384 Chronic Fatigue Syndrome
be a psychological problem. Many physicians and re-
searchers believed that CFS was similar to neurasthenia, and
that CFS would eventually have a similar fate once people
recognized that most patients with this disease were really
suffering from a psychiatric illness. Psychiatrists and physi-
cians have also regarded fatigue as one of the least important
presenting symptoms. These biases have been “ltered to the
media, which has portrayed CFS in simplistic and stereotypic
ways.
Some progress has occurred with regard to the improved
reliability and validity of results emerging from CFS re-
search. At the same time, problems remain, which constitute
important challenges for social science researchers. In the
area of CFS epidemiology, critiques of sample selection bi-
ases in earlier studies (Richman et al., 1994) have lead to
more recent research addressing the true prevalence of CFS
in community samples, which is not biased by help-seeking
behaviors or by access to the health care system (Jason et al.
1995; Jason, Richman, et al., 1999). However, a broadened
interpretation of CFS appears to have complicated estimates
of CFS prevalence by confounding the diagnosis of CFS with
diagnoses of other illnesses, which have overlapping symp-
toms but which may not constitute CFS at all, or with con-
ditions that are often comorbid with CFS. Moreover, beyond
the need to obtain accurate epidemiologic estimates of CFS
prevalence for public health policy formulation, reliable and
valid diagnoses are crucial for determinations of CFS treat-
ment ef“cacy. We believe that it is crucial for CFS research to
move beyond fuzzy recapitulations of the neurasthenia con-
cept and clearly delineate precise criteria for diagnosing pure
CFS versus CFS that is comorbid with psychiatric disorders.
It is also necessary to better differentiate CFS from other dis-
orders that share some CFS symptoms but are not true CFS
cases.
Approaches to treatment must be comprehensive, address-
ing a variety of care needs. Much attention of researchers has
focused on the potential bene“ts of cognitive behavioral in-
terventions. As mentioned, the long-term outcomes of this
type of intervention are still unclear, but interventions that
challenge basic patient illness beliefs might solidify already-
negative attitudes of medical personnel toward people with
this syndrome. Moreover, future research “ndings may legit-
imate patient beliefs regarding the organic nature of their
illness, similar to the historical evolution of the social
construction of multiple sclerosis from a psychological to an
organically based illness (Richman & Jason, 2001). In addi-
tion to more psychologically based interventions, there is a
clear need for advocacy, in which the general public and the
medical community become better educated about the prob-
lems and dif“culties associated with CFS. Some patients with
CFS may need assistance from others to complete daily
living tasks. Living arrangements that include •healthyŽ indi-
viduals or housing may be needed by people with CFS,
because weakness from this illness might prevent them from
accomplishing necessary chores. Interventions are needed
that focus on enriching the sense of community, and such in-
terventions may prevent isolation, depression, and preoccu-
pation with the illness among patients with CFS (Jason,
Kolak, et al., 2001). Unfortunately, there are few funding
opportunities for these more innovative types of social
and community interventions. Given that this syndrome is
one of the more common chronic health conditions (Jason,
Richman, et al., 1999) and the documented personal and
familial costs associated with this condition (Friedberg &
Jason, 1998), there is a clear need for public policy of“cials
to devote more resources to developing a better infrastructure
of support for individuals with CFS (Taylor, Friedberg, &
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