Chronisches Fatigue-Syndrom, 2026, Alexa Alica Kupferschmitt & Volker Köllner

Response by 30 scientists and health care professionals.
The statement has been organized by Bettina Grande:
Chandelier said:
Joint Statement from Healthcare and Academia

In Support of a Differentiated, Respectful, and Factually Appropriate Approach to People with ME/CFS​

In our medical, psychotherapeutic, and/or scientific work, we regularly encounter people with ME/CFS who are living in an exceptionally challenging situation. Most are severely restricted by their illness in their independence, social participation, and ability to pursue their professional and private lives. At the same time, only limited therapeutic options are currently available. Adequate healthcare structures are still largely lacking, and all too often people affected by the disease are, in practical terms, left to cope with their severe illness largely on their own by our healthcare system.

Against this background in particular, in our clinical and/or scientific work we frequently experience a high degree of gratitude and appreciation from people with ME/CFS for reliable support, careful diagnostic assessment, and an approach that fully recognizes and takes into account their individual limits of exertion as well as the often devastating extent of the limitations caused by their illness. Many people affected also have a strong interest in professional and scientific matters. They closely follow developments in research, engage thoughtfully with new findings, and often themselves devote what little energy they have left to improving healthcare, public awareness, and research.

Our shared experience is that the vast majority of people affected approach medical, therapeutic, and scientific questions in a constructive, reflective, and solution-oriented manner. Many contribute their own experiences in ways that provide important additional insights for healthcare and research. As medical and psychotherapeutic practitioners or scientists, we can benefit from this wealth of experience. Particularly in view of an illness that remains insufficiently understood and the existing deficiencies in healthcare provision, the perspective of those affected can be of considerable value.

As in any other patient population, there may of course occasionally be difficult or conflictual encounters involving people with ME/CFS. In our experience, however, such situations are neither characteristic of this patient population nor more frequent than in other medical contexts. Individual negative experiences must therefore never be generalized or used as the basis for attributing particular characteristics to an entire group.

Against this background, we are particularly concerned by portrayals that characterize people with ME/CFS as having a “combative and accusatory tone,” emphasize “aggressiveness” among affected individuals as a characteristic problem, or otherwise frame this patient population as generally “difficult.” Such sweeping statements turn individual negative experiences into a purported distinctive feature of this patient population, even though our experience in clinical practice and research provides no basis for such a characterization. Such portrayals can foster unwarranted mistrust of people with the disease, encourage the premature psychologization of physical symptoms, and contribute to medical concerns not being assessed without prejudice. In this way, they further impede the already inadequate healthcare available to people with ME/CFS.

We therefore strongly advocate for differentiated, respectful, and factually appropriate language, as well as a corresponding attitude toward this patient population. Both are essential prerequisites for trusting and effective healthcare and for constructive scientific collaboration.
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Something that needs to be acknowledged: given everything we know of this illness, everything that is documented, things that the authors of this offensive drivel acknowledge, it's entirely reasonable for us to be angry. We are mistreated and discarded like garbage, and we stand up to it as best as we can. The idea that we should be taking this laying down and saying thank you is not only offensive, it's ridiculous.

In fact, we should be far angrier than this, and I'd say that technically we are, but we can't do anything about it. We are at the mercy of a profession that has completely abandoned us, and they keep responding to our rightful protests and complaints with the only thing they've ever brought us: disrespect and negligence. We have every right and reason to demand that this criminal negligence not only stop, but gets fully reversed, compensated and the systems that enabled this atrocity be reformed.

To hold any other position is ridiculous. Look at the lies they write about us. They would be angry if they were the target of 1% of this affront. Anyone would be angry. And yet all we keep doing is accommodate, work nicely within the systems, because even imaginary transgressions, hallucinations for the most part, get us collectively punished.

It's not as if they hide their contempt for us. There has never been a time in history in which a group of people is held in half this much contempt by authorities that has not led to a human rights disaster. And it is a documented disaster. No one can deny that, and lying about how we do this to ourselves, as if treatments exist and are easy to do but we are too stupid for it, only adds insult to a system built on nothing but adding insult to injury.
 
Another response by a group of 140 healthcare professionals.
From Bluesky account
MissingDOCTORSandPSYCHOTHERAPISTS

Machine translation:

Statement on Chapter 91 “Chronic Fatigue Syndrome” in the Newly Published 10th Edition of​

Dear members of the responsible editorial team at Springer Nature,​
Dear Professor Linden,​
Dear Professor Hautzinger,​
Dear Dr. Kupferschmitt,​
Dear Professor Köllner,​
​
We are a group of more than 140 physicians, psychotherapists, pharmacists, and veterinarians who are themselves affected by Post-COVID and ME/CFS of various causes. Our group includes specialists from almost all somatic medical disciplines, as well as numerous psychiatrists, psychosomatic medicine specialists, and medical and psychological psychotherapists. As healthcare professionals with, in some cases, extensive professional experience and substantial practical knowledge, complemented by expertise gained from lived experience, we feel compelled to comment on the chapter “Chronic Fatigue Syndrome” by Dr. Kupferschmitt and Professor Köllner, as it contains significant methodological and substantive errors.​



Statement on Chapter 91 “Chronic Fatigue Syndrome” in the Newly Published 10th Edition of​

Dear members of the responsible editorial team at Springer Nature,
Dear Professor Linden,
Dear Professor Hautzinger,
Dear Dr. Kupferschmitt,
Dear Professor Köllner,

We are a group of more than 140 physicians, psychotherapists, pharmacists, and veterinarians who are themselves affected by Post-COVID and ME/CFS of various causes. Our group includes specialists from almost all somatic medical disciplines, as well as numerous psychiatrists, psychosomatic medicine specialists, and medical and psychological psychotherapists. As healthcare professionals with, in some cases, extensive professional experience and substantial practical knowledge, complemented by expertise gained from lived experience, we feel compelled to comment on the chapter “Chronic Fatigue Syndrome” by Dr. Kupferschmitt and Professor Köllner, as it contains significant methodological and substantive errors.

Given the large number of points requiring criticism, we will list them below in bullet-point form. In addition, we have compiled a number of studies on the somatic pathogenesis of the disease, which we strongly encourage our colleagues to consider.

1. Disease terminology and classification​

1.1.​

The title itself refers exclusively to “CFS” rather than “ME/CFS”, and the text likewise predominantly uses “CFS” alone, which is highly problematic. The term “CFS” was used in the 1980s and 1990s to psychologize the disease that had been recognized by the WHO as Myalgic Encephalomyelitis (ME) in 1969. For this reason, focusing on this terminology is rejected by experts and patient organizations. The scientifically established terminology is ME/CFS, which also clearly distinguishes the disease linguistically from fatigue states associated with other underlying conditions, which differ substantially both etiologically and in terms of therapeutic implications.

1.2.​

The neurological classification of ME/CFS and the corresponding correct ICD-10 coding (G93.3x) are omitted. Instead, Myalgic Encephalomyelitis is equated with psychiatric and psychosomatic disorders such as neurasthenia (F48.0) and somatoform disorders (F45.x), or with other conditions such as fibromyalgia (M79.7) and other fatigue states. However, these must not be used synonymously, as they are entirely different diseases with different treatment approaches. The ICD-10 explicitly excludes a diagnosis of neurasthenia (F48.0) when G93.3x is present, and also in the case of R53.0/1. The term “fatigue syndrome” (“Müdigkeitssyndrom”) listed in the text has likewise long since been removed from the ICD-10 as an incorrect term.

1.3.​

Post-COVID syndrome (PCS) as an umbrella term and ME/CFS as a specific disease are not sufficiently differentiated throughout the text. In addition, both are conflated with nonspecific fatigue (e.g. the statement that “post-viral fatigue” has long been known independently of COVID).

1.4.​

Conclusions derived from studies of PCS cohorts are repeatedly transferred to ME/CFS, even though it was not established whether the individuals studied actually fulfilled the diagnostic criteria for ME/CFS (see also point 10).

2. Diagnostic criteria and the cardinal symptom PEM/PENE​

2.1.​

The Canadian Consensus Criteria (CCC; Carruthers et al., 2003) are mentioned but are not adequately or accurately explained. ME/CFS can be diagnosed using these clinical criteria, as well as the International Consensus Criteria (ICC; Carruthers et al., 2011), particularly with consideration of Post-Exertional Malaise (PEM)/Post-Exertional Neuroimmune Exhaustion (PENE) and the exclusion of relevant differential diagnoses.

2.2.​

The statement that there are “no reliable clinical symptoms” or no reliable diagnostic criteria contradicts the simultaneous mention of established clinical criteria. Symptoms are also described that do not, in fact, correspond to the disease, such as “chronic, non-restorative fatigue.”

2.3.​

In particular, the nature and significance of PEM/PENE should be presented centrally and unambiguously.

2.4.​

Autonomic dysfunction (dysautonomia) can occur as a manifestation of ME/CFS. Orthostatic intolerance (OI) and postural orthostatic tachycardia syndrome (POTS, G90.80) are common comorbidities, but they are by no means obligatory components of ME/CFS.

3. Publications on the somatic pathogenesis of ME/CFS​

Contrary to the statement in the text that “there is currently no empirical evidence for the etiological concepts associated with ME/CFS,” numerous empirical findings supporting a somatic pathogenesis of ME/CFS already exist. We will cite only a few examples here so as not to exceed the scope of this statement.

The studies have identified, among other findings, endothelial dysfunction (Scherbakov et al., 2020), reduced cerebral blood flow (van Campen et al., 2020), and altered red blood cell deformability (Saha et al., 2019). In addition, impaired adrenergic signaling (Hartwig et al., 2020) and autoantibodies against G-protein-coupled receptors (Freitag et al., 2021) have been identified.

Other studies demonstrate cerebral neuroinflammation and disruption of the glymphatic system (Yu et al., 2026; Thapaliya et al., 2026). Furthermore, disturbances in energy metabolism (Lien et al., 2019; Tomaskovic et al., 2026), alterations in plasma proteomics with maladaptive regulation following exertion (Germain et al., 2025), and pathological muscle changes have been described, providing a basis for hypotheses regarding the pathophysiology of PEM/PENE (Appelman et al., 2024; Charlton et al., 2026; Davenport et al., 2025; Davenport et al., 2026; Scheibenbogen and Wirth, 2025; Westermeier et al., 2026). It has also already been demonstrated that pathological metabolic changes in muscle cells can be induced by exposure to serum from ME/CFS patients (Mughal et al., 2025).

4. Differentiation from psychiatric and psychosomatic disorders​

4.1.​

Although the stated purpose should be to differentiate ME/CFS from primarily psychogenic disorders, the authors’ presentation effectively promotes a psychosomatic and even psychogenic explanation of ME/CFS. This begins with the synonymous linking of ME/CFS to neurasthenia and somatoform disorders, which are even explicitly provided in the text with diagnostic codes, while any correct somatic coding is omitted. It continues throughout the chapter in the form of erroneous assumptions about the disease and its possible management.

4.2.​

Patient behavior is pathologized without any supporting evidence. The text states, for example:

“A striking characteristic of some patients with fatigue is […] dysfunctional illness behavior involving self-harming protective and avoidance behavior, increased self-monitoring, and involvement of the social environment,”
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which allegedly “fulfills the criteria for a hypochondriacal disorder” (section 91.1, p. 568).

Here, pacing, which is essential activity management in the presence of PEM/PENE, is labeled as dysfunctional and the disease itself is placed in close proximity to hypochondria. This is not only unsupported by evidence but also stigmatizing.

4.3.​

Social isolation may likewise constitute a reasonable protective mechanism in ME/CFS in view of PEM/PENE and should not be prematurely interpreted as pathological behavior. Fear of PEM/PENE can be an understandable and adaptive response to repeatedly experiencing deterioration following overexertion.

4.4.​

Psychiatric and psychosomatic diagnoses should not be used as fallback diagnoses for medically insufficiently researched diseases or unexplained symptoms (Schomerus et al., 2026).

5. Stigmatization of patients​

5.1.​

The assertion that a “striking characteristic of some patients with fatigue” is “a combative, reproachful attitude toward healthcare providers who do not share their diagnostic assumptions” is scientifically unsupported, inappropriately judgmental, and ultimately harmful to people with ME/CFS. The same applies to the label “aggressive patients” and the alleged “defensive attitude” and “sense of grievance.”

5.2.​

Self-help and patient empowerment in the field of ME/CFS have emerged in response to decades of inadequate healthcare provision. Compared with other diseases, ME/CFS remains severely underserved. Even in 2026, the disease is not included in any standard medical school curriculum, and irreversible harm resulting from inappropriate treatment remains common. Pathologizing efforts to change these conditions encourages biased or inadequate treatment and makes scientifically informed care more difficult.

5.3.​

When patients reject psychosomatic concepts because these concepts overemphasize the role of the psyche or the possibility of activation and pathologize appropriate behavior, this constitutes a necessary form of protection against the resulting inappropriate treatment.

5.4.​

The authors likewise present incorrect diagnostic classifications and disease concepts. Problems within our healthcare professions are externalized and inappropriately shifted onto patients.

5.5.​

It is neither plausible nor supported by evidence that a hypochondriacal presentation is a characteristic feature of patients with ME/CFS. No data or conceptual model is presented to explain why this particular disease should differ from other severe diseases in the prevalence of anxious or hypochondriacal comorbidities. Since, unlike people with depression, patients with ME/CFS do not generally have a primary impairment of drive or motivation, and often have to learn to monitor themselves precisely because their functional limits become apparent only with a delay, this attribution may even be dangerous. Accurate differential diagnosis is only possible if healthcare professionals understand the underlying somatic disease.

5.6.​

The same applies to other psychiatric comorbidities and behavioral problems.

5.7.​

The authors’ overall model is also stigmatizing, as it overlooks the broad middle ground of healthy coping between avoidance and endurance, as well as the component of resource assessment. In effect, 100% of patients are labeled as dysfunctional.

5.8.​

It is an ethical professional obligation not to cause additional harm to seriously ill patients. Stigmatization of people with ME/CFS may, in addition to the risk of harmful overactivation and iatrogenic psychological harm—including suicidal thoughts (König et al., 2024)—perpetuate deficiencies in care. These may include denial of recognition within the social-medical system, more difficult access to assistive devices, nursing care and other support services, withholding of symptom-oriented treatment, or inappropriate referral to primarily psychotherapeutic care instead of needs-based multidisciplinary treatment.

5.9.​

The text also implies that affected individuals “attribute” their symptoms to the disease because it has been “present in the media after the coronavirus pandemic,” rather than acknowledging high infection rates with a novel, highly pathogenic virus as a cause of the increasing number of cases.

6. Information on psychiatric comorbidities and their treatment​

6.1.​

The claimed prevalence of psychiatric comorbidities of up to 70% appears dramatically inflated and should be supported by clearly identifiable sources. We also question what the exclamation mark in this context is intended to emphasize, and what such an exclamation mark is doing in a scientific publication.

6.2.​

It should be explicitly acknowledged that inappropriate screening instruments can lead to an overestimation of psychiatric comorbidities. In particular, the PHQ-9 and GAD-7 are not suitable for people with ME/CFS to distinguish depressive or anxiety symptoms from symptoms caused by the disease itself (Schomerus et al., 2026).

6.3.​

When discussing depression and anxiety disorders, a distinction should also be made between primary psychiatric comorbidity and psychological consequences of a chronic, severely burdensome somatic illness.

6.4.​

Psychological distress without psychopathological significance, such as appropriate grief over often profound losses, as well as realistic fear, should be clearly distinguished from mental disorders. Accordingly, fear of PEM/PENE should not be equated with an anxiety disorder.

6.5.​

The authors identify depression and anxiety disorders as common comorbidities and state that their treatment should be integrated into the treatment plan in accordance with the respective clinical guidelines. In the presence of PEM/PENE, however, many elements of guideline-based psychotherapy involve substantial physical and/or emotional activation and are therefore contraindicated in ME/CFS. Treatment must accordingly always be adapted to PEM in order to prevent iatrogenic harm (see also Grande et al., 2023), and emotional activation should likewise be kept as low as possible as an integral part of psychotherapy.

6.6.​

Somatopsychic and neuropsychiatric aspects are not discussed, even though neuroinflammation and emotional fatigue may mimic depressive phenomena, while postural tachycardia and orthostatic intolerance can be mistaken for panic attacks or anxiety attacks. Careful differential diagnosis in this regard is essential and should not be omitted from any such publication.

7. Pacing and activation​

7.1.​

The authors use the concept of pacing incorrectly. Pacing is not “slow activation” and should therefore not be described as such. Nor is it a psychotherapeutic procedure. Rather, the goal of pacing is to make the best possible use of the energy resources available within an individual’s personal limits while avoiding PEM/PENE.

7.2.​

Accordingly, activation is contraindicated in ME/CFS. ME/CFS is precisely not a disease characterized by pathological avoidance. Rather, patients must restrict their activity despite their healthy drive to remain active in order to prevent progression.

7.3.​

The recommendation of gradual increases in activity is not only professionally incorrect and grossly negligent in severe ME/CFS and pronounced PEM/PENE. Even milder forms of the disease can deteriorate as a result of overexertion. An increase in activity is only possible once sustained physical stability has been achieved. Externally imposed activation, however, puts this stability at risk.

7.4.​

It is inherent to PEM/PENE that overexertion may only become apparent days later and, in the case of cumulative micro-overexertion, even weeks later. People with ME/CFS may be able to exceed their limits for a period of time, but they may subsequently experience delayed and not infrequently permanent deterioration as a consequence.

7.5.​

The primary objective in ME/CFS, in addition to improving quality of life, is particularly to stabilize and preserve the remaining level of functioning and to provide symptomatic treatment. Treatment success should therefore not be assessed on the basis of a short-term or subjectively measured expansion of activity levels, but rather in terms of long-term functional capacity.

7.6.​

There is also evidence that inactivity does not cause a “myalgic fatigue syndrome.” This is not an established technical term. Moreover, it has now been demonstrated that the muscles of patients with ME/CFS behave differently under inactivity than the muscles of healthy individuals (Charlton et al., 2026).

7.7.​

The risk of nocebo effects is overemphasized in comparison with the widespread and considerably more serious risk of permanent harm resulting from activity escalation. Lack of knowledge among healthcare professionals or minimization of PEM/PENE continue to prevent appropriate patient education in the early stages of the disease. Appropriate education, however, can be decisive for prognosis: early pacing may contribute to recovery, while timely use of assistive devices, reduction of demands, and establishment of nursing and other support can limit exacerbation. Conversely, inappropriate concepts may promote overexertion.

7.8.​

There are still no established safe rehabilitation concepts, as demonstrated by the study of a rehabilitation program specifically adapted to ME/CFS conducted by Charité Berlin in cooperation with the Kreischa Rehabilitation Clinic (Kedor et al., 2026, preprint). Despite optimal conditions, almost 45% of participants experienced deterioration. Contrary to the presentation in the text, harm resulting from rehabilitation interventions is therefore by no means merely a phenomenon of the past.
 

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8. Evidence base for cognitive behavioral therapy​

8.1.​

The statement that there is “mixed evidence” for Cognitive Behavioral Therapy (CBT) should be supported by the underlying studies in a manner that allows the evidence to be evaluated. The limited and heterogeneous evidence base is not presented in a sufficiently differentiated manner.

8.2.​

The studies available to date cannot be regarded as evidence of the efficacy of CBT in ME/CFS, because they either investigated poorly defined fatigue cohorts or patients with Post-COVID, for whom PEM/PENE was not systematically assessed. The findings therefore cannot simply be generalized to ME/CFS.

8.3.​

The text does not explain how or to which specific characteristics of ME/CFS cognitive behavioral interventions are supposed to apply. Nor does it explain what the proposed improvement in “functioning” actually means. Existing studies generally assess treatment success using short-term subjective endpoints rather than long-term functional capacity. Furthermore, the measurement instruments regularly contain substantial overlap between depressive symptoms and symptoms of ME/CFS. It therefore remains unclear to what extent the reported effects represent genuine improvements or merely altered symptom appraisal resulting from nonspecific expectancy effects, such as short-term induction of hope or improved mood, without any change in objective physical capacity.

8.4.​

Framing psychotherapy in this context as the only available treatment is incorrect in two respects: first, psychotherapy can only provide support to affected individuals; second, there are indeed symptomatic treatment options for ME/CFS.

8.5.​

Rejecting an excessive focus on psychological factors, an overestimation of the possibilities for activation, and minimization of PEM/PENE has nothing whatsoever to do, contrary to the authors’ assertion, with rejecting appropriately conducted psychotherapeutic support. Such support is in fact indispensable for many patients as long as ME/CFS remains incurable.

8.6.​

We share the difficulty of integrating the disease itself into a behavioral therapy model—precisely because it is a somatic disease.

9. Role of psychotherapy, psychoeducation, and therapeutic attitude​

9.1.​

The differential diagnosis of a physical disease is not the primary responsibility of psychotherapists.

9.2.​

Psychoeducation should be based on a current and evidence-based understanding of ME/CFS and presupposes that the treating professional understands the disease and its central mechanisms.

9.3.​

A therapeutic relationship requires patients’ complaints to be taken seriously and not prematurely psychologized.

9.4.​

Difficulties in integrating ME/CFS into an existing behavioral therapy model should not lead to disease-related symptoms and their management being reinterpreted as dysfunctional behavior.

9.5.​

The Endurance-Avoidance Model, as well as other models derived from the field of somatization disorders, has not been validated specifically for ME/CFS.

9.6.​

The authors classify patients as either “anxious-avoidant” or “self-overexerting” (section 91.3.3, point 1), seemingly failing to consider the possibility of appropriate adaptation to the disease.

9.7.​

Associated with this categorization into these two groups is a striking lack of empathy toward the severe limitations and profound losses of roles and resources experienced by these patients. At the level of conceptualization itself, an opportunity is therefore lost to establish the therapeutic relationship as an emotionally stabilizing and protective environment.

9.8.​

It should be acknowledged that even the cognitive and emotional burden associated with appropriately adapted psychotherapeutic interventions may trigger deterioration in ME/CFS, even when the treatment is experienced as supportive.

10. Problematic handling of sources and evidence​

10.1.​

The selection of sources shows clear selectivity in favor of studies consistent with the authors’ hypotheses. Some sources are of poor quality. The evidence reported by the authors is either overstated or does not exist.

10.2.​

The evidence concerning Graded Exercise Therapy (GET) is inaccurately represented through reliance on the Cochrane review (Larun et al., 2024).

The underlying data are old; the most recent study included was published in 2014, with participant recruitment taking place between 1997 and 2011. Nonspecific diagnostic criteria were used that are now considered outdated because they capture PEM/PENE only optionally, if at all. It is therefore unlikely that the studies actually investigated ME/CFS cohorts.

The data on activity increases with GET include data from the methodologically highly controversial PACE trial, whose findings regarding the efficacy of activation and CBT were considered unsupported following an independent reanalysis of the raw data (Wilshire et al., 2018). In addition to using overly broad and nonspecific inclusion criteria, the authors lowered the predefined thresholds for improvement and recovery during the course of the study, thereby producing a stronger apparent effect for CBT and GET. Following substantial criticism of the study, NICE therefore withdrew its recommendations for GET and CBT in 2021, among other changes. Cochrane itself accordingly rates the evidence as low certainty.

10.3.​

The Institute for Quality and Efficiency in Health Care (IQWiG) (2023) likewise rates the evidence for GET as uncertain and emphasizes the possibility of serious adverse effects.

10.4.​

The study by Salzmann et al. (2024), which is cited as evidence for a nocebo effect allegedly reinforcing the “dysfunctional behavior” of patients, likewise did not investigate an ME/CFS cohort. PEM/PENE was not assessed at all and is not mentioned anywhere in the paper.

10.5.​

The cited source by Haberger et al. (2025) describes gradual increases in activity in seven severely affected Post-COVID patients. It is merely a small uncontrolled case series without evidence that the participants fulfilled the diagnostic criteria for ME/CFS. It therefore cannot establish efficacy or provide a general recommendation for increasing activity in ME/CFS.

10.6.​

In other relatively recent studies of people with Post-COVID, often within the first year after infection, PEM/PENE was either not assessed (Frisk et al., 2023, incidentally not a randomized study) or was not a prerequisite for inclusion and was reported only for a subset of patients (Nerli et al., 2024).

10.7.​

Spontaneous recovery is frequently described in Post-COVID cohorts and, more generally, during the first year after infection. This must be considered a potential confounder, particularly when PEM/PENE was absent. In the absence of an RCT, coincidental recovery may otherwise be mistaken for a causal effect of the treatment, resulting in an incorrect attribution of recovery to the intervention.

10.8.​

It is also problematic to use selectively chosen recovery stories that are consistent with the authors’ hypotheses and to equate such reports with scientific evidence. One of the cited publications is explicitly labeled an “Opinion” article and presents a one-sided argument (Miller et al., 2025). The other source is a collection of interviews with patients from an insufficiently characterized cohort, in which, in particular, transparent assessment of PEM/PENE is not apparent (Bakken et al., 2023). The disease trajectories and recovery experiences reported there are primarily attributed to psychological mechanisms.

By contrast, the numerous reports of deterioration and significant harm associated with such programs or treatment approaches are not considered, meaning that the evidentiary value of these reports is not established.

10.9.​

In general, patient reports or “recovery stories,” as well as sources such as Stiftung Warentest, should be clearly distinguished from empirical evidence with regard to their scientific evidentiary value.

10.10.​

Some statements are not supported by any sources at all, for example the alleged increased prevalence of “CFS” among “ethnic” minorities and people of lower socioeconomic status (see section 91.1, p. 568).

10.11.​

The appearance of sources generated by ChatGPT without transparent disclosure of the use of AI, as well as non-functioning links in the reference list, does not appear compatible with scientific standards in the context of a professional scientific publication. This raises the question of how robust the statements made in the text actually are. We also questionwhether the chapter underwent appropriate expert review or editorial scrutiny and how it was able to pass the intended review and approval processes in its present form.

10.12.​

It should likewise be clarified whether, and to what extent, multiple self-citations (3 out of only 14 sources) areprofessionally justified in the specific contribution.

11. Contradictions within the contribution​

From our perspective, there are several internal contradictions that require revision. Some have already been explained above but are summarized here for clarity:

11.1.​

“No reliable diagnostic criteria” ↔ simultaneous presentation of established clinical criteria.

11.2.​

Differentiation from primarily psychogenic disorders ↔ equating ME/CFS with neurasthenia and somatoform disorders.

11.3.​

Increased self-monitoring as problematic behavior ↔ recommendation of mindfulness and self-monitoring to support pacing.

11.4.​

Promotion of acceptance of the illness ↔ accusation of “hypochondria.”

11.5.​

Correct recognition of the significance of PEM/PENE ↔ presentation of pacing as a form of activation.

11.6.​

Demand for validation of symptoms ↔ simultaneous partially psychologizing or pathologizing description of patientbehavior.

12. Fundamental scientific criticism​

12.1.​

There is a fundamental methodological problem in transferring results from heterogeneous Post-COVID or fatigue cohorts to patients with diagnostically confirmed ME/CFS.

12.2.​

A medical professional publication should therefore consistently distinguish between ME/CFS, Post-COVID syndrome, post-viral fatigue, nonspecific fatigue, psychiatric disorders, and fatigue associated with other somatic diseases.

12.3.​

Statements concerning diagnosis and treatment should be derived exclusively from studies whose study populationactually corresponds to the target population being discussed.

12.4.​

Particularly in a disease in which PEM/PENE is a central characteristic, assessment of PEM/PENE is of fundamental importance when determining whether study findings can be generalized.

12.5.​

There are generally recognized and valid standards to which researchers are expected to adhere. These are set out, among other places, in the resolution of the 60th General Assembly of the German University Association (Deutscher Hochschulverband, 2010) and in its statement on dealing with suspected scientific misconduct (Deutscher Hochschulverband, 2011). We refer, on the one hand, to the requirement for integrity in dealing with sources and data; from our perspective, this also implies an obligation not to omit important and current data and scientific findings. On the other hand, we refer to the principle that science must serve humanity. We believe that science, too, should adhere to the generally recognized principle of non-maleficence, primum non nocere, which, in our view, is not upheld in the present contribution.

12.6.​

Furthermore, the text should urgently be reviewed for compliance with relevant scientific standards, particularly with regard to knowledge and transparency concerning the sources used, the independence of the scientific and linguistic work, and disclosure of the use of generative AI.

We ask you to review the points raised above with regard to scientific accuracy, the current state of the evidence, and, in particular, the therapeutic recommendations.

Our concern is explicitly to promote a factual and evidence-based presentation of ME/CFS that does justice both to the complexity of the disease and to the particular vulnerability of the patients affected.

The Missing Doctors & Psychotherapists

15 September 2026
 

References​

Appelman, B. et al. (2024) ‘Muscle abnormalities worsen after post-exertional malaise in long COVID’, Nature Communications, 15(1). https://doi.org/10.1038/s41467-023-44432-3.

Bakken, A.K. et al. (2023) ‘Acquiring a new understanding of illness and agency: a narrative study of recovering from chronic fatigue syndrome’, International Journal of Qualitative Studies on Health and Well-being, 18(1), p. 2223420. https://doi.org/10.1080/17482631.2023.2223420.

van Campen, C.L.M.C. et al. (2020) ‘Cerebral blood flow is reduced in ME/CFS during head-up tilt testing even in the absence of hypotension or tachycardia: A quantitative, controlled study using Doppler echography’, Clinical Neurophysiology Practice, 5, pp. 50–58. https://doi.org/10.1016/j.cnp.2020.01.003.

Carruthers, B.M. et al. (2003) ‘Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Clinical Working Case Definition, Diagnostic and Treatment Protocols’, Journal of Chronic Fatigue Syndrome, 11(1). https://doi.org/10.1300/J092v11n01_02.

Carruthers, B.M. et al. (2011) ‘Myalgic encephalomyelitis: International Consensus Criteria’, Journal of Internal Medicine, 270(4), pp. 327–338. https://doi.org/10.1111/j.1365-2796.2011.02428.x.

Charlton, B.T. et al. (2026) ‘Skeletal muscle properties in long COVID and ME/CFS differ from those induced by bed rest’, Nature Communications, 17(1), p. 9125. https://doi.org/10.1038/s41467-026-75725-y.

Davenport, T.E. et al. (2025) ‘Altered effort and deconditioning are not valid explanations of myalgic encephalomyelitis/chronic fatigue syndrome’, Nature Communications, 16(1). https://doi.org/10.1038/s41467-025-64538-0.

Davenport, T.E. et al. (2026) ‘ME/CFS and Long COVID Demonstrate Similar Bioenergetic Impairment and Recovery Failure on Two-Day Cardiopulmonary Exercise Testing’, Clinical & Translational Metabolism, 24(1), p. 6. https://doi.org/10.1007/s12018-026-09326-0.

Deutscher Hochschulverband (2010) ‘Wissenschaft und Ethik. Resolution des 60. DHV-Tages’, 23 March. https://www.hochschulverband.de/positionen/presse/resolutionen/wissenschaft-und-ethik (Accessed: 15 September 2026).

Deutscher Hochschulverband (2011) ‘Zum Umgang mit dem Verdacht wissenschaftlichen Fehlverhaltens. Empfehlungen des Deutschen Hochschulverbandes’, 12 April. https://www.hochschulverband.de/pos...em-verdacht-wissenschaftlichen-fehlverhaltens (Accessed: 15 September 2026).

Freitag, H. et al. (2021) ‘Autoantibodies to Vasoregulative G-Protein-Coupled Receptors Correlate with Symptom Severity, Autonomic Dysfunction and Disability in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome’, Journal of Clinical Medicine, 10(16). https://doi.org/10.3390/jcm10163675.

Frisk, B. et al. (2023) ‘A safe and effective micro-choice based rehabilitation for patients with long COVID: results from a quasi-experimental study’, Scientific Reports, 13(1), p. 9423. https://doi.org/10.1038/s41598-023-35991-y.

Germain, A. et al. (2025) ‘Temporal Dynamics of the Plasma Proteomic Landscape Reveals Maladaptation in ME/CFS Following Exertion’, Molecular & Cellular Proteomics, 24(12), p. 101467. https://doi.org/10.1016/j.mcpro.2025.101467.

Grande, T. et al. (2023) ‘The Role of Psychotherapy in the Care of Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome’, Medicina, 59(4), p. 719. https://doi.org/10.3390/medicina59040719.

Haberger, R. et al. (2025) ‘Ein stationäres Therapieprogramm für schwerstbetroffene Post-COVID-Patient:innen’, Ärztliche Psychotherapie, 20(4), pp. 266–271. https://doi.org/10.21706/aep-20-4-266.

Hartwig, J. et al. (2020) ‘IgG stimulated β2 adrenergic receptor activation is attenuated in patients with ME/CFS’, Brain, Behavior, & Immunity – Health, 3, p. 100047. https://doi.org/10.1016/j.bbih.2020.100047.

Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG) (2023) ‘Myalgische Enzephalomyelitis / Chronic Fatigue Syndrome (ME/CFS): Aktueller Kenntnisstand’. IQWiG-Berichte-Nr. 1539, Abschlussbericht N21-01. https://www.iqwig.de/download/n21-01_me-cfs-aktueller-kenntnisstand_abschlussbericht_v1-0.pdf.

Kedor, C. et al. (2026) ‘Evaluation of an Integrated Multidisciplinary Care Model for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Prospective, Open-label, Nonrandomized Controlled Intervention Study’. http://dx.doi.org/10.2139/ssrn.6989698.

König, R.S. et al. (2024) ‘Identifying the mental health burden in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) patients in Switzerland: A pilot study’, Heliyon, 10(5). https://doi.org/10.1016/j.heliyon.2024.e27031.

Larun, L. et al. (2024) ‘Exercise therapy for chronic fatigue syndrome’, Cochrane Database of Systematic Reviews, (12). https://doi.org/10.1002/14651858.CD003200.pub9.

Lien, K. et al. (2019) ‘Abnormal blood lactate accumulation during repeated exercise testing in myalgic encephalomyelitis/chronic fatigue syndrome’, Physiological Reports, 7(11), p. e14138. https://doi.org/10.14814/phy2.14138.

Miller, A. et al. (2025) ‘Patients with severe ME/CFS need hope and expert multidisciplinary care’, BMJ (Clinical Research ed.), 389, p. R977. https://doi.org/10.1136/bmj.r977.

Mughal, S. et al. (2025) ‘Metabolic adaptation and fragility in healthy 3D in vitro skeletal muscle tissues exposed to chronic fatigue syndrome and Long COVID-19 sera’, Biofabrication, 17(4). https://doi.org/10.1088/1758-5090/adf66c.

National Institute for Health and Care Excellence (NICE) (2021) ‘Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management (NG206)’. https://doi.org/www.nice.org.uk/guidance/ng206.

Nerli, T.F. et al. (2024) ‘Brief Outpatient Rehabilitation Program for Post-COVID-19 Condition: A Randomized Clinical Trial’, JAMA Network Open, 7(12), p. e2450744. https://doi.org/10.1001/jamanetworkopen.2024.50744.

Saha, A.K. et al. (2019) ‘Red blood cell deformability is diminished in patients with Chronic Fatigue Syndrome’, Clinical Hemorheology and Microcirculation, 71(1), pp. 113–116. https://doi.org/10.3233/CH-180469.

Salzmann, S. et al. (2024) ‘Side-effect expectations are associated with disability, physical fitness, and somatic symptoms 3 months after post-COVID neurological inpatient rehabilitation’, Journal of Psychosomatic Research, 186, p. 111902. https://doi.org/10.1016/j.jpsychores.2024.111902.

Scheibenbogen, C. and Wirth, K.J. (2025) ‘Key Pathophysiological Role of Skeletal Muscle Disturbance in Post COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Accumulated Evidence’, Journal of Cachexia, Sarcopenia and Muscle, 16(1). https://doi.org/10.1002/jcsm.13669.

Scherbakov, N. et al. (2020) ‘Peripheral endothelial dysfunction in myalgic encephalomyelitis/chronic fatigue syndrome’, ESC Heart Failure, 7(3), pp. 1064–1071. https://doi.org/10.1002/ehf2.12633.

Schomerus, G. et al. (2026) ‘Welche Rolle spielt „die Psyche“? Long COVID und ME/CFS als Prüfsteine für eine evidenzbasierte und patient*innenorientierte Psychiatrie und Psychotherapie’, Psychiatrische Praxis, 53, pp. 263–269. https://doi.org/10.1055/a-2866-9127.

Thapaliya, K. et al. (2026) ‘Disrupted glymphatic function and its relationship with sleep and cognitive impairment in ME/CFS assessed via DTI-ALPS’, Frontiers in Neuroscience, 20 (2026). https://doi.org/10.3389/fnins.2026.1875420.

Tomaskovic, A. et al. (2026) ‘Cardiopulmonary Exercise Testing Reveals Functional Limitations and Work Disability in Severe Post-COVID-19 and ME/CFS Patients’, Sports Medicine – Open, 12(1), p. 50. https://doi.org/10.1186/s40798-026-00995-1.

Westermeier, F. et al. (2026) ‘A cardiometabolic perspective on post-exertional malaise in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and Long COVID’, Cardiovascular Diabetology, 25(1), p. 250. https://doi.org/10.1186/s12933-026-03316-8.

Wilshire, C.E. et al. (2018) ‘Rethinking the treatment of chronic fatigue syndrome – a reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT’, BMC Psychology, 6(1), p. 6. https://doi.org/10.1186/s40359-018-0218-3.

Yu, Q. et al. (2026) ‘Evidence of White Matter Neuroinflammation in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Diffusion-Based Neuroinflammation Imaging Study’, Human Brain Mapping, 47(4). https://doi.org/10.1002/hbm.70505.
 
A truly breathtaking contribution by Dr. Alexa Alica Kupferschmitt and Professor Volker Köllner!
They generated so much publicity for a chapter in a psychology textbook – who would have thought that possible?
These guys are worth their weight in gold!

I think it’s time for a promotion.

How about a patient organized fundraiser for the two authors?
The maximum donation amount would be set to 1 cent.
The donations would be handed over during an official ceremony.
Video clips of pwME clapping with tears in their eyes while endless PDF pages of errata are displayed in the background. :emoji_military_medal:
 
That is excellent. Exactly the sort of hard, detailed, and clear pushback required from within the profession. Much thanks to all those involved in producing it. :hug:

In a formal scientific debate that is about as hard a kicking to an opponent as one is allowed to administer.
 
From a new thread:
Chandelier said:
This article in a german psychology magazine is interesting because there have been several critical letters to the editor.
A good opportunity to learn how the authors weasle themselves out of criticism.
Click to expand...
ETA: wow!
Kupferschmitt & Köllner said:
We do not believe that people with ME/CFS are harmed by publishing these positive findings regarding PCS—just as we do not believe that people with bipolar disorder are harmed when positive study results concerning chronic depressive disorders are published.
Click to expand...
 
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Chandelier said:
A statement by 30 health professionals and scientists has been released in German as a response to an absymal chapter on ME/CFS in a German psychology textbook that characterized pwME as combatant and potential hypochondriacs.
Among the signatories are names like Prusty, Schomerus, Stingl and Grande.

I wonder if we can build on that?
Next time an atrocious article on ME/CFS is published, we respond with a statement signed by 50-100 professionals to set the record straight.
Click to expand...
Update from Bettina Grande via Bluesky:

​
​
Support for the joint statement is growing.​
​
Since its publication, further colleagues have joined.​
​
For respectful and factually appropriate treatment of people with #MECFS.​
​
Additional co-signatories are welcome!​




From the PDF:
​
Note on co-signing​
People working in healthcare and research may continue to co-sign this statement. If interested, please get in touch by email.​
​
Responsible for the content and contact​
Dipl.-Psych. Bettina Grande​
Hauptstraße 48​
69117 Heidelberg​
 
Chandelier said:
Joint Statement from Healthcare and Academia

In Support of a Differentiated, Respectful, and Factually Appropriate Approach to People with ME/CFS​

In our medical, psychotherapeutic, and/or scientific work, we regularly encounter people with ME/CFS who are living in an exceptionally challenging situation. Most are severely restricted by their illness in their independence, social participation, and ability to pursue their professional and private lives. At the same time, only limited therapeutic options are currently available. Adequate healthcare structures are still largely lacking, and all too often people affected by the disease are, in practical terms, left to cope with their severe illness largely on their own by our healthcare system.

Against this background in particular, in our clinical and/or scientific work we frequently experience a high degree of gratitude and appreciation from people with ME/CFS for reliable support, careful diagnostic assessment, and an approach that fully recognizes and takes into account their individual limits of exertion as well as the often devastating extent of the limitations caused by their illness. Many people affected also have a strong interest in professional and scientific matters. They closely follow developments in research, engage thoughtfully with new findings, and often themselves devote what little energy they have left to improving healthcare, public awareness, and research.

Our shared experience is that the vast majority of people affected approach medical, therapeutic, and scientific questions in a constructive, reflective, and solution-oriented manner. Many contribute their own experiences in ways that provide important additional insights for healthcare and research. As medical and psychotherapeutic practitioners or scientists, we can benefit from this wealth of experience. Particularly in view of an illness that remains insufficiently understood and the existing deficiencies in healthcare provision, the perspective of those affected can be of considerable value.

As in any other patient population, there may of course occasionally be difficult or conflictual encounters involving people with ME/CFS. In our experience, however, such situations are neither characteristic of this patient population nor more frequent than in other medical contexts. Individual negative experiences must therefore never be generalized or used as the basis for attributing particular characteristics to an entire group.

Against this background, we are particularly concerned by portrayals that characterize people with ME/CFS as having a “combative and accusatory tone,” emphasize “aggressiveness” among affected individuals as a characteristic problem, or otherwise frame this patient population as generally “difficult.” Such sweeping statements turn individual negative experiences into a purported distinctive feature of this patient population, even though our experience in clinical practice and research provides no basis for such a characterization. Such portrayals can foster unwarranted mistrust of people with the disease, encourage the premature psychologization of physical symptoms, and contribute to medical concerns not being assessed without prejudice. In this way, they further impede the already inadequate healthcare available to people with ME/CFS.

We therefore strongly advocate for differentiated, respectful, and factually appropriate language, as well as a corresponding attitude toward this patient population. Both are essential prerequisites for trusting and effective healthcare and for constructive scientific collaboration.
Click to expand...

Chandelier said:
People working in healthcare and research may continue to co-sign this statement. If interested, please get in touch by email.
bettina@psychotherapie-grande.de
Click to expand...

I wonder if some of the healthcare professionals on the forum would be willing to join and co-sign this statement?
@Jonathan Edwards @SNT Gatchaman @DMissa @PhysiosforME @jnmaciuch @Chris Ponting @Joan Crawford
 
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A contribution from Dr med Karin Kelle-Herfurth, MHBA (Germany), who is also a signatory to the joint statement organised by Bettina Grande

posted on LinkedIn:
https://de.linkedin.com/posts/drkel...06098534979616769-JCSj?utm_source=chatgpt.com

original text in German; English translation by ChatGPT:

How a specialist text explicitly rejects #psychologisation while simultaneously perpetuating it:

Chapter 91, “Chronic Fatigue Syndrome”, of the Behaviour Therapy Manual – Adults, published in 2026, comes from the field of psychosomatic rehabilitation. It warns against mistakenly regarding “CFS” as a “purely psychogenic clinical condition”. In the very next sentence, however, rejection of a “psycho-somatic concept” is problematised, and warnings about exertion are linked to nocebo effects and “dysfunctional illness behaviour”.

With regard to aetiological concepts of #MECFS, the text states that empirical evidence is lacking. By contrast, it says of patients that a “combative and reproachful tone” is a striking characteristic of “some fatigue patients”; protective and avoidance behaviour is classified, irrespective of the primary aetiology, as potentially meeting the criteria for a hypochondriacal disorder — without providing the reasoning by which this conclusion is reached.

Where does the burden of proof lie?
Aetiological explanations are required to justify themselves empirically. Psychological interpretations of patients, by contrast, are asserted without comparable substantiation.

“Uncertainty and frustration among clinicians” may arise, for example, because of “patient aggressiveness, lack of continuing-education opportunities regarding CFS”, “difficulty integrating the illness into a classical behavioural-therapy model”, and “frustration due to slow progress”. A “metacognitive reflection on one’s own level of expectations” is recommended.

This places very different types of problems alongside one another within the therapeutic encounter. What is reflected upon is the clinician’s own level of expectations — not the FORM through which illness, behaviour and compatibility with the model come to appear as problems. The categories of observation being used remain unexamined.

Psychologisation operates through different forms of attribution:
The psychological explains the cause.
Psychological or behavioural factors explain the course or maintenance of the illness.
Attribution becomes recursive when objection to an interpretation can itself once again be read as a characteristic of the person objecting to it.

ME/CFS can restrict independence, everyday life and participation to an extreme degree. The text acknowledges that the evidence it draws upon does not include people with high levels of disease severity, yet nevertheless formulates recommendations for severely affected patients.

A manual claims to provide professional guidance by supplying professionals with categories through which to perceive, classify and treat patients. Standards of evidence, professional ethics and sensitivity to discrimination should, particularly in this context, form part of quality assurance.

Professional counterarguments have been made. ⤵️

Questions prompted by this:
What role is being attributed to psychological factors — cause, course, or consequence?
What becomes the object of scrutiny when a model reaches its limits?
What structures prevent an unsupported interpretation from acquiring institutional validity?

Professional self-reflection does not end with reflecting upon one’s own level of expectations. It must also extend to the categories through which we observe, evaluate and make decisions.

For a more detailed conceptual and functional analysis of psychologisation — how attributions are organised linguistically and communicatively, how they acquire validity, and how they can perpetuate themselves in the face of objection:
karin-kelle-herfurth.de/glossar/psychologisierung/

Two recent statements address, from different perspectives, the problematic attributions and/or the chapter:

1) Joint statement by the Psychotherapy Network ME/CFS from healthcare practice and research:
“For a differentiated, respectful and factually appropriate attitude towards people with ME/CFS” — focusing on rejecting such sweeping attributions and on the conditions required for trusting and effective healthcare, as well as constructive scientific collaboration.

psychotherapie-mecfs.de/stellungnahme/

2) Missing Doctors & Psychotherapists:
“Statement on Chapter 91 ‘Chronic Fatigue Syndrome’ in the 10th edition of Behaviour Therapy Manual – Adults” — a detailed substantive and methodological response by professionals who themselves have Post-COVID and ME/CFS, addressed to the specialist editorial team, editors and authors.


More relevant contributions from Kelle-Herfurth on psychologisation, ME/CFS and related systemic issues (in German):

  • The Paradox of Holism — Form Trumps Evidence (2025)
Kelle-Herfurth, K. (2025). Das Paradox der Ganzheitlichkeit – Form schlägt Evidenz.
  • Understanding Psychologisation: Why It Does Not Disappear Through “Holistic Perspectives” (2026)
Kelle-Herfurth, K. (2026). Psychologisierung verstehen: Warum sie nicht durch „ganzheitliche Perspektiven“ verschwindet.
  • Person-Centred Models of Illness and Explanations Intended to Strengthen Hope Are Not Only Helpful (2026)
Kelle-Herfurth, K. (2026). Personzentrierte Krankheitsmodelle und Erklärungen, die Hoffnung stärken sollen, sind nicht nur hilfreich
  • Therapeutic Explanations Can Help — While Simultaneously Reinforcing Adaptation to System Logics (2026)
Kelle-Herfurth, K. (2026). Therapeutische Erklärungen können helfen – und gleichzeitig die Anpassung an Systemlogiken stabilisieren
  • “One Does Not Exclude the Other.” When Does an Interpretation Become Information for Decision-Making? (2026)
Kelle-Herfurth, K. (2026). „Das eine schließt das andere nicht aus.“ Wann wird eine Deutung zur Entscheidungsinformation?
  • Can You Advocate for a Cause Without Sharing the Opinion Associated With It? (2026)
Kelle-Herfurth, K. (2026). Kann man ein Anliegen vertreten, ohne die dazugehörige Meinung zu teilen?
  • Pogo Ability or Violent Dancing? How to Recognise Communication Patterns That Programme Conflict (2025)
Kelle-Herfurth, K. (2025). Pogofähigkeit oder Violent Dancing? Woran Sie kommunikative Muster erkennen, die Konflikte programmieren
  • When Communication Fails — Intention Is Not Effect, and Meaning Is Not Reality (2025)
Kelle-Herfurth, K. (2025). Wenn Kommunikation nicht trägt – Absicht ist nicht Wirkung und Bedeutung nicht Wirklichkeit.

The latter includes an accompanying commentary by Gitta Peyn on how a particular form of communication can transform a substantive medical problem into a problem of power and reality.


About Dr med Karin Kelle-Herfurth, MHBA:

original text in German; English translation by ChatGPT:

I am a consultant specialist in Physical and Rehabilitative Medicine and a health economist (MHBA). I have been self-employed since 2017 and work independently of location throughout Germany, Austria and Switzerland, based in Hamburg.

What guides me: Decisions about health are rarely determined by knowledge and expertise alone. How effectively knowledge is put into practice also depends on how illness, functioning and responsibility are described and evaluated — and on the consequences that follow from this within healthcare and the world of work. Those who focus solely on the desired outcome can easily overlook the conditions that make that outcome possible or prevent it.

ME/CFS and Long COVID are key areas of both my medical and analytical work, and I write and conduct research on them. They make particularly visible the ways in which health-related functioning, occupational demands, and institutional logics of interpretation and decision-making interact.

And it is precisely at such interfaces that I work — both with people undergoing major changes in their health and professional lives and with professionals and leaders navigating complex professional situations.

I provide advice where medical assessment, a systemic perspective and an independent view of the conditions that shape decision-making and what is accorded validity are all needed together — yet are rarely found together.

This makes it possible to distinguish what you can rely upon, where genuine room for manoeuvre exists, and what can provide a sound basis for the next step. You can then base your decisions on solid foundations — and explain and advocate for those decisions in everyday life, at work or when dealing with institutions.
 
Last edited:
Chandelier said:
Update from Bettina Grande via Bluesky:

​
​
Support for the joint statement is growing.​
​
Since its publication, further colleagues have joined.​
​
For respectful and factually appropriate treatment of people with #MECFS.​
​
Additional co-signatories are welcome!​




From the PDF:
​
Note on co-signing​
People working in healthcare and research may continue to co-sign this statement. If interested, please get in touch by email.​
​
Responsible for the content and contact​
Dipl.-Psych. Bettina Grande​
Hauptstraße 48​
69117 Heidelberg​
Click to expand...

Update: the statement now has 76 signatories.

The signatories now include a substantial number of psychologists, psychotherapists, psychiatrists and specialists in psychosomatic medicine, alongside clinicians and researchers from other fields.
 
When magic thinking escapes the text book, what a glorious and mysterious excuse they came up with!

Erratum zu: Chronisches Fatigue-Syndrom, 2026, Kupferschmitt et al.

Kupferschmitt, Alexa Alica; Köllner, Volker

Die ursprünglich veröffentlichte Version dieses Kapitels enthielt Aussagen, die nicht von den Autoren Alexa Kupferschmitt und Volker Köllner stammen, nicht mit ihrer therapeutischen Haltung übereinstimmen und nicht von ihnen zu verantworten sind. Leider wurden die finalen Korrekturen vor Drucklegung nicht an die Autoren kommuniziert. In der Folge wurde daher eine von den Autoren nicht autorisierte Version des Kapitels publiziert.

Mittlerweile wurde das Kapitel nachträglich angepasst und spiegelt nun die ursprüngliche, von den Autoren freigegebene Version des Kapitels wider.

Machine translated erratum:
The originally published version of this chapter contained statements that were not written by the authors, Alexa Kupferschmitt and Volker Köllner, did not reflect their therapeutic approach, and were not their responsibility. Unfortunately, the final corrections were not communicated to the authors before the chapter went to press. As a result, a version of the chapter that had not been authorized by the authors was published.

The chapter has since been amended and now reflects the original version approved by the authors.

Web | DOI | Psychotherapie: Praxis
 
Chandelier said:
The originally published version of this chapter contained statements that were not written by the authors, Alexa Kupferschmitt and Volker Köllner, did not reflect their therapeutic approach, and were not their responsibility. Unfortunately, the final corrections were not communicated to the authors before the chapter went to press. As a result, a version of the chapter that had not been authorized by the authors was published.
Click to expand...
Sorry guys. You’re the only listed authors, this was definitively your responsibility, unless you’re claiming that the changes were made by the editors?
 
Utsikt said:
Sorry guys. You’re the only listed authors, this was definitively your responsibility, unless you’re claiming that the changes were made by the editors?
Click to expand...

Book subeditors very often, if not always, do this. They screw up what you have writted (sic). They should tell you what they have changed but routinely they do not and unless you are expert as a proof reader you miss dreadful errors in your own text. It has happened to me repeatedly. Almost always something is wrong in a book chapter. So I think the authors have a legitimate complaint.
 
Jonathan Edwards said:
Book subeditors very often, if not always, do this.
Click to expand...
I did not expect that to be common in an academic setting. Useless peer review - sure, but not outright editing.

The abstract still says this, so I’m not sure I have much hope about the quality of the paper even without unhelpful edits:
Empirical evidence of effectiveness in improving fatigue symptoms currently exists only for cognitive behavioral therapy (CBT) and gently activating exercise therapy in mild to moderate cases, while sufficient data for severe CFS is lacking. Furthermore, the potential for worsening symptoms due to PEM must be considered, although the data on this is also inconsistent. To support coping with the illness, ACT-based approaches and, for PCS, the avoidance-endurance concept adapted from pain therapy are helpful.
Click to expand...
 
From Bluesky:

​
​
Springer is publishing an erratum for a #MECFS specialist chapter, claiming that statements were published without the authors' authorization.​
​
The corrected version removes, among other things, passages that frame patients as "aggressive" or "hypochondriacal."​
An exculpatory narrative?​
The assertion that such clear value judgments were introduced only during the production process is absurd.​
​
Why would a publisher of @springer.springernature.com's caliber stoop to such a dubious scientific publishing charade?​
​
#MECFS #FBM26​
​


Springer veröffentlicht ein Erratum zu einem #MECFS - Fachkapitel:Aussagen seien ohne Autorisierung der Autoren veröffentlicht worden.

In der korrigierten Fassung fehlen u.a. jene Passagen,die Betroffene als „aggressiv“ oder „hypochondrisch“ rahmen.
Ein Entlastungsnarrativ?
Die Behauptung, derart klare Wertungen seien erst im Produktionsprozess ins Kapitel gelangt, ist absurd.

Warum gibt sich ein Verlag vom Rang @springer.springernature.com für ein derart dubioses wissenschaftspublizistisches Possenspiel her?

#MECFS #FBM26

link.springer.com

Erratum zu: Chronisches Fatigue-Syndrom

'Erratum zu: Chronisches Fatigue-Syndrom' published in 'Verhaltenstherapiemanual – Erwachsene'
link.springer.com link.springer.com
 
Chandelier said:
The corrected version removes, among other things, passages that frame patients as "aggressive" or "hypochondriacal."
An exculpatory narrative?
The assertion that such clear value judgments were introduced only during the production process is absurd.
Click to expand...

It does seem far fetched for that.
Unless there is a section editor who has tampered with material. That can happen, but it seems pretty unlikely here.
 
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