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Chronic fatigue syndrome and an illness-focused approach to care: controversy, morality and paradox
  1. Michael Sharpe1,
  2. Monica Greco2
  1. 1 Psychiatry, University of Oxford, Oxford, UK
  2. 2 Sociology, Goldsmiths College, London, UK
  1. Correspondence to Professor Michael Sharpe, Psychiatry, University of Oxford, Oxford, OX3 7JX, UK; michael.sharpe{at}


Contemporary medicine distinguishes between illness and disease. Illness refers to a person’s subjective experience of symptoms; disease refers to objective bodily pathology. For many illnesses, medicine has made great progress in finding and treating associated disease. However, not all illnesses are successfully relieved by treating the disease. In some such cases, the patient’s suffering can only be reduced by treatment that is focused on the illness itself. Chronic disabling fatigue is a common symptom of illness, for which disease-focused treatment is often not effective, but for which illness-focused treatments (psychological or behavioural) often are. In this article, we explore a controversy surrounding illness-focused treatments for fatigue. We do this by contrasting their acceptance by people whose fatigue is associated with a disease (using the example of cancer-related fatigue) with their controversial rejection by some people whose fatigue is not associated with an established disease (chronic fatigue syndrome or CFS, sometimes called ME (myalgic encephalomyelitis)). In order to understand this difference in acceptability we consider the differing moral connotations of illness and disease and then go on to examine the limitations of the concepts of illness and disease themselves. We conclude that a general acceptance of illness-focused treatments by all who might benefit from them will require a major long-term change in thinking about illness, but that improvements to the care of individual patients can be made today.

  • fatigue
  • chronic fatigue syndrome
  • mind-body
  • philosophy
  • integrated care

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  • Contributors MS and MG contributed equally.

  • Funding This study was funded by Wellcome Trust (grant no: WT107428AIA).

  • Competing interests Dr Sharpe reports: I have published on CFS and its treatment. I was an author on the PACE trial of treatments for CFS cited in this article.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.