Chronic fatigue syndrome is among the prominent contested illnesses in the world. For decades, scientists, patients, and doctors have struggled to define and manage the illness largely due to conflicting points of views. While some conceptualize it as a physical manifestation of underlying physiological and mental imbalances, others view it as a biomedical illness that necessitates medical treatment. The contested nature of the condition has hardly helped in advancing research on the chronic fatigue syndrome to come up with better, effective, evidence-based interventions. This paper interrogates the contested nature of the illness delineating the gendered dynamics involved and the role the big pharma plays in shaping the conceptualization of chronic fatigue syndrome. Analysis indicates that the complex nature of the chronic fatigue syndrome symptoms, coupled with its unknown etiology, and the medicalization of its definition and treatment are the core reasons chronic fatigue syndrome is perceived as a contested illness.

Contested Illness

Chronic fatigue syndrome became a contested illness right from the moment it was discovered in the 1980s. The contested nature of the illness arose from the conceptualization of the condition and how it has, with time, come to be understood as a medical issue. The incapacitating fatigue was seen as a materialization of physical and mental deterioration, a social experience. However, gradually researchers and other scientists have increasingly defined it as a medical illness. This is despite the fact that the condition does not have any particular set of symptoms. The core symptoms of the condition include muscle pain, exhaustion, sleeplessness, and depression. In other instances, there is also the presence of gastrointestinal problems and recurring viral infections and the combination of the symptoms tend to vary from a single person to another. Though related to an extent, the symptoms do not stem from a single cause. They often co-occur in a patient, but there is no baseline that points to a unifying cause which makes it rather inappropriate to conceptualize chronic fatigue syndrome as a medical issue. Furthermore, despite the presence of a generally-agreed set of indicative symptoms, the occurrence of additional symptoms in others makes it hardly convenient to be defined as a medical issue because there is, fundamentally, no defined biomedical cause and proper diagnostic tests. Even though there are common traits, in most instances, the unidentified biomedical mechanism coupled with competing ideas of causation and treatment makes chronic fatigue syndrome a contested illness.

Social Constructionist Perspective

The social constructionist perspective can be used to explain the contested nature of chronic fatigue syndrome including its causation, treatment, and management. Social constructionism provides a necessary counterproposal to medical determinism. For instance, it is evident that some illnesses are embedded with cultural meanings. Thus, conditions like chronic fatigue illnesses, too, have both biomedical and experiential dimensions and should not be conceptualized only as medical issues. The social and cultural meanings attached to the condition, including its metaphorical meanings, should be addressed to treat the condition. Addressing the symptoms alone is not effective, as has been the case since the 1980s.

Secondly, the social constructionist perspective explains that all illnesses are socially constructed. At the experiential level, each societal group has a different conceptualization of the illness and how to live with the illness. It is not surprising, then, that the condition is even named differently across the globe. In the U.S. it is essentially known as chronic fatigue syndrome, having been named so by the Center for Disease Control and Prevention (CDC). However in other circles and other parts of the world, the condition is known differently. The medical-oriented environments refer to it as myalgic encephalomyelitis, in the U.K it is known as chronic fatigue immunodysfunction syndrome (CFIDS), while in some parts of the world it is known as the post-viral fatigue syndrome (PVFS). Hence, depending on how the condition is experienced, its definition, treatment, and management may change.

Lastly, the medical knowledge, too, is in most instances socially constructed. The knowledge about a disease or illness is not only informed by the nature of the illness but also by the experiences of the members of the society who experience it. The claim-makers and interested parties seek to uniquely define a medical condition to reflect own interests and values. Hence, medical knowledge cannot be taken to be, by itself, value-neutral. It is, implicitly or explicitly, influenced by interests of researchers, drug manufacturers, and other stakeholders.

Gendered Dynamics

Chronic fatigue syndrome is one of the conditions that have adversely been influenced by the gendered dynamics especially with regards to how the conditions are advertised. In this instance, even though chronic fatigue syndrome predominates in women, they are not involved in the devising of its treatment and management. Research studies indicate that the female gender has a higher prevalence to suffer chronic fatigue syndrome by more than 20%. However, the illness is advertised as mainly affecting the male. Consequently, all the medical institutions that conduct CFS-related research, including its orientation and other modalities, remain male-dominated. To further compound the situation, the treatment interventions greatly disadvantage womens health status and their access to their preferred or desired care. The medical fraternity, largely male-dominated, is increasingly dismissing or otherwise trivializing the benefits of appropriating feminist epistemological methods to comprehend the experiences of chronic fatigue syndrome patients. As a result, some women even fail to seek medical help because, in the process, they are subjected to dehumanizing and humiliating experiences. The medical community should include women in the definition of the treatment and management of the condition as they form the bulk of the patient population. Their experiences, informed by the social constructionist perspective, should be factored in not only in the definition of chronic fatigue syndrome but also in its treatment and management.

Big Pharma Influence

Just like in many other conditions that have come to be understood as medical issues, big Pharma has played a significant role in shaping the perception and presentation of chronic fatigue syndrome. The large pharmaceutical companies have increasingly commissioned research studies which present chronic fatigue syndrome as largely psychogenic in nature. Whether these studies are subjectively skewed is yet to be determined. What is evident though is that these large pharmaceutical companies progressively frame chronic fatigue syndrome in psychiatric terms and even recommend treatments regimens including psychotherapeutic interventions that are appropriated to address psychiatric disorders. The big Pharma has essentially made contested illnesses a battleground for legitimacy and since they have the necessary capital they have almost always managed to sway the conceptualization of the medical conditions and gained legitimacy through increased use of their medical interventions. It thus barely confounds that, currently, the major treatment for chronic fatigue syndrome is a combination of anti-depressant and anti-anxiety drugs.

In conclusion, it is evident that chronic fatigue syndrome is a contested illness because of its unknown etiology and multiple unrelated yet intricate set of symptoms. Ordinarily, it does not qualify to be a medical issue since its biomedical cause cannot be pinpointed, yet it continues to be presented as psychogenic in nature. Further, there are gender dynamics at play which exacerbate the inefficiency of the treatment and management of the condition. Despite it predominating in women, they are hardly considered when devising its treatment and management interventions. The large pharmaceutical companies, too, barely help the situation by increasingly defining chronic fatigue syndrome as a purely medical issue. A sociological integrative approach that considers the input of medical researchers and the social agents experiencing the illness is the best approach towards adequately and effectively defining, treating, and managing of chronic fatigue syndrome.

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