps something quite useful about now having a small number of people who are from the generation who can at least look at those decades 'fresh' in a way if you lived through all of that stuff being perfectly fair game (whereas now it is still probably as bad, just more deviously covered with 'it's only because we care/want to help' BS)

It would have been interesting to either have had some analysis or even have them vox-popping some of these phrases, and some of those TV clips and newspaper articles that came after that were said and seeing how their current younger generation perceived these and what they thought of them vs the different generations who did not just live through them but were so soaked in them that you stop really noticing how much of it you are getting/it just becomes 'life' or eventually 'truisms'

Then we would be looking at the why it was being done - and of course I'd like it because we'd see the difference between those who maybe actually think up or believe these things as really true and helpful from a medical point of view (or trapped in the hierarchy that does so 'having to toe the line' and then getting sucked into believing it after they've had to parrot it enough) vs those who are basically just selling propaganda and know that's what they are doing - and what there was to be achieved by that. ie they would be hitting on the real two issues, and how they combine.

And because it is now a point of hindsight they could also plot back some of the developments and initiatives that happened over that time, as well as more general developments and how that difference in 'place in society' might have impacted those who this was aimed at, to see what it achieved and change the direction/rewrote the truth on etc.

I suspect that the other might have missed that bit where people talking about morals in forms that are to be disseminated and publicised is different to actual morals so the title needs to be reworded as 'an exploration of the employment of claims about morals in illness and accountability' which could have left room for the difference between those who freshly sought their soul and thought this vs those who were either influenced by propaganda and thought it was a moral position, or were purveyors of that.

Edit: and oh yes there is the added bit of who got to have their voice heard in this. Which would be a whole bigger project because it would need to start employing the skills that I think currently a lot of universities are starting to try and build into their studies and academics which is decolonisation of the literature - ie looking at who was also writing at the time, be they academics who were ignored for whatever reason or just seeking out the bits of evidence of laypersons or patients or the vox pops from the news of the time (to see how man on the street had been influenced to think of certain things)