Catherine’s Chronic Fatigue Syndrome

Catherine, a pale thin woman in her thirties, was into her third year with chronic fatigue syndrome (CFS). She’d been “everywhere,” including the Mayo Clinic, but no one had been able to answer her question: why am I ill? All treatments, conventional and alternative, had given her only temporary relief before they stopped working or were discontinued by her because of side effects.

Catherine had read many books on CFS, and had even traveled to the author-physicians for treatment, again with no results. She had plumbed the depths of the internet, where she was active in chronic fatigue chat rooms; she was also a member of her local CFS support group.

On her first visit to me, Catherine was accompanied by her elderly father. She’d canceled her two earlier appointments at the last minute, citing a flare-up of her fatigue. Her father had pulled his car as close as possible to our front door, carrying in for her both her purse and a shopping bag filled with medical records and supplements. She leaned heavily on his arm. He then arranged her comfortably across two chairs, covered her feet and legs with a blanket, and went out to park the car.

In our initial conversation I learned that at one time Catherine had been on her way to a high-powered law career. When I asked about her life, she told me her childhood had been difficult–her mother had died suddenly when she was eight and her father was a recovering alcoholic. She couldn’t remember much about her childhood, except that she was unhappy most of the time. To compensate, she’d done extraordinarily well in both high school and college, where she’d been popular, athletic, and smart. She was accepted into a highly competitive law school and seemed to know what she wanted in life: to scale the ranks of a prestigious downtown firm, full partnership in record time.

She’d gotten her wish, and was recruited directly from school. The work, as any fledgling lawyer knows, was brutal. Seventy-hour weeks were common, and expected if partnership was your goal. And then, after about four years of late nights at the office and frozen dinners at midnight, Catherine collapsed with the flu.

Her life would never be the same.

It was flu season, and many in her office were ill, but hers was different. She never felt well again after this flu. Tired, achy, feverish, she found that she couldn’t get out of bed to do anything except use the toilet or heat up food.

After a couple of weeks of this, she’d staggered to her doctor, who ran a few tests, prescribed some antibiotics, and reassured her she’d get over it. A month later, Catherine was back again, no better. By this time, her father was stopping by her apartment with groceries and helping with housekeeping. Her doctor ran a whole battery of tests, but again, nothing significant turned up.

Catherine knew she couldn’t return to her job feeling like this, so she applied for disability insurance at work, and it provided enough money to get by for the next few weeks. She’d heard her doctor mention the possibility of CFS, read about it constantly on the internet, and decided this was indeed what she had. There seemed to be a lot of paths she could follow, and eventually one would lead her to wellness.

Three years later, her law career was history. Now she was on long-term disability and had moved in with her father. He was spending his retirement years driving her to doctors, food shopping, and helping her fill out the seemingly endless insurance and disability forms.

The Mayo Clinic had confirmed a diagnosis of CFS, with a treatment plan consisting of antidepressants, stimulants, physical therapy, and exercise, but Catherine rejected it all as impossibly difficult or fraught with side effects. Alternative practitioners, including MDs, chiropractors, acupuncturists, and homeopaths, had tried a smorgasbord of unconventional therapies. Nothing ever worked.

Now in my office for the first time, a sad Catherine asked if she could relate her story while lying down. I reviewed dozens of pages of medical history and during a physical exam found nothing notable except the pallor of a person who’d spent months indoors and the muscle wasting of someone who hadn’t exerted herself in years.

Catherine told me she was currently involved in two complex lawsuits and that I might be asked to testify about chronic fatigue and her disability.

I suggested four conventional and two alternative treatments, to be started simultaneously. My conventional approach was based on the DePaul University Chronic Fatigue Study several years ago. After enrolling more than 100 patients, researchers concluded that two forms of therapy were most effective:

• a form of psychotherapy called Cognitive Behavioral Therapy (CBT)
• a form of physical therapy called graded exercise

I’ll write a health tip about CBT in the future. Graded exercise pretty much speaks for itself. Day One: virtually nothing, just get up on the exercise bike. Day Two: spin the pedals twice and lift one-pound weights.

I also prescribed an antidepressant to boost her serotonin and Provigil to prevent her daytime drowsiness. The alternative therapies were Myers’ Cocktails and traditional Chinese medicine with my associate Mari Stecker.

After I handed Catherine the summary of all this (what we call a Healing Path) the look on her face suggested “Same old, same old,” even though she’d not tried any of it in the past except the antidepressant. Like a chess master, she blocked every suggestion (“I don’t want counseling.” “No acupuncture–I’m needle phobic” “I get side effects from all antidepressants.” “My insurance doesn’t cover…)

Two weeks later, she told me she tried a half tablet of Provigil (“it made me sick”) and abandoned physical therapy after two sessions (“I was exhausted”).

I’ll now press fast-forward on this seemingly hopeless case of a non-fatal illness that looked like it might go on forever. It was quickly clear that there was no place for medicine in Catherine’s recovery process. There would never be a pill, gentle exercise program, or acupuncture needle that would solve everything.

In my view, Catherine unconsciously was trying to accomplish two goals by not taking any steps toward resolving her illness. First, there was the issue with her father. She never revealed, or simply had repressed, what happened between them after her mother died. But now he was spending the last years of his life supporting her, physically and financially. The man had no life of his own.

Second, by developing an “untreatable” chronic illness, Catherine allowed herself to exit gracefully from a career that had been completely wrong for her. She was never meant to tolerate the incredible pressures she placed herself under. Her mind and body screamed OUT! and all systems collapsed.

You can see how Catherine’s case exemplifies resistance, which Freud emphasized was an unconscious but definitely counterproductive defense maneuver. There’s no blame anywhere here. Sadly, Catherine’s years are drifting by, she a professional patient, her father her purse-carrier.

Is she a hypochondriac? Definitely not. She is genuinely exhausted, and getting worse as her muscles progressively deteriorate from inactivity.

You might wonder how I continue to try to help patients like Catherine. The answer is “gingerly.” Tiny steps, a little at a time. Do I ever confront a patient about resistance? Almost never—they have to sense it in themselves.

What finally happened was that Catherine’s father died, and most of her disability money came through. Her health insurance was now covered by Medicare. She inherited her father’s condominium and some money. Not enough for a lavish life, but her cost of living is very low. She “gets by.”

Catherine has a new relationship these days with a nice enough fellow who drives her to her support group meetings and spends hours with her on the internet reading about the latest developments in CFS. Catherine’s health is virtually the same, but she does go out to the occasional movie, took a beach vacation last winter, and now is able to sit up during her visits with me.