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Post-viral fatigue syndrome (myalgic encephalomyelitis) is a physically debilitating disorder associated with chronic disabling fatigue. This thesis presents two studies which look at the impact of illness from a personal-psychological and from a family perspective. The first investigates the psychological features of the syndrome. The prevalence of psychiatric disorder in 20 patients with the PVFS was determined. Sixty percent satisfied criteria for a current psychiatric disorder. Diagnoses were of neurotic depression and other neuroses. Only 25 % of a comparatively disabled group of 20 arthritis sufferers received similar diagnoses. Diagnoses did not substantially differ in type from a group of 20 subjects with major depressive disorders, although selected differences in symptom profile and the role of previous life-time psychiatric episodes, suggest that the PVFS cannot be regarded as a variant form of depressive disorder. A logistic regression analysis achieved a satisfactory separation of the two disorders on the basis of psychiatric symptoms. The second study investigates 9 school-aged children with mothers suffering from the syndrome, and 9 children with healthy parents. The children in the PVFS group had been exposed to their mother's illness from between 18 months and 14 years. They were found to have significantly more problems in the school environment in comparison to controls, rated as more shy and anxious, less assertive and with more relationship problems with peers. General family orientation was less active with fewer out-of-home family pursuits. Family interactions were somewhat more negative. Child adjustment is discussed in terms of the linkages between family, school and peer-group in the lives of these children. Investigations into the adaptive potential of such linkages and the permeability of the boundaries between the spheres raise important questions for ameliorative work in the counselling of PVFS sufferers and their families.

This thesis is an analysis of the discursive construction of a controversial medical condition (Myalgic Encephalomyelitis) and how it has been made sense of, in and through the discourse of medical scientists, general practitioners, and M E sufferers. Various kinds of text and talk are analysed from the perspective of discursive psychology, arguing that versions of reality are a product of participants' constructive and dialogical practices. (I include my own text as an example of this.) The analysis of scientific texts, illness narratives, diagnostic narratives, and M E self-help group discussions, show how explanations about the status of M E and its causes are embedded in accounts of the identity of sufferers, the nature and status of medical explanation, and the competencies of medical practitioners. There is a sense in which the controversial topic of this thesis provides an ideal forum for examining both lay and professional reasoning practices about illness, in a context where the 'objective' world of 'medical facts' threatens to disintegrate into merely subjective points of view. One of my concerns has been to show how the participants themselves orient to, and manage this 'reality disjuncture' by means of a variety of discursive devices. The main body of the thesis addresses this problem through issues such as: the significance of diagnostic labels, different models of medicine, and the relevance of mind and body in explanations for illness. Finally, there is an analysis of the narrative constructions of M E sufferers and GPs, to show how psychosocial 'evidence' is used to warrant the speaker's interpretation of illness as either a mental or physical phenomenon.

Chronic fatigue syndrome (CFS) describes a condition characterised by severe fatigue of at least six months' duration. In this thesis, it is argued that the complexity of CFS with respect to other symptoms, the patients' response to their illness and the determinants of emotional distress, has yet to be fully recognised. This may have narrowed the focus of research and limited the range of treatments available. The first of the three studies investigated CFS from the patients' perspective. The findings challenge some of the generalisations concerning CFS, particularly those relating to the patients' attributions and their choice of coping strategies. They also suggest that the effects of the condition may have been underestimated and that certain influences on emotional distress may have been overlooked. The second study assessed a number of variables thought to be associated with emotional distress and psychological adjustment. The results show that uncertainty and lack of social support were significantly correlated with anxiety and depression while functional impairment was more closely linked to cognitive difficulties and other illness-related measures. The third study evaluated a management programme which acknowledges the complexity of CFS. After six months, significant differences between the treated patients and waiting-list controls were found for a number of variables, including fatigue, somatic symptoms, anxiety and perceived self-efficacy. However, many patients continued to record high levels of emotional distress, showing that the programme was not sufficient to deal with all the problems experienced.

Dissertation Submitted to the Faculty of Science, University of the Witwatersrand, Johannesburg, for the degree of Master of Science. Johannesburg 1993 / This dissertation studies the relationship between the use of certain coping strategies and the relapse of'illness, Eighty subjects with 1\'{yalgicEncephalomyelitis (M.E.) were followed OVera nine month period, initially completing a biographical questionnaire which showed some interesting common features, but these characteristics may be attributed to the narrow population from which the sample was drawn. The subjects then completed a battery of tests every eight weeks. These tests monitored appraisal of stressors, ways of coping and general health over the eight weeks since the previous test. Results were analysed using a Pearson's product moment correlation and a principal components factor analysis with a varimax rotation. The subjects were expected to show a positive correlat'on between certain coping techniques (such as denial, avoidance, and self- blame) and the relapse of M.B., while a zero or negative correlation between other coping techniques (such as seeking social support and problem solving when the stressor is controllable) and relapse. Neither of these hypotheses was supported by the data gathered. However, the subjects showed a remarkable consistency inthe types of'coping used, rather than adapting the mode of coping to the type of stressor experienced. It was concluded that the subjects used abnormal coping techniques and that these techniques Weresomehow related to their illness. However, the exact causal relationship between the coping techniques and the illness could not be assessed. It is possible that the subjects' poor coping mechanisms contributed to the development and exacerbation of the illness but it in also possible that the illness limited the repertoire of coping techniques available to the p"atient.

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No description available.

This thesis explores the meaning and experience of the bodily states associated with the condition referred to as myalgic encephalomyelitis (ME). It uses as a theoretical point of departure an understanding of the body as a socially constructed phenomenon and, in so dOing, offers an interpretation of illness that is seen to differ markedly from those offered by the medical and behavioural sciences. Using descriptive narrative research analysis, the thesis attempts to elicit personal trajectories of illness experience. In contrast to biomedical and social trajectories of illness, in which the interpretation and meaning given to the condition are imposed externally, personal trajectories are seen to provide unique subjective accounts of illness experience. And the value of using narrative accounts of illness is seen to lie in their ability to bring to light these individualised versions of illness experience. It is shown, in addition, that these narrative accounts of illness are also valuable in exposing the culturally shared knowledge that is employed in the process of assigning meaning to illness experiences. The aim of the thesis, then, in employing the descriptive narrative research method is to describe these shared cultural schemas. It is suggested that this approach leads to an interpretation of illness experience which sheds light on important links between the body, self and society. It is argued, more specifically, that Western capitalist society is associated with the creation of an "unnatural" environment and social context which is perceived to be inherently damaging and threatening to the well·being of those living in it; and that this assumption is pivotal to the interpretation of the illness experiences narrated and analysed for the thesis. This sociological reading of embodiment provides a basis for understanding the experience of illness, as not one simply embedded in the body or mind of the individual, but as one laden with personal meaning assimilated from, and hence revealing of, the social context in which the illness is experienced. As such, an attempt is made to provide an account of illness experience distinct from the dominant biomedical and behavioural accounts of ME.

Chronic Fatigue Syndrome (CFS) is a contested condition that generates scepticism and occupies a marginalised position within medical and social contexts. The thesis examines the illness experiences, and specifically the experiences of self, for people affected with CFS. Using qualitative inquiry, a substantive theory related to the process of self-renewal and adaptation associated with CFS is explicated. The theory encompasses the trajectory of CFS from onset to chronicity, and in exceptional instances, recovery. Illness narratives were derived from in-depth, semi-structured interviews of 19 adults, including 16 people affected with, and 3 people recovered from, CFS. Data was coded and analysed using a grounded theory approach. Analysis generated two parallel narratives that defined the illness experience of CFS: the narrative of the illness biographies and the narrative of self, specifically the struggling and diminished self seeking renewal. The illness biographies encompassed the stories of symptoms and their explanations, the encounters that ensued and their contentious milieu. The narrative of self was the primary narrative. It articulated the negative consequences to self and personhood associated with CFS, named the Violation of Self, and the consequent efforts of participants to decrease the struggle and violation by use of the Guardian Response and the Reconstructing Response. The Guardian Response provided protection and self-reclamation. The Reconstructing Response fostered self-renewal and meaning. The two narratives were bridged by the threats of CFS. That is, the illness biographies were accompanied by threats of disruption related to chronic illness, and by threats of invalidation that arose from CFS as a contested condition. In turn, these threats provided the catalyst to the violation and responses as described in the narrative of self. Under different conditions the relative strengths of violation, guardianship or reconstruction fluctuated, and it was these fluctuations that presented the participants with the ongoing struggle of CFS.