By Joel Klein MD
Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FM) are related conditions that have the same fundamental roots and can occur separately or, as is common, together. As it name implies, CFS involves persistent, debilitating fatigue that affects social, occupational, or personal activities. FM primarily involves diffuse, chronic muscular pain. Conventional medicine classifies both of these as “syndromes,” a word used to describe a pattern of symptoms that means “occurring together,” with no specific identifiable causes. More progressive physicians have discovered that these conditions typically arise from interrelated functional abnormalities involving the gastrointestinal tract and, what is now being called, the neuro-endocrine-immune system. It has been clearly demonstrated that the nervous system, the hormone system, and the immune system form a complex network where each “talks” to other and it is in dysfunctions of this crosstalk that we find the origin of many chronic illnesses and diseases, particularly CFS and FM. At the somatic level, when the hormonal, immune and gastrointestinal disturbances are addressed in unison, a large number of patients obtain significant, and often lasting, improvement.
In the same vein, when we look at CFS and FM patients from a psycho-spiritual perspective, several common root issues appear. In my clinical experience, those people for whom these issues remain quite prominent in the workings of their lives will not achieve good relief unless these issues are dealt with in a meaningful fashion, even with good medical treatment. While it has become almost a cliché, the common element seems to revolve around low self-esteem. Within that dynamic, two basic patterns commonly emerge. The result of both is chronic, unrelenting stress which then serves to bring about the physiologic changes responsible for the symptoms.
The first pattern is one of people who believe that they must sacrifice for the good of others. These are people commonly found in the helping professions, notably nurses, as well as other fields where care of others is involved. These folks are very hard working, dependable to a fault, and habitual people pleasers who put their needs last. They are commonly the ones that everyone else turns to in an emergency and can always be counted on to fill in, in a pinch. What they sometimes fail to realize is that they have trained everyone in their lives to treat them this way and then, of course, feel obligated to say “Yes” when asked again in order to avoid disapproval. In this group, whether they realize it or not, the CFS and FM frequently provide them with the appearance of a valid excuse to say no. Migraine headaches, commonly a part of the CFS picture, can accomplish the same purpose. Not feeling worthy to just say “no” to someone, the physical problem affords them the permission they are seeking since, on the surface, it is more difficult to argue with something that is “real.” True healing in these patients will necessarily involve rehabilitating their ability to set appropriate boundaries in their lives and ask for what they want. They also need to learn how to “put their own oxygen mask on first.”
The second commonly pattern seen pattern in CFS and FM patients is one of habitually being victimized. The lives and relationships of these patients are usually chaotic and they seem to attract circumstances which, on the surface, do not appear to be their fault, although when one looks closer, it can be seen that they are repeatedly, unconsciously setting up situations in their lives that leave them vulnerable to being taken advantage of and gravitating towards people, especially partners, who have their own pattern of manipulation and taking advantage of others. These patients commonly have histories of early childhood abuse – physical, sexual, and/or verbal. This history then commonly continues to get re-enacted later in life, for example, by marrying an abusive spouse. These patients learned, at some level, that they were not worthy of love and caring unless they were ill, so that illness becomes the only acceptable way to seek the love and support they need. In another way, the illness becomes their protection from an unsafe world, or at least is perceived to be at a subconscious level. Again, let us be clear that the chronic stress engendered by a lifetime of living in this pattern has true physiologic consequences in the hormone and immune systems that can be addressed with an appropriate therapeutic regimen. The problems are not just “in their head.” However, unless these deeper issues are addressed, not an easy task to be sure, there will be little improvement as these patients, deep down, may actually be afraid to get better and have their symptoms taken away from them, thus losing their “protection.” And, while it can be useful to be given a diagnosis, these patients are also at risk for having the diagnosis become their identity and a way that they can feel “special,” something commonly lacking in their childhoods.
The purpose of this discussion is not to prejudicially psycho-analyze those who suffer from CFS and FM, but to shed some light on some of the possible underlying dynamics at work in these conditions. In this way it is hoped that patients suffering from them, (although I would like to point out that, while pain is inevitable, suffering is optional) and their friends and loved ones will be empowered to look more deeply, if necessary, to find real solutions that provide true healing, not just relief of symptoms. I strongly recommend that patients with these conditions consider some kind of deeper work, whether it be psychotherapy, energy work, or some other modality that can assist them in looking within, to truly be healed and, ultimately, become whole.
Joel B. Klein, MD
The Klein Center for Holistic Medicine
620 S. Cascade Ave., Suite C
Colorado Springs, CO 80903
(719)457-0330 Fax (719)457-0860