382 Chronic Fatigue Syndrome
Florence Nightingale Disease has been suggested as a possi-
ble eponym for CFS, since Florence Nightingale, a nurse well
known for improving public health during the Crimean War,
became very ill following the war and spent the remainder of
her life con“ned to bed and sofa due to chronic fatigue. It is
possible that people with CFS would be taken more seriously
if labeled with a medical diagnosis like Myalgic En-
cephalomyelitis or by an eponym.
Social stigma as de“ned by Gilbert, Fiske, and Lindzey
(1998) involves having an attribute that conveys a devalued
social identity in a particular context. More speci“cally, the
problem of stigma does not reside in the stigmatized attribute,
or in the person who possesses the attribute, but in the unfor-
tunate circumstance of possessing an attribute that, in a given
social context, leads to devaluation. For persons with CFS,
the effects of stigmatization can be palpable. A source of this
stigma arises from the fact that many people with this syn-
drome have symptoms that vary from person to person and
”uctuate in severity. Thus, speci“c symptoms may come and
go, complicating treatment and the person•s ability to cope
with the illness. In addition, most symptoms are not visibly
apparent, which makes it dif“cult for others to understand the
vast array of debilitating symptoms that patients have.
Shlaes, Jason, and Ferrari (1999) developed the CFS Atti-
tude Test (CAT), as one way of assessing stigma, discrimina-
tion, and attitudes toward individuals with CFS. Using this
newly developed scale, they found a relationship between be-
liefs about the degree to which people with CFS are respon-
sible for their illness, beliefs about the relevance of CFS as a
valid illness, and beliefs about the personality traits of people
with CFS. If someone believes that people with CFS are
responsible for their illness, it is likely that they will also
believe that people with CFS have negative personality char-
acteristics, such as being compulsive or overly driven.
Name changes that have been made for other illnesses
have reduced stigma. For example, gay related infectious dis-
ease had less scienti“c information available when the name
was changed to AIDS than is available for CFS. Multiple
Sclerosis (MS) is a neurological disease with many symp-
toms similar to CFS (Richman et al., 2000). MS was previ-
ously believed to be caused by stress linked with oedipal
“xations. When the name of the disorder changed from
hysterical paralysis (a name functioning to discredit the legit-
imate medical complaints of predominantly female patients;
see Richman & Jason, 2001), to MS, when no more scienti“c
information was available than we currently have for CFS,
less stigma was associated with this illness. Psychiatric as-
sumptions, however, were not put to rest until after empirical
research failed to show any consistent personality patterns in
MS (Murray, 1995).
There has been considerable controversy over the term
CFS during the past decade. In general, patients feel that this
label tends to minimize the seriousness of the illness. During
the summer of 1997, the chronic fatigue and immune dys-
function syndrome (CFIDS) Association of America con-
ducted a survey of its members to determine their opinion
about changing the diagnostic label. Eighty-“ve percent of
respondents indicated they wanted the name changed (Name-
Change Survey Results, 1997). Another survey of 182 re-
spondents by the editor of a newsletter indicated that 92%
wanted the CFS name changed (Burns, 1998). Many medical
personnel and research scientists feel that if the name were
changed, it would be best to have a scienti“c basis for the
change. Unfortunately, few data have been collected to help
guide the process of revising the name.
In a study by the research team headed by the “rst author
(Jason, Taylor, Plioplys, Stepanek, & Shlaes, in press), 105
medical trainees were randomly assigned to one of three con-
ditions, each featuring one of three different types of diag-
nostic labels for CFS. The same case study of a patient with
classic symptoms of CFS was described across conditions.
The only difference between the three conditions involved
the name given for the illness that was described in the case
study. For one-third of the trainees, the patient was described
as having CFS. For another third of the trainees, the patient
was described as having an illness known as Florence
Nightingale Disease (FN), and for the “nal third of the
trainees, the patient was described as having Myalgic En-
cephalopathy (ME). Findings indicated that those with a di-
agnosis of Myalgic Encephalopathy were considered less
likely to improve over time, and less likely to qualify as can-
didates for organ donation. These attributions may, in part, be
due to the medical terminology contained in the Myalgic
Encephalopathy label, which may lead individuals to think
that the illness is more severe and as more likely to have bio-
logical underpinnings.
This study also found that some medical trainees continue
to attribute CFS to nonorganic factors and may not recognize
the signi“cance of associated physical symptoms. For exam-
ple, almost half of the entire sample of trainees indicated that
it was likely or very likely that CFS is stress-related, and 37%
felt that the patient was suffering primarily from depression.
In addition, symptoms of cognitive impairment and pain
were not considered to be severe by 90% of respondents.
Thus, although both stress and depression can play a role in
exacerbating the course of many illnesses, including CFS, the
medical trainees• tendency to attribute the illness solely to
these factors and to grant little recognition to the severity of
the patient•s cognitive problems and pain suggests that many
medical trainees may continue to hold stigmatizing beliefs