Abbey, S E, Garfinkel, P E · The American journal of psychiatry · 1991 · DOI
This article compares chronic fatigue syndrome (CFS) to an older diagnosis called neurasthenia that was common in the 1800s. The authors suggest that both conditions became popular during times of major social and economic change, and both were seen as medical rather than mental health problems. They argue that CFS may eventually be viewed the same way neurasthenia is today—as primarily a psychiatric or stress-related condition rather than a distinct medical illness.
This study is important because it raises critical questions about how cultural factors and medical assumptions shape disease recognition and diagnosis. For ME/CFS patients, understanding these historical patterns can illuminate why their condition has been controversial and sometimes dismissed as psychiatric, helping explain the barriers to recognition and appropriate medical care.
This paper does not prove that CFS is primarily psychiatric or psychophysiological; it is a theoretical argument based on historical analogy, not empirical evidence. It does not demonstrate the biological mechanisms of CFS or provide data about the actual prevalence of psychiatric comorbidity in CFS populations. The comparison to neurasthenia, while intellectually interesting, does not establish that CFS will follow the same trajectory or that the same conclusions apply.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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