The Enigma of Chronic Fatigue

(cited by Barnett [2] ) identified the ‘maladie des meca-niciens’. Victorian doctors regarded the soul as some-thing that could be exhausted by overuse or over-stimu-lation of body or mind. Fatigue was not just physical, but also mental [3]. ‘Neurasthenia ’ was a descriptive term coined by George Miller Beard [4] for what was colloqui-ally known as ‘nervous exhaustion ’ – commonplace in the 19th century; the word has the merits of simplicity and its meaning is self-evident. A celebrated example was the philosopher and psychologist Herbert Spencer. In his later years, dogged by fatigue and depression, ‘The retreat into illness was also for Spencer a retreat from social in-tercourse ’ [5]. The concept of neurasthenia declined between the 1930s and 1960s. But curiously, in the 1980s, when the term ‘chronic fatigue ’ emerged as a medical term, neur-asthenia was not replaced but reappeared. The symptoms of fatigue were modern variants of neurasthenia, which had ‘adopted the organic inheritance of Beard’s ideas of neurasthenia, despite the fact that the question of orga-nicity could not be decisively answered in a single case’ [6]. In both World Wars, combat fatigue was a nervous disorder resulting from prolonged or severe battle experi-ence. In modern times, fatigue worryingly appears to be burgeoning in the healthy population, and cultural trends uncover the symptom as a common complaint that on enquiry often closely relates to a state of boredom, espe-cially in teenagers. Yet, the intensity of complaints is no less severe in teenage boredom than in illness: ‘Fatigue is more than tiredness – pathological exhaustion, per-haps – and in its medical sense it has been associated with modernity, with fear of the new ’ [2]. Key Word