Stigma and discrimination

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Stigma is "an attribute that links a person to an undesirable stereotype, leading other people to reduce the bearer from a whole and usual person to a tainted, discounted one."[1] People with myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS) often described feeling stigmatized and discriminated against.[2][3][4][5]


Sufferers of ME are often stigmatised and marginalised, as their conditions are not fully recognised by the Government or the medical profession. A number of my constituents suffer from ME. At least two have been bedridden for 30 years because of their condition, and their story is not uncommon.

Mohammad Yasin, MP,  Appropriate ME Treatment debate (Jan 24, 2019)[6]


...believing ME/CFS is a condition that can be cured by attitude and effort is stigmatizing, no matter how carefully you try to frame it. That’s harmful, for individuals who blame themselves (or get blamed) for their suffering, and for the collective of people deeply affected... — Hilda Bastian, Consumer-Contested Evidence: Why the ME/CFS Exercise Dispute Matters So Much[7]

The Yuppie flu label[edit | edit source]

ME was dismissed as "yuppie flu" and even "shirker syndrome" in the 1980s and described as a reaction to the stresses of modern life.[8] Under the label yuppie flu, ME was regarded as only affecting one group in society - young to middle-aged professionals.[9]

Stigma from the media[edit | edit source]

A number media interviews and newspaper coverage have presented negative views of patients with ME, including representing some reporting legitimate claims through official chanqqnels as harassing, or intimidating researchers described as "vilification" and listed alongside unproven allegations of criminal acts such as sending "death threats".[10] Murray et al. (2019) found a significant gender bias in their analysis of English newspaper articles featuring patients with ME/CFS, women were presented as more emotionally distressed with their physical symptoms minimized, and the impact on social and home functioning was emphasized, while men were portrayed as "action men" prior to their illness, with physical symptoms prominent and the impact on career and sports emphasized.[11]

In other coverage, treatment success rates have been grossly exaggerated, with the controversial graded exercise therapy (GET) referred to as simply "exercise" in headlines rather than a specialist treatment.[12] A BBC report, believed to be heavily influenced by the biased Science Media Centre (SMC), "overstated" and made inaccurate claims that the Dutch FITNET trial could cure "two-thirds" of [British] children with CFS within 6 months, when the actual figure was under 40%, with those results heavily disputed due to including very broad diagnostic criteria, and the treatment only being available in 10% of the UK.[12]

A number of charities including Invest in ME Research and The ME Association have filed complaints or raised objections, in addition to individual patients.[13][10] The exaggerated recovery rates and headlines about "exercise" or a talking treatment have encouraged the public to stereotype patients as lazy, simply lacking the willingness to exercise, or as having mental health problems.

Stigma from the family, friends and the public[edit | edit source]

Patients with ME/CFS may be judged by friends as extremely lazy rather than ill, and become isolated from friends when they are too ill to spend time with others.[14][15]

Work colleagues may accuse the person of being lazy, teachers may accuse children with ME of "enjoying themselves" when they are too ill to attend school.[15]

Stigma from health professionals[edit | edit source]

A number of highly influential health professionals have made highly stigmatized, dismissive and offensive comments about patients with ME/CFS, which continues to this day. Many patients in the UK and elsewhere in continue to report that their doctor was either openly skeptical about their ones, or expressed disbelief.[16][17][18] Similar experiences have been reported within disability assessments, and by clinicians at a specialist CFS/ME clinic in the UK.[19][20] In 2019, a UK parliament debate highlighted that the members of the medical profession did not fully recognize ME, which increased the stigma and the marginalization of people with ME.[6]

ME patients have been stereotyped in many ways, including being accused of having negative attitudes towards mental illness and being "anti-psychiatry", however Wood & Wessely (1999) showed that attitudes towards mental illness are no different from those of other patient groups, for example rheumatoid arthritis patients.[21]

Researchers with ME/CFS: stigma from academic colleagues[edit | edit source]

Scientists who work on biomedical research or treat patients outside of the psychiatry and exercise focused biopsychosocial model (BPS) have been denied work in their country's public health care system, portrayed as quacks, anti-science, struggled to get research funding or lab time and been isolated and ostracized by their peers.[5][22] Doctors, researchers and other health professionals who have called for controversial research or review articles to be retracted (withdrawn) on the grounds of not meeting adequate scientific standards have been labeled "activists" regardless of the scientific reasons they gave, the field they work in or their personal history.

Professors at medical schools report that they have been instructed by their department chairs to stop seeing ME/CFS patients, have been denied promotions due to their ME/CFS research, have received unfounded letters of reprimand, and have been subjected to ethics investigations for using their medical school email and other medical school resources to investigate ME/CFS.[23] A charity offered to donate a scholarship to a medical school, to benefit medical students who study ME/CFS, but the medical school refused the donation because "ME-CFS patients set up an artificial distinction between psychiatric and organic illness, and the school does not wish its students exposed to patients who make such a distinction."[23]

Discrimination[edit | edit source]

Blease and Geraghty (2018) found that "medical authorities" used "widespread negative stereotyping of patients" and acted to marginalize and exclude patient voices, which created "epistemic injustice."[24] For instance, patients who challenged the views or actions of medical authorities were labeled "militant" and "activists", with several mainstream newspapers reporting unfounded accusations that they sent "death threats" to ME/CFS researchers[24]

Effects of stigma[edit | edit source]

Stigma has resulted in patients being treated as

  • lazy or work shy, resulting in denial of disability benefits and rejection from society and family[22][19]
  • hypochondriacs[22][17]
  • not ill, or only having trivial symptoms,[18] resulting in denying basic medical treatment and tests,[17] and denial of funding for medical research
  • undeserving of medical care[5][22]
  • mentally ill, resulting in denial of medical care and disability aids, and limited / reduced disability or sickness payments[25]
  • dangerous, threatening and mentally unstable[24]
  • resistant to treatment, resulting in forced in-patient psychiatric care (including in children)
  • children with ME/CFS have been put on child protection and "at risk" registers and separated from their parents, who are investigated for child abuse and Munchausen syndrome by proxy[26][27][26][28]
  • children too ill to attend school, or even too ill to eat have been diagnosed with "Pervasive School Refusal Syndrome" or Pervasive Refusal Syndrome, with their health limitations interpreted as a "behavioral" issue[29]

Examples of stigma and discrimination of ME/CFS[edit | edit source]

By Rod Liddle: "ME, which used to be known as yuppie flu", "stigmatised as malingering mentals", "foaming paranoia" (on the ME Association website)
By Stefanie Marsh: "Such was the vitriol and the constant ratcheting up of the threats emanating from the fringes that, ten years ago, Professor Wessely chose to give up his research."
Untrue: This was 7 months after the PACE trial was published, which Wessely helped design the PACE trial and was a PACE trial center manager for several years, and still researchs ME/CFS
Professor Wessely comments "―They‘re (ME activists) not as bad as the animal liberation people ... ―But they‘re just as fanatical. It‘s constant stalking, harassment, attempts at intimidation."
By Rod Liddle started with: "My New Year’s resolution for 2012 was to become disabled. Nothing too serious, maybe just a bit of bad luck or one of those newly invented illnesses which make you a bit peaky for decades – fibromyalgia, or M.E."
ME Association complaint, Press Complaints Commission response
By Anthony Collings and David Newton, Essex CFS Service, UK.
ME Association complaint, Essex CFS Service apologises
ME patients and other disabled people tweet their dismay at Netflix's Afflicted
Individuals who were lied to and misrepresented by Netflix’s Afflicted include Jake, Pilar, Jamison, Jake & Bekah, Jill & Janine
  • 2018, Dr Keith Geraghty tweet:
  • "I have written a paper with a colleague at Harvard on whether or not Militancy has been used by researchers to downplay the legitimate concerns of ME/CFS sufferers; {we have FOI case] - awaiting final acceptance - we tackle this important point/issue (hope to see paper out soon)"

Prevalence[edit | edit source]

A study of 68 ME/CFS patients in the UK in 2001 found that more than half of patients reported that their doctor was either openly skeptical about their ME/CFS symptoms, or appeared disbelieving; similar experiences have been reported within disability assessments by clinicians at a specialist CFS/ME clinic in the UK.[16][20]

In 2019, a UK parliament debate highlighted that the members of the medical profession did not fully recognize ME, which increased the stigma and the marginalization of people with ME.[6]

Interviews and news articles[edit | edit source]

Notable studies[edit | edit source]

  • 1982, Suffering and the Social Construction of Illness: The Delegitimation of Illness Experience in Chronic Fatigue Syndrome[30](abstract)
  • 1999, Stigma and Chronic Fatigue Syndrome[32](Abstract)
  • 2001, Attitudes Regarding Chronic Fatigue Syndrome: The Importance of a Name[33](Abstract)
  • 2001, Gender biases underlying the social construction of illness states: The case of chronic fatigue syndrome[34](Abstract)
  • 2001, Measuring Attributions About Chronic Fatigue Syndrome[35](Abstract)
  • 2001, Assessing attitudes toward new names for chronic fatigue syndrome[36](Abstract)
  • 2001, Patients' perceptions of medical care in chronic fatigue syndrome[16](Abstract)
  • 2006, Pediatric Chronic Fatigue Syndrome and Munchausen-By-Proxy: A Case Study[28] - (Full text)
  • 2007, The Effectiveness of Early Educational Intervention in Improving Future Physicians' Attitudes Regarding CFS/FM[39](Abstract)
  • 2008, Obstructions for quality care experienced by patients with chronic fatigue syndrome (CFS)—A case study[18](Abstract)
  • 2016, Educational Priorities for Healthcare Providers and Name Suggestions for Chronic Fatigue Syndrome: Including the Patient Voice[41](Full Text)
  • 2017, Research Volunteers’ Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis[42] (Abstract)
  • 2017, Epistemic injustice in healthcare encounters: evidence from chronic fatigue syndrome[24](Full text)
  • 2018, Are ME/CFS Patient Organizations "Militant"? : Patient Protest in a Medical Controversy.[43](Abstract)
  • 2018, Myalgic encephalomyelitis/chronic fatigue syndrome and the biopsychosocial model: a review of patient harm and distress in the medical encounter[25](Abstract)
  • 2018, Effects of unsupportive social interactions, stigma, and symptoms on patients with myalgic encephalomyelitis and chronic fatigue syndrome[3](Abstract)
  • 2018, A content analysis of chronic fatigue syndrome and myalgic encephalomyelitis in the news from 1987 to 2013[4](Abstract)
  • 2018, Stigma in Myalgic Encephalomyelitis and its association with functioning[2](Abstract)
  • 2019, Duvet woman versus action man: the gendered aetiology of Chronic Fatigue Syndrome according to English newspapers[11](Abstract)

See also[edit | edit source]

Learn more[edit | edit source]

References[edit | edit source]

  1. Goffman, E. (1983). Stigma: notes on the management of spoiled Identity. New York: Simon and Schuster. p. 11. 
  2. 2.02.1 Baken, Don M.; Harvey, Shane T.; Bimler, David L.; Ross, Kirsty J. (Jan 2, 2018). "Stigma in Myalgic Encephalomyelitis and its association with functioning". Fatigue: Biomedicine, Health & Behavior. 6 (1): 30–40. doi:10.1080/21641846.2018.1419553. ISSN 2164-1846. 
  3. 3.03.1 McManimen, Stephanie L.; McClellan, Damani; Stoothoff, Jamie; Jason, Leonard A. (May 4, 2018). "Effects of unsupportive social interactions, stigma, and symptoms on patients with myalgic encephalomyelitis and chronic fatigue syndrome". Journal of Community Psychology. 46 (8): 959–971. doi:10.1002/jcop.21984. ISSN 0090-4392. 
  4. 4.04.1 Siegel, Zachary A.; Brown, Abigail; Devendorf, Andrew; Collier, Johanna; Jason, Leonard A. (Mar 2018). "A content analysis of chronic fatigue syndrome and myalgic encephalomyelitis in the news from 1987 to 2013". Chronic Illness. 14 (1): 3–12. doi:10.1177/1742395317703175. ISSN 1745-9206. PMID 28403636. 
  5. 5.05.15.25.3 Dimmock, Mary; Lazell-Fairman, Matthew (Dec 2015). "THIRTY YEARS OF DISDAIN: How HHS and a group of psychiatrists Buried Myalgic Encephalomyelitis" (PDF). Retrieved Nov 5, 2018. 
  6. 6.06.16.2 Hansard | UK Parliament (Jan 24, 2019). "Appropriate ME Treatment | 24 January 2019 Volume 653". hansard.parliament.uk. Retrieved Jan 25, 2019. 
  7. Bastian, Hilda (Feb 8, 2019). "Consumer-Contested Evidence: Why the ME/CFS Exercise Dispute Matters So Much". PlosOne. Retrieved Mar 3, 2019. 
  8. Tuller, David (2007). "Chronic Fatigue no longer seen as Yuppie Flu" (PDF). New York Times. Retrieved Dec 30, 2018. 
  9. Dowsett, Elizabeth G. (Jan 1992). P D Welsby. "Conversation piece. Interview by P. D. Welsby." Postgraduate Medical Journal. 68 (795): 63–65. ISSN 0032-5473. PMC 2399326Freely accessible. PMID 1561197. 
  10. 10.010.1 BBC News Online (Jul 29, 2011). ""Torrent of abuse" hindering ME research | Today programme | BBC Radio 4" (PDF). Retrieved Mar 2, 2019. 
  11. 11.011.1 Murray, Rebecca; Day, Katy; Tobbell, Jane (Apr 15, 2019). "Duvet woman versus action man: the gendered aetiology of Chronic Fatigue Syndrome according to English newspapers". Feminist Media Studies: 1–16. doi:10.1080/14680777.2019.1595694. ISSN 1468-0777. 
  12. 12.012.1 BBC Trust (Mar 2017). "Editorial Standards Findings Appeals to the Trust and other editorial issues considered by the Editorial Standards Committee: Decisions by the Head of Editorial Standards, Trust Unit February and March 2017" (PDF). Retrieved Mar 2, 2019. 
  13. Invest in ME Research (Jan 2015). "INVEST IN ME RESPONSE to BBC ARTICLE". Invest in ME Research. Retrieved Mar 2, 2019. 
  14. BBC Radio 4 (2007). "Case notes: Programme number 10 - ME" (Transcript). Archived from the original on Dec 21, 2007. 
  15. 15.015.1 Richardson, Josie (Apr 4, 2019). "ME Affects Four Times More Women Than Men – Dismissing This Terrifying Illness Is Sexist". Huffington Post. Retrieved Apr 10, 2019. 
  16. 16.016.116.2 Deale, A.; Wessely, S. (Jun 2001). "Patients' perceptions of medical care in chronic fatigue syndrome". Social Science & Medicine (1982). 52 (12): 1859–1864. ISSN 0277-9536. PMID 11352411. 
  17. 17.017.117.2 Geraghty, Keith; Esmail, Aneez (Aug 1, 2016). "Chronic fatigue syndrome: is the biopsychosocial model responsible for patient dissatisfaction and harm?". British Journal of General Practice. 66 (649): 437-438. doi:10.3399/bjgp16X686473. 
  18. 18.018.118.2 Gilje, Ann Marit; Söderlund, Atle; Malterud, Kirsti (Oct 2008). "Obstructions for quality care experienced by patients with chronic fatigue syndrome (CFS)—A case study". Patient Education and Counseling. 73 (1): 36–41. doi:10.1016/j.pec.2008.04.001. 
  19. 19.019.1 Forward-ME (Feb 2011). "Countess of Mar's 'Forward ME' Group – minutes of meeting, 26 January 2011". ME Association. Retrieved Mar 4, 2019. 
  20. 20.020.1 Collings, Anthony D; Newton, David (Jun 18, 2014). "Is Chronic Fatigue Syndrome a meme?". BMJ. ISSN 0959-8138. 
  21. Wood, Barbara; Wessely, Simon (Oct 1999). "Personality and social attitudes in chronic fatigue syndrome". Journal of Psychosomatic Research. 47 (4): 385–397. doi:10.1016/S0022-3999(99)00025-2. No differences were found between CFS and RA patients in measures of perfectionism, attitudes toward mental illness, defensiveness, social desirability, or sensitivity to punishment (a concept related to neuroticism), on either crude or adjusted analyses... There was no evidence from this study of major differences between the personalities of CFS patients and RA patients. The stereotype of CFS sufferers as perfectionists with negative attitudes toward psychiatry was not supported. 
  22. 22.022.122.222.3 Maes, Michael; Mihaylova, Ivana; Bosmans, Eugene (August 2007). "Not in the mind of neurasthenic lazybones but in the cell nucleus: patients with chronic fatigue syndrome have increased production of nuclear factor kappa beta" (PDF). Neuro Endocrinology Letters. 28 (4): 456–462. ISSN 0172-780X. PMID 17693979. For decades, CFS patients were (and still are) dismissed as lazybones or hypochondriacs. Since 1994, the baffling illness has received recognition by the introduction of diagnostic criteria [1]. Nevertheless, many medical doctors and insurance companies still assert that CFS merely is a mental condition.
    Doctors who treat CFS patients as suffering from a biological disorder and scientists who deal with the psycho-neuro-immune pathophysiology of CFS are often considered quacks by some of their colleagues, insurance companies and anti-quack societies, which are sometimes officially supported by governments, e.g. the Dutch government, in order to eliminate the scientific view that CFS is an organic disorder. The latter obviously would mean that the national health care system is obliged to financially support those patients who now are considered hypochondriacs and thus are suspended from the national health care systems. In accordance, the mainstream, “evidence based” treatment for CFS is cognitive behavioural therapy, which means that patients with CFS are being treated as having a mental illness with “treatments” that do not treat any underlying pathophysiology.
    There is, however, evidence that CFS is accompanied by severe immune disorders, such as activation of the inflammatory response system (IRS) and increased oxidative and nitrosative stress with a significant damage to membrane lipids and functional proteins [2–4].
     
  23. 23.023.1 Friedman, Kenneth. "Elephants in the room" (PDF). Retrieved Mar 4, 2019. 
  24. 24.024.124.224.3 Blease, Charlotte; Carel, Havi; Geraghty, Keith (Aug 1, 2017). "Epistemic injustice in healthcare encounters: evidence from chronic fatigue syndrome". Journal of Medical Ethics. 43 (8): 549–557. doi:10.1136/medethics-2016-103691. ISSN 0306-6800. PMID 27920164. 
  25. 25.025.1 Geraghty, Keith J.; Blease, Charlotte (Jun 21, 2018). "Myalgic encephalomyelitis/chronic fatigue syndrome and the biopsychosocial model: a review of patient harm and distress in the medical encounter". Disability and Rehabilitation: 1–10. doi:10.1080/09638288.2018.1481149. ISSN 0963-8288. 
  26. 26.026.1 Colby, Jane (2014). "False Allegations of Child Abuse in Cases of Childhood Myalgic Encephalomyelitis (ME)" (PDF). Tymes Trust. 
  27. BBC news (Nov 8, 1999). "Panorama | Sick and Tired". news.bbc.co.uk. Retrieved Feb 12, 2019. 
  28. 28.028.1 Van Hoof, E.; De Becker, P.; De Meirleir, K. (Jan 2006). "Pediatric Chronic Fatigue Syndrome and Munchausen-By-Proxy: A Case Study". Journal of Chronic Fatigue Syndrome. 13 (2-3): 45–53. doi:10.1300/J092v13n02_02. ISSN 1057-3321. 
  29. Invest in ME Research (2006). "The Elephant in the Room - The General Medical Council - Dr Nigel Speight". www.investinme.org. Retrieved Feb 15, 2019. Where there are some doctors who do not believe in ME as a diagnosis or do not accept that children with ME can be so seriously ill that they need tube feeding then flawed diagnoses are introduced such as Pervasive Refusal Syndrome. It is in these cases that Dr Speight’s experience and knowledge have provided enormous help to child patients and their families. 
  30. Ware, Norma C. (Dec 1992). "Suffering and the Social Construction of Illness: The Delegitimation of Illness Experience in Chronic Fatigue Syndrome". Medical Anthropology Quarterly. 6 (4): 347–361. doi:10.1525/maq.1992.6.4.02a00030. ISSN 0745-5194. 
  31. Goudsmit, Ellen M (1993). "All in her mind! Stereotypic views and the psychologisation of women's illness". Health Psychology Update. 12: 28–32. 
  32. Green, Judith; Romei, Jennifer; Natelson, Benjamin H. (Jan 1999). "Stigma and Chronic Fatigue Syndrome". Journal of Chronic Fatigue Syndrome. 5 (2): 63–75. doi:10.1300/j092v05n02_04. ISSN 1057-3321. 
  33. Jason, Leonard A.; Taylor, Renée R.; Stepanek, Zuzana; Plioplys, Sigita (Jan 1, 2001). "Attitudes Regarding Chronic Fatigue Syndrome: The Importance of a Name". Journal of Health Psychology. 6 (1): 61–71. doi:10.1177/135910530100600105. ISSN 1359-1053. 
  34. Richman, Judith A.; Jason, Leonard A. (May 2001). "Gender Biases Underlying the Social Construction of Illness States: The Case of Chronic Fatigue Syndrome". Current Sociology. 49 (3): 15–29. doi:10.1177/0011392101049003003. ISSN 0011-3921. 
  35. Jason, Leonard A.; Taylor, Renée R. (2001). "Measuring Attributions About Chronic Fatigue Syndrome". Journal of Chronic Fatigue Syndrome. 8 (3–4): 31–40. doi:10.1300/J092v08n03_04. 
  36. Jason, L. A.; Eisele, H.; Taylor, R. R. (Dec 2001). "Assessing attitudes toward new names for chronic fatigue syndrome". Evaluation & the Health Professions. 24 (4): 424–435. doi:10.1177/01632780122034993. ISSN 0163-2787. PMID 11817200. 
  37. Asbring, Pia; Närvänen, Anna-Liisa (Feb 2002). "Women's experiences of stigma in relation to chronic fatigue syndrome and fibromyalgia". Qualitative Health Research. 12 (2): 148–160. ISSN 1049-7323. PMID 11837367. 
  38. Jason, L. A.; Holbert, C.; Torres-Harding, S; Taylor, R. R. (2004). "Stigma and chronic fatigue syndrome: Surveying a name change. Journal of Disability Policy Studies". 14: 222–228. 
  39. Lu, Tony V.; Torres-Harding, Susan R.; Jason, Leonard A. (Jan 2007). "The Effectiveness of Early Educational Intervention in Improving Future Physicians' Attitudes Regarding CFS/FM". Journal of Chronic Fatigue Syndrome. 14 (2): 25–30. doi:10.1300/j092v14n02_03. ISSN 1057-3321. 
  40. Mihelicova, Martina; Siegel, Zachary; Evans, Meredyth; Brown, Abigail; Jason, Leonard (Dec 2016). "Caring for People with Severe Myalgic Encephalomyelitis: An Interpretative Phenomenological Analysis of Parents' Experiences". Journal of health psychology. 21 (12): 2824–2837. doi:10.1177/1359105315587137. ISSN 1359-1053. PMC 4675701Freely accessible. PMID 26063209. 
  41. Nicholson, Laura; Brown, Abigail; Jason, Leonard; Ohanian, Diana; O'Connor, Kelly (Feb 18, 2016). "Educational Priorities for Healthcare Providers and Name Suggestions for Chronic Fatigue Syndrome: Including the Patient Voice". Clinical Research: Open Access ( ISSN 2469-6714 ). 2. doi:10.16966/2469-6714.112. 
  42. Nehrke, Pamela I; Fox, Pamela A; Jason, Leonard A (2017). "Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis". Neurology (E-Cronicon). 7 (4): 172–178. PMC 5898812Freely accessible. PMID 29662969. 
  43. Blease, Charlotte; Geraghty, Keith J. (Sep 2018). "Are ME/CFS Patient Organizations "Militant"? : Patient Protest in a Medical Controversy" (PDF). Journal of Bioethical Inquiry. 15 (3): 393–401. doi:10.1007/s11673-018-9866-5. ISSN 1176-7529. PMID 29971693. 

Myalgic encephalomyelitis or M.E. has different diagnostic criteria to chronic fatigue syndrome; neurological symptoms are required but fatigue is an optional symptom.Cite error: Closing </ref> missing for <ref> tag

Graded Exercise Therapy, a gradual increase in exercise or activity, according to a pre-defined plan.Cite error: Closing </ref> missing for <ref> tag

biopsychosocial model (BPS model) - a school of thought, usually based in psychology, which claims illness and disease to be the result of the intermingling of biological, psychological and social causes.

Myalgic encephalomyelitis or M.E. has different diagnostic criteria to chronic fatigue syndrome; neurological symptoms are required but fatigue is an optional symptom.<ref name="ICP2011primer">{{Citation

biopsychosocial model (BPS model) - a school of thought, usually based in psychology, which claims illness and disease to be the result of the intermingling of biological, psychological and social causes.

The information provided at this site is not intended to diagnose or treat any illness.
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