Fatigue — The Chronic Syndrome: Taking Refuge in Inner Peace

The introduction opens with stress, a punishing work pace and psychological pressure, and divides fatigue into three types: mental, physical and chronic. Yet the two-page introduction also contains the book's most problematic advice: «toxin-flushing treatment regimens» such as saunas, «replacing missing vitamins» with magnesium, D-ribose, B vitamins, melatonin and probiotics, and «serum therapies that promote mitochondrial recovery». No sources are given for any of these, and most have no proven effectiveness in CFS.

Chapter one is the best part of the book. The differences between tiredness, exhaustion, weakness, sleepiness and fatigability are explained clearly, and fatigue is classified in three ways: phenomenologically (physiological and perceived), by duration (acute, subacute, chronic) and by pathophysiology (non-pathological and pathological, primary and secondary). Details such as central and peripheral fatigue, the role of glycogen and lactate in muscle fatigue, and the different thresholds American and British researchers use for «chronic» are presented at textbook level but accessibly. It is clear that this section is compiled from academic sources.

Problems begin in chapter two. Under the heading «The US Centers for Disease Control and Prevention's Definition» no definition is actually given; instead, factors are listed such as viral infections, stress, «working in state institutions», «being a woman», «living in high socioeconomic conditions», «marrying at an early age», «not being sent to school» and «Type A people». This list belongs rather to the risk factors for occupational burnout and has nothing to do with the CDC's 1994 Fukuda criteria. A few pages later the book says the syndrome is «more common among those with low educational level» — contradicting the earlier «high socioeconomic» claim.

The «unknowns» list is confusing too: it says the syndrome «may be contagious», may arise from «irregular functioning of the adrenal glands», and affects 30–40% of doctors — the last figure again seems borrowed from burnout research. The same list says «the patient does not benefit from psychiatric treatment», even though the book's fifth chapter is devoted to cognitive behavioural therapy. Among the physical symptoms, the most important one — exhaustion lasting more than 24 hours after physical or mental effort (PEM) — appears only as one bullet among many, whereas in current approaches (the 2015 US Institute of Medicine report, the 2021 NICE guideline) it is the core feature of the diagnosis.

The pathophysiology and aetiology sections are more balanced: it is stated plainly that the HPA-axis, cortisol and cytokine hypotheses remain unproven, infections such as Epstein-Barr virus are described as «triggers rather than initiators», and the model of predisposing, precipitating and perpetuating factors is set out systematically. But presenting «physical inactivity» as the most important obstacle to recovery, along with the deconditioning model, is contested today — since 2021 NICE no longer recommends graded exercise therapy. The severity levels (mild, moderate, severe, very severe), on the other hand, match current guidelines and are useful.

In the end the book repeats the flaws of other volumes in the series: the text reads like a compilation from various sources, the editing is weak (a sidebar biography runs into the main text), and the treatment chapter lists drug names directly to the reader (antidepressants, psychostimulants, erythropoietin). The final chapter — on «compassion fatigue» — is about burnout among healthcare workers and has no direct connection to chronic fatigue syndrome. For readers living with CFS this book is not a reliable source; talking to a specialist and consulting current guidelines would serve them better.

• A short textbook style divided into headings and bullet points
• A fatigue classification diagram and assessment questionnaires (Fatigue Severity Scale, etc.)
• A bibliography and the translator's sources at the end