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Title: The therapists’ view on rehabilitation of clients with fatigue syndrome. A study of the therapists’ perspectives in occupational health care and primary care.  Abstract The purpose of the study was to examine how therapists in occupational health care and primary care looked at clients’ rehabilitation and recovery from fatigue syndrome. The study was based on a qualitative method and an inductive thematic analysis where nine semi-structured interviews acted as data collection method. The results of the study highlight the following themes: Between the chairs, An accepted mental illness and lack of well-being and Easy way not always the right way. The results three main themes provide answers to the study’s questions. The respondents were therapists from primary care and occupational health care. Differences in the working methods of the various organizations were demonstrated based on that the organizations´ assignments. Different amounts of time, resources and expertise are available for the rehabilitation of clients with fatigue syndrome. The conclusion drawn from the study was that time and money acted as an obstacle for clients to receive the right diagnosis and the right circumstances for rehabilitation.

Theory and evidence suggests that person-centred models may be especially relevant for elucidating the role of perfectionism in health and well-being in those with chronic health conditions. This may be particularly true for conditions, such as chronic fatigue syndrome (CFS), in which perfectionism is known to play a prominent role in health outcomes. Yet to date no research has taken a person-centred approach to examine how within-person combinations of perfectionistic strivings and perfectionistic concerns are linked to vulnerability for poor health in CFS. The current study compared matched samples of people with CFS and healthy controls (N = 163 each) on measures of stress, depression, and health problems. Consistent with the Stress and Coping Cyclical Amplification Model of Perfectionism in Illness and the tripartite model of perfectionism, within-person combinations of high perfectionistic concerns and strivings had the poorest health profile compared to other within-person combinations, but only among those with CFS. In addition, the perfectionism was indirectly associated with health through stress in those with CFS only. Findings add to a growing evidence base on the utility of person-centred models for understanding the health risks of perfectionism in the context of chronic illness.

The impacts of chronic fatigue syndrome (CFS) are far reaching, resulting in many burdens in the individual lives of CFS patients. One notable challenge lies in the inability to participate in the workforce due to associated physical, mental, and emotional symptoms. Previous research indicates that alternative employment options may help to overcome work related barriers presented with various types of chronic illness. Entrepreneurship is one path to working that offers many benefits, including autonomy, flexibility of work schedule, choice of work environment, and control. Questions though remain as to whether entrepreneurship enhances QOL or exacerbates symptoms among individuals with CFS. This interpretive descriptive study investigated the lived experiences of individuals diagnosed with CFS who have pursued a path of entrepreneurship. A semistructured interview was used to gather the 12 participants' descriptions of their history of living with CFS while working as entrepreneurs. The interviews were coded and analyzed to extract overarching themes. Results included the ways in which participants were transformed as a result of having CFS, their experiences of living with CFS and being self-employed, and the interpersonal factors that arose in connection with these experiences. This study served to shed light on the challenges involved in being self-employed while living with CFS, how being self-employed affected participants' quality of life both positively and negatively, and how participants interpret these changes. The findings of this study have the potential to set the stage for future qualitative and quantitative research that would provide more support in terms of tangible action when it comes to employment options for individuals living with CFS.

The project investigate the role of space, architecture and landscape in the rehabilitation process.

Bakgrund: Psykisk ohälsa, där utmattningssyndrom är en av diagnoserna är ett ökande problem. Många av de som drabbas överges och får inte den vård de behöver och har rätt till. Tid för samtal och egenvård är en viktig del i rehabiliteringen där primärvården och företagshälsovården är de huvudsakliga vårdgivarna. Syfte: Avsikten med studien var att undersöka vilken erfarenhet som sjuksköterskor inom primär- och företagshälsovård har av patienter med utmattningssyndrom. Metod: Åtta sjuksköterskor från primär- och företagshälsovård intervjuades med semistrukturerade frågor. Intervjumaterialet analyserades med hjälp av kvalitativ innehållsanalys. Resultat: Ett tema lyssna samt två kategorier grindvakt och skapa begriplighet skapades. Alla sjuksköterskor beskrev att de initialt hade långa samtal men deras erfarenheter skiljde sig åt. Några sjuksköterskor beskrev att det var till nytta för patienterna medan andra berättade att de inte jobbade med den här patientgruppen. Konklusion: Genomgående beskriver alla sjuksköterskor att det de gör innebär att de lyssnar på patienterna samtidigt som flera av dem inte explicit uttrycker det som ett stöd. Det kan tolkas som att den relationella delen av omvårdnaden är osynlig för sjuksköterskorna som inte uppfattar att deras lyssnande är av värde för patienterna. / Background: Mental illness where fatigue syndrome is one of the diagnoses is an increasing problem. Many persons with fatigue syndrome experience abandonment and do not achieve the help they need and are entitled to. Time for conversation and self-care is an important part of rehabilitation where primary healthcare and occupational healthcare have a prominent role Aim: This study's purpose was to explore what experience that nurses in primary and occupational healthcare had of patients with fatigue syndrome. Method: Eight nurses from primary and occupational healthcare were interviewed using semi-structured questions. The interview material was analyzed using content analysis. Results: A theme listening and two categories gatekeeper and create comprehensibility emerged. All nurses had initially long conversations with the patients, but their experience differed. Some of the nurses told that they were important to the patients and others indicated that they were not working with this patient group. Conclusion: All nurses describes that what they do means that they are listening to the patients at the same time that several of them not explicit express it as a support. That can be interpreted as the relation part of nursing are invisible for the nurses who does not perceive their listening valuable for the patients.

Hysteria has been researched from many different angles, but this thesis focuses on the persistence of gendered medical diagnoses following the demise of hysteria. In Chapter One, I provide an overview of hysteria’s long history, beginning with the first reference to the disorder in Ancient Egypt. I then conduct a study of nineteenth-century hysteria in Chapter Two, where I highlight the interactions between medicine and culture that characterized the hysteria epidemic in Victorian Britain and America. Chapter Three continues this discussion of nineteenth-century hysteria, detailing the rise of psychological explanations for hysteria in Europe. My most important research, however, comes in Chapters Four and Five where I chronicle the rise of specific diagnoses that replaced hysteria in the twentieth century. I focus on gendered wastebasket diagnoses—illnesses that predominantly affect women, are categorized based on shared symptoms rather than causes, and are defined in relation to femininity. In the Diagnostic and Statistical Manual of Mental Disorders (DSM), the descriptions of certain psychiatric conditions that are more frequently diagnosed in women contain stigmatizing language used to describe hysteria, especially in the nineteenth century. Outside of the psychiatric realm, chronic fatigue syndrome and fibromyalgia are also wastebasket diagnoses that are described by both doctors and academics using the dismissive language of earlier descriptions of hysteria. I argue that throughout all of this history, the mutual influence of medical theory and cultural assumptions—particularly about gender and femininity—has allowed women’s mysterious medical complaints to remain unexplained. The ambiguous nature of conditions descended from hysteria and their association with femininity causes doctors to return to long-standing stereotypes that diminish the suffering of these patients. Many patients with these conditions struggle to access effective treatments for their symptoms. Understanding these illnesses in the historical context of hysteria can help explain and address these experiences. / Thesis / Master of Arts (MA) / The medical field has long been influenced by its surrounding cultural context. Social factors, including gender, race, and class, all colour the ways in which illnesses are understood and patients are treated. This thesis examines these interactions between medicine and culture in the context of nineteenth-century hysteria and the related diagnoses that arose to replace it in the twentieth century. The disease entity hysteria disappeared in the early twentieth century, but patients continued to experience the symptoms associated with hysteria under a range of diagnostic titles. Situating these illnesses in the historical context of hysteria can help address patient complaints and deconstruct the stigmatizing stereotypes that affect these patients— particularly those stereotypes associated with femininity that were once attributed to hysteria patients

Hierdie studie is 'n kwalitatiewe ekosistemiese ondersoek van die fenomeen Chroniese Moegheidsindroom (CMS) . Die paradigmaverskuiwing vanaf die Cartesiaans-Newtoniaanse epistemologie na die kubernetiese epistemologie, het 'n aantal belangrike implikasies vir die bestudering en konseptualisering van CMS, soos uiteengesit in hierdie studie. 'n Bespreking van die konseptualisering en behandeling van CMS vanuit die tradisionele, reduksionistiese navorsing word verskaf. Die aannames van twee-orde kubernetika en sosiale konstruksionisme, is bespreek en toegepas op die beskrywing van twee sisteme waarin CMS voorkom. Die navorsingsmetodologie van die studie is gegenereer op grand van die genoemde teoretiese aannames. Die implikasies van die toepassing van die ekosistemiese epistemologie vir die konseptualisering van CMS word uitgewys. Die herkonseptualisering van CMS as 'n transisieproses word bespreek en riglyne vir verdere navorsing en psigoterapie word aangedui. Die huidige studie bied 'n beskrywing van die unieke betekenisse en oplossings wat gesinne genereer tydens die veranderings wat CMS vergesel. / The present study is a qualitative ecosystemic exploration of the phenomenon known as chronic fatigue syndrome (CFS). The paradigm shift from the Newtonian epistemology to the epistemology of cybernetics, has important implication for research and the conceptualisation of CFS, as indicated in the study. The traditional, reductionist conceptualisation of CFS in research and treatment methods, is discussed. The suppositions of second order cybernetics and social constructionism, are discussed and applied in the description of two systems where CFS occurs. The research methodology of the present study is generated from the theoretical suppositions. Die implications of the use of the ecosystemic epistemology for the conceptualisation of CFS are indicated. The re-conceptualisation of CFS as a transition process is discussed and guidelines are given for future research and psychotherapy. The present study is a description of the unique meanings and solutions that the families generated during the changes that accompany CFS. / Psychology / M.A. (Kliniese Sielkunde)

Hierdie studie is 'n kwalitatiewe ekosistemiese ondersoek van die fenomeen Chroniese Moegheidsindroom (CMS) . Die paradigmaverskuiwing vanaf die Cartesiaans-Newtoniaanse epistemologie na die kubernetiese epistemologie, het 'n aantal belangrike implikasies vir die bestudering en konseptualisering van CMS, soos uiteengesit in hierdie studie. 'n Bespreking van die konseptualisering en behandeling van CMS vanuit die tradisionele, reduksionistiese navorsing word verskaf. Die aannames van twee-orde kubernetika en sosiale konstruksionisme, is bespreek en toegepas op die beskrywing van twee sisteme waarin CMS voorkom. Die navorsingsmetodologie van die studie is gegenereer op grand van die genoemde teoretiese aannames. Die implikasies van die toepassing van die ekosistemiese epistemologie vir die konseptualisering van CMS word uitgewys. Die herkonseptualisering van CMS as 'n transisieproses word bespreek en riglyne vir verdere navorsing en psigoterapie word aangedui. Die huidige studie bied 'n beskrywing van die unieke betekenisse en oplossings wat gesinne genereer tydens die veranderings wat CMS vergesel. / The present study is a qualitative ecosystemic exploration of the phenomenon known as chronic fatigue syndrome (CFS). The paradigm shift from the Newtonian epistemology to the epistemology of cybernetics, has important implication for research and the conceptualisation of CFS, as indicated in the study. The traditional, reductionist conceptualisation of CFS in research and treatment methods, is discussed. The suppositions of second order cybernetics and social constructionism, are discussed and applied in the description of two systems where CFS occurs. The research methodology of the present study is generated from the theoretical suppositions. Die implications of the use of the ecosystemic epistemology for the conceptualisation of CFS are indicated. The re-conceptualisation of CFS as a transition process is discussed and guidelines are given for future research and psychotherapy. The present study is a description of the unique meanings and solutions that the families generated during the changes that accompany CFS. / Psychology / M.A. (Kliniese Sielkunde)

Bakgrund: Myalgic Encephalomyelitis eller Chronic Fatigue Syndrome (ME/CFS) omfattar ett spektrum av olika symptom som bland annat påverkar de autonoma och neurologiska systemen, kognitiv funktion och ger immunologiska störningar med mera. De karakteristiska symptomen är oförklarlig kronisk trötthet, ansträngningsutlöst fysisk och mental uttröttbarhet Post Exertional Malaise (PEM). Trots forskning inom ett flertal områden är den underliggande molekylära orsaken bakom ME/CFS inte fastställd. Flertalet hypoteser om sjukdomsorsaken finns, varav en är att ME/CFS är en autoimmun sjukdom. Syfte: Syftet med litteraturstudien är att undersöka huruvida det finns autoimmuna aspekter i ME/CFS. Metod: Systematisk litteraturstudie utifrån vetenskapliga artiklar, publicerade 2010—2020 i databasen PubMed. Resultat: Studieresultaten är inte helt entydiga när det kommer till att påvisa autoimmuna aspekter i ME/CFS. Antikroppsstudier riktade mot neuronalt protein hos ME/CFS-patienter och behandlingar riktade mot antikroppar, immunoadsorption och rituximab, gav negativa resultat. Däremot observeras HSP60 (heat shock protein 60) antikroppar för specifika korsreaktiva epitoper i en undergrupp av ME/CFS-patienter, vilket stämmer överens med infektionsutlöst autoimmunitet. Även i de två genstudierna, HLA-association (human leucocyte antigen) och SNP (single nucleotide polymorphism) genotypning i immungener, observeras karakteristiska riskgener för autoimmun sjukdom, tydligast resultat observerades hos de patienter som har en infektionsutlöst ME/CFS. Slutsats: Trots delvis negativa resultat ges visst stöd för hypotesen då dessa indikerar autoimmuna aspekter i en undergrupp av infektionsutlöst ME/CFS. / Background: Myalgic Encephalomyelitis or Chronic Fatigue Syndrome (ME/CFS) is a debilitating disease which is characterized by unexplained and persistent post exertional fatigue (PEM) and a myriad of symptoms related to neurological disturbance, immunological, cognitive and autonomous dysfunction. Despite biomedical research from a disparate field of expertise the pathogenesis and etiology of ME/CFS is not well-understood. Several hypotheses regarding the pathogenesis have been proposed one of which is that ME/CFS is an autoimmune disease. Aim: The purpose of the literature study is to investigate whether there are autoimmune aspects in ME/CFS. Method: A systematic literature study based on scientific articles, published 2010-2020 in the PubMed database. Results: The study results are not entirely consistent when it comes to detecting autoimmune aspects in ME/CFS. Antibody studies targeting neuronal proteins in ME/CFS-patients and antibody treatments, immunoadsorption, and rituximab yielded negative results. In contrast, HSP60 (heat shock protein 60) antibodies for specific cross-reactive epitopes are observed in a subset of ME/CFS patients, which corresponds to infection-triggered autoimmunity. The two gene studies, HLA (human leucocyte antigen) association and genotyping of SNP (single nucleotide polymorphism) in immune genes, observed characteristic risk genes for autoimmune disease. Significant results were observed in ME/CFS- patients with an infection-triggered onset. Conclusion: Despite partially negative results, some support exists for the hypothesis as results indicate autoimmune aspects in ME/CFS with an infection-triggered onset.