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Conceptualising illness and disease: reflections on Sharpe and Greco (2019)
  1. Carolyn Wilshire,
  2. Tony Ward
  1. School of Psychology, Victoria University of Wellington, Wellington, New Zealand
  1. Correspondence to Dr Carolyn Wilshire, School of Psychology, Victoria University of Wellington, Wellington 6140, New Zealand; carolyn.wilshire{at}


In a recent paper, Sharpe and Greco suggest that chronic fatigue syndrome/myalgic encephalomyelitis (MECFS) can be viewed as an instance of “illness without disease”, and consequently, treatment should be directed towards altering the patient’s experience of, and response to, their symptoms. We discuss two broad issues that arise from Sharpe and Greco’s article, one relating to the assumptions they make about MECFS and its treatment specifically, and the other relating to their conceptualisation of the illness/disease dichotomy. We argue that the term “illness without disease”, in the sense that Sharpe and Greco use it, is problematic because it can lead to unwarranted causal assumptions. Following these critical comments, we present a new framework for conceptualising the relationship between explanatory disease models and the experience of illness.

  • chronic fatigue syndrome/myalgic encephalomyelitis
  • illness, disease
  • mental disorders
  • explanation

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  • Contributors CW and TW contributed equally.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests CW has collaborated with patients with CFS on several previous articles that are critical of behavioural interventions for CFS.

  • Patient consent for publication Not required.

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